Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health?

There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers' contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers' behaviors may contribute to these disparities.

[1]  S. Quinn,et al.  The contributions of health communication to eliminating health disparities. , 2004, American journal of public health.

[2]  N. Powe,et al.  Patient race/ethnicity and quality of patient-physician communication during medical visits. , 2004, American journal of public health.

[3]  Juan Chen,et al.  Effect of discrimination on mental health service utilization among Chinese Americans. , 2004, American journal of public health.

[4]  W. Fisher,et al.  Racial/Ethnic Disparities in Admissions to Public and Private Psychiatric Inpatient Settings: The Effect of Managed Care , 1998, Administration and Policy in Mental Health and Mental Health Services Research.

[5]  R. Mayberry,et al.  Racial and Ethnic Disparities in Health Care , 2001, Annals of Internal Medicine.

[6]  S. Saha,et al.  Patient-physician relationships and racial disparities in the quality of health care. , 2003, American journal of public health.

[7]  A. Zaslavsky,et al.  Racial disparities in the quality of care for enrollees in medicare managed care. , 2002, JAMA.

[8]  A. Green,et al.  Why the disease-based model of medicine fails our patients. , 2002, The Western journal of medicine.

[9]  A. Green,et al.  Integrating Social Factors into Cross‐cultural Medical Education , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[10]  M. Chin,et al.  When Is Risk Stratification by Race or Ethnicity Justified in Medical Care? , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[11]  G. Mensah,et al.  Physician Advice, Patient Actions, and Health-Related Quality of Life in Secondary Prevention of Stroke Through Diet and Exercise , 2002, Stroke.

[12]  Kevin Fiscella,et al.  Disparities in Health Care by Race, Ethnicity, and Language Among the Insured: Findings From a National Sample , 2002, Medical care.

[13]  M. van Ryn,et al.  Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care , 2002, Medical care.

[14]  N. Kressin,et al.  Contribution of the Veterans Health Administration in understanding racial disparities in access and utilization of health care: a spirit of inquiry. , 2002, Medical care.

[15]  Adrienne Y. Stith,et al.  Unequal treatment: confronting racial and ethnic disparities in health care. , 2003 .

[16]  Linda C. Centers Beyond Denial and Despair: ALS and Our Heroic Potential for Hope , 2001, Journal of palliative care.

[17]  T. Mcguire,et al.  Statistical discrimination in health care. , 2001, Journal of Health Economics.

[18]  R. Glasgow,et al.  Physician advice and support for physical activity: results from a national survey. , 2001, American journal of preventive medicine.

[19]  N. Kressin,et al.  Racial Differences in the Use of Invasive Cardiovascular Procedures: Review of the Literature and Prescription for Future Research , 2001, Annals of Internal Medicine.

[20]  L. Dixon,et al.  Variables associated with disparities in treatment of patients with schizophrenia and comorbid mood and anxiety disorders. , 2001, Psychiatric services.

[21]  D C Cole,et al.  Does how you do depend on how you think you'll do? A systematic review of the evidence for a relation between patients' recovery expectations and health outcomes. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[22]  Debbie R. Robinson,et al.  Stereotyping among Providers and Consumers of Public Mental Health Services , 2001, Behavior modification.

[23]  A. Epstein,et al.  Racial disparities in medical care. , 2001, The New England journal of medicine.

[24]  J. Lähdevirta,et al.  Hope, despair and hopelessness in living with HIV/AIDS: a grounded theory study. , 2001, Journal of advanced nursing.

[25]  J. Kleijnen,et al.  Influence of context effects on health outcomes: a systematic review , 2001, The Lancet.

[26]  L. Meeuwesen,et al.  Doctor-parent-child communication. A (re)view of the literature. , 2001, Social science & medicine.

[27]  J. Kelly,et al.  Factors Influencing Physicians’ Judgments of Adherence and Treatment Decisions for Patients with HIV Disease , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  M. Stern,et al.  The prematurity stereotype in Israeli health care providers , 2001, Medical education.

[29]  C. Neil Macrae,et al.  Social cognition: Categorical person perception. , 2001, British journal of psychology.

