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Book Review

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Race matters. Race—particularly racial segregation—casts a pervasive shadow over the organization of American health care. It influences the ownership and governance of institutional providers. It helps account for the high cost of health care in the United States. It contributes to America’s abysmal health status, among the worst of the industrialized world. It is reflected, in part, in the lack of national health insurance. So David Barton Smith begins this book, a book he describes as the story of “a divided nation, a divided health care system, and the uncompleted journey to heal both.”[1]

Most of us are not comfortable talking about race and racism. Race is not a biological determinant and to focus on race seems to run afoul of the American melting pot theory. Talking about racism is even harder because to be racist is to use one’s individual and institutional power to exclude others. To talk of race and racism is to acknowledge the capacity and willingness of members of our society, either intentionally or unconsciously, to wield this power to harm others.

To talk about race, racism, and health care is particularly awkward because we know so little about it. The government gathers statistics on racial segregation in housing, schools, and jobs, so we have information to inform these discussions. With health care, no one reports data on segregation. More federal dollars go to health care than flow to housing, schools, and jobs combined, yet we know less about the effects of race and racism on access to and quality of medical care. This book is a call to begin gathering and reporting race-based health care data.