Investigating the Role of Racial/Ethnic Bias in Health Outcomes

Although legalized segregation and discrimination have been eliminated in the United States, bias against people of color exists in many sectors of our society. Discrimination based on race/ethnicity is detrimental to the individuals who experience discrimination as well as to society at large. It has also been suggested that there are serious mental and physical health consequences for people who routinely live with discrimination.1–3 However, the scientific evidence underlying these beliefs needs to be carefully examined to determine the weight of the evidence and where gaps exist. Toward this end, in April 2002 the Office of Behavioral and Social Sciences Research of the National Institutes of Health convened a meeting of approximately 100 leading scientists to present scientific evidence of the effects of racial/ethnic bias on health and to identify areas for future research to further explicate the relationship. We intentionally chose the term “racial/ethnic bias” instead of “racism” to reflect our desire to address a wide range of types of discrimination that may affect health, including bias against populations that do not define themselves based on race. The Office of Behavioral and Social Sciences Research and its 3 cochairs (James Jackson, David Williams, and Nancy Krieger) designed the conference to consider the historical and contextual factors relating to racial/ethnic bias in the United States today, and the evidence relating various forms of bias and the well-documented disparities in health that are found among the various racial/ethnic groups in US society. One panel examined pathways through which racial/ethnic prejudice acts on the individual, creating a psychophysiological response that can ultimately result in a negative health outcome. Another panel examined how racism and ethnic prejudice operate within the structures of our society to produce inequalities in employment, housing, and the environment that may translate into differential health outcomes among diverse racial/ethnic populations. Special emphasis was given to racial/ethnic bias in the medical care system, an area in which it has been repeatedly demonstrated that certain racial/ethnic minority patients receive diagnoses and treatment recommendations differing from those for similar White patients.4 This issue of the Journal presents the conference papers.