[30]  N. Powe,et al.  U.S. NEPHROLOGISTS’ ATTITUDES TOWARDS RENAL TRANSPLANTATION: RESULTS FROM A NATIONAL SURVEY , 2001, Transplantation.

[31]  I. Blair,et al.  Implicit stereotypes and prejudice. , 2001 .

[32]  K. Schulman,et al.  Sex differences in the referral process for invasive cardiac procedures. , 2001, Journal of the American Medical Women's Association.

[33]  S. Strakowski,et al.  Effects of race on psychiatric diagnosis of hospitalized adolescents: a retrospective chart review. , 2001, Journal of child and adolescent psychopharmacology.

[34]  S. Hudson,et al.  Equity in the diagnosis of chest pain: race and gender. , 2001, American journal of health behavior.

[35]  M. Schell,et al.  The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening? , 2001, American journal of public health.

[36]  C. Sherbourne,et al.  The quality of care for depressive and anxiety disorders in the United States. , 2001, Archives of general psychiatry.

[37]  C. Messina,et al.  A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium. , 2000, Preventive medicine.

[38]  K Kroenke,et al.  Visit-specific expectations and patient-centered outcomes: a literature review. , 2000, Archives of family medicine.

[39]  E. Paskett,et al.  Predictors of stage of adoption for colorectal cancer screening. , 2000, Preventive medicine.

[40]  M. Stewart,et al.  The impact of patient-centered care on outcomes. , 2000, The Journal of family practice.

[41]  C. Bingham,et al.  Race, psychiatric diagnosis, and mental health care utilization in older patients. , 2000, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[42]  A. LaCroix,et al.  Does provider prevention orientation influence female patients' preventive practices? , 2000, American journal of preventive medicine.

[43]  C. Bingham,et al.  Race and inpatient psychiatric diagnoses among elderly veterans. , 2000, Psychiatric services.

[44]  M. Doescher,et al.  Physicians' advice to quit smoking. The glass remains half empty. , 2000, The Journal of family practice.

[45]  K. Fiscella,et al.  Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. , 2000, JAMA.

[46]  N. Kearney,et al.  Oncology healthcare professionals' attitudes toward elderly people. , 2000, Annals of oncology : official journal of the European Society for Medical Oncology.

[47]  M. Borum,et al.  The Effects of Patient Race on Outcomes in Seriously Ill Patients in SUPPORT: An Overview of Economic Impact, Medical Intervention, and End‐Of‐Life Decisions , 2000, Journal of the American Geriatrics Society.

[48]  K. Weinfurt,et al.  The effects of patient sex and race on medical students' ratings of quality of life. , 2000, The American journal of medicine.

[49]  Laura M. Bogart,et al.  Impact of Medical and Nonmedical Factors on Physician Decision Making for HIV/AIDS Antiretroviral Treatment , 2000, Journal of acquired immune deficiency syndromes.

[50]  C. Cleeland,et al.  Minority cancer patients and their providers , 2000, Cancer.

[51]  M. van Ryn,et al.  The effect of patient race and socio-economic status on physicians' perceptions of patients. , 2000, Social science & medicine.

[52]  D. Roter The medical visit context of treatment decision‐making and the therapeutic relationship , 2000, Health expectations : an international journal of public participation in health care and health policy.

[53]  G. Widdershoven The doctor-patient relationship as a Gadamerian dialogue: A response to Arnason , 2000, Medicine, health care, and philosophy.

[54]  K. Todd,et al.  Ethnicity and analgesic practice. , 2000, Annals of emergency medicine.

[55]  K. Schulman,et al.  The effect of race on the referral process for invasive cardiac procedures. , 2000, Medical Care Research and Review.

[56]  C. Macrae,et al.  Social cognition: thinking categorically about others. , 2000, Annual review of psychology.

[57]  J. Giannetta,et al.  Problem-solving ability of inner-city children with and without in utero cocaine exposure. , 1999, Journal of developmental and behavioral pediatrics : JDBP.

