Health Care is Not Color-Blind 

Race Impacts Access to Care 

By Kauthar B. Umar, MA


Closing the Gap, Working Toward Our Goal • August 2003


Within the past decade, experts have made great research 

investments to find out if health care was indeed color 

blind. And, many are not too pleased with the answer. 

Despite the fact that we are all the same on the inside, research shows 

that race partially determines who has access to health care and how 

much care is available. 

According to Dr. Vanessa Gamble, health policy consultant, 

member of the National Advisory Council for Healthcare Research 

and Quality, and author of Making A Place for Ourselves: The Black 

Hospital Movement, 1920-1945, disparities need to be viewed in the 

context of how race has been viewed historically and how it has 

changed. 

“Race is a powerful social construct that has an impact on health 

outcomes,” said Gamble. “We need to decide what it means. There 

was a time in this country when people, because of the color of their 

skin, were not allowed in hospitals. There was a segregated hospital 

movement and system in the country, and for a lot of elderly African 

Americans, they remember it and that influences their perception of 

our health care system,” Gamble added. 

Socioeconomic status, health practices, psychosocial stress, resources, environmental exposures, and limited English proficiency are 

additional factors believed to contribute to racial and ethnic disparities in health care, which impact the unequal burden of disease and 

mortality among the diverse racial and ethnic populations. 

Only by re-tracing what Gamble refers to as the “medical 

civil rights movement,” can a clear picture of today’s system be drawn. 

Acts were passed and followed by cases that challenged hospital segregation at Federal and privately-funded hospitals. From the civil rights 

legislation to anti-discrimination clauses in Medicare and Medicaid, 

the fight for equal health care has been an ongoing battle that Gamble 

stresses is still being fought. 

“When people were trying to desegregate hospitals they were 

trying to get access to care, but they were defining access to care as 

simply being allowed to get into the door,” said Gamble. “What we 

have to talk about today in terms of the medical civil rights movement 

is what happens once you get in the door.” 

According to Gamble, the medical civil rights movement, originally based on a Black/White dichotomy, has changed drastically, but 

still continues. “Language proficiency found its way into the picture, 

as the U.S. became more diverse. With the ever-changing face of the 

nation there are still remnants of segregation in this country. This 

segregation appears to be color neutral, but in actuality, it is history 

repeating it self,” she added. 

Affecting Today’s Community 

The history of race in the U.S. and how it affects access to health 

care today, has been linked with a lack of financial resources as one of 

the many barriers to equal health care for people of color. Released in 

2002, the Commonwealth Fund’s 2001 Health Care Quality Survey 

found that Hispanics and African Americans are most at risk of being 

uninsured. Minorities in general have lower rates of insurance coverage and as a result, less access to health care. 

Despite insurance status, the survey’s findings indicate that minorities are more likely than Whites to be disconnected from their 

regular sources of care and the health care system overall. Uninsured 

minorities are more likely than uninsured Whites to experience difficulties in accessing health care. During the year prior to the survey, 

those who were temporarily or permanently uninsured—39 percent 

of Hispanics, 38 percent of African Americans, and 32 percent of 

Asian Americans—said they had very little or no choice in their source 

of health care. On the other hand, 25 percent of uninsured Whites 

reported very little or no choice in source of care. 

“Minorities are facing different barriers today,” said Dr. Jose 

Arbelaez, a data analyst at Johns Hopkins School of Medicine. “One 

of the most important [barriers] is the lack of health insurance, a big 

factor among African Americans and other minorities.” 

Arbelaez said that rates of the uninsured and underinsured, particularly among African Americans, remain very high, affecting how 

care is received. A 1998-99 Allegheny County Health Department 

project, in collaboration with Johns Hopkins School of Medicine, 

explored demographics, barriers to health care, interaction with providers, and medical myths in a cross-sectional study of more than 200 

community members in the Pennsylvania county. 

The study found that 28.6 percent of African Americans and 

13.5 percent of Whites had difficulty receiving care in the previous 

12 months. African Americans were five times more likely to be asked 

their availability to pay for treatment, independent of their insurance 

status. Twenty-five percent of African Americans and 45.3 percent of 

Whites reported that providers made payment allowances for them, 

while 38.2 percent of African Americans and 22.1 percent of Whites 

were referred to collection agencies for medical bills. 

Statistics and research show that the health care experience for 

Whites and people of color differ dramatically throughout the nation. 

According to Arbelaez, health care barriers, such as financial need, low 

literacy, and discrimination provide an answer to the question, is health 

care a color-blind process? To many, unfortunately, the answer is no. 

To contact Dr. Vanessa N. Gamble, call 202-299-0430.

For more information on the 1998-99 Allegheny County Health 

Department project, contact Dr. Jose Arbelaez, at 410-955-6953 or 

jarbelae@jhsph.edu

Health Care is Not Color-Blind is based on the Summit workshop “Race and Access to Health Care.” 

Office of Minority Health Resource Center U.S. Department of Health and Human Services