[58]  P. Cleary,et al.  The effect of patients' preferences on racial differences in access to renal transplantation. , 1999, The New England journal of medicine.

[59]  N. Powe,et al.  Race, gender, and partnership in the patient-physician relationship. , 1999, JAMA.

[60]  L. Kasten,et al.  Patient assertiveness and physician decision-making among older breast cancer patients. , 1999, Social science & medicine.

[61]  L. Lipsitz,et al.  Correlates and Management of Nonmalignant Pain in the Nursing Home , 1999, Journal of the American Geriatrics Society.

[62]  D. Patrick,et al.  The quality of patient-doctor communication about end-of-life care: a study of patients with advanced AIDS and their primary care clinicians. , 1999, AIDS.

[63]  E. Funkhouser,et al.  Compliance with mammography guidelines: physician recommendation and patient adherence. , 1999, Preventive medicine.

[64]  K A Schulman,et al.  The effect of race and sex on physicians' recommendations for cardiac catheterization. , 1999, The New England journal of medicine.

[65]  Astrid M. Schloerscheidt,et al.  Tales of the unexpected: executive function and person perception. , 1999, Journal of personality and social psychology.

[66]  Z. Kunda,et al.  Social Cognition: Making Sense of People , 1999 .

[67]  Samin K. Sharma,et al.  Access to coronary artery bypass surgery by race/ethnicity and gender among patients who are appropriate for surgery. , 1999, Medical care.

[68]  J. Robbins,et al.  Physician practice styles and patient outcomes: differences between family practice and general internal medicine. , 1998, Medical care.

[69]  S. Zuravin,et al.  Bias in child maltreatment reporting: revisiting the myth of classlessness. , 1998, The American journal of orthopsychiatry.

[70]  R. Murray,et al.  First episodes of psychosis in Afro-Caribbean and White people , 1998, British Journal of Psychiatry.

[71]  A. Whaley,et al.  Racism in the provision of mental health services: a social-cognitive analysis. , 1998, The American journal of orthopsychiatry.

[72]  M. Ryn Developing Effective Helping Relationships in Health Education Practice , 1997 .

[73]  A. Tarlov,et al.  The relationship between patient income and physician discussion of health risk behaviors. , 1997, JAMA.

[74]  C. Cleeland,et al.  Pain and Treatment of Pain in Minority Patients with Cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study , 1997, Annals of Internal Medicine.

[75]  J. Bargh,et al.  Nonconscious Behavioral Confirmation Processes: The Self-Fulfilling Consequences of Automatic Stereotype Activation , 1997 .

[76]  J. Piette,et al.  Communication of preferences for care among human immunodeficiency virus-infected patients. Barriers to informed decisions? , 1997, Archives of family medicine.

[77]  J. Earp,et al.  Race and mammography use in two North Carolina counties. , 1997, American journal of public health.

[78]  K. Vehviläinen-Julkunen,et al.  Hope in nursing research: a meta-analysis of the ontological and epistemological foundations of research on hope. , 1997, Journal of advanced nursing.

[79]  M. Stewart,et al.  Communication patterns of primary care physicians. , 1997, JAMA.

[80]  Rupert Brown,et al.  Category and stereotype activation: Is prejudice inevitable? , 1997 .

[81]  C. Heaney,et al.  Developing effective helping relationships in health education practice. , 1997, Health education & behavior : the official publication of the Society for Public Health Education.

[82]  S. Strakowski,et al.  The effects of race and information variance on disagreement between psychiatric emergency service and research diagnoses in first-episode psychosis. , 1997, The Journal of clinical psychiatry.

[83]  S. Spencer,et al.  Stereotypes and Prejudice , 1996 .

[84]  H. Staudenmayer Clinical consequences of the EI/MCS "diagnosis": two paths. , 1996, Regulatory toxicology and pharmacology : RTP.

[85]  G. Thornicroft,et al.  Ethnic differences in risk of compulsory psychiatric admission among representative cases of psychosis in London , 1996, BMJ.

[86]  C. Heaney,et al.  The implications of status, class and cultural diversity for health education practice: the case of worksite stress reduction programs , 1996 .

[87]  J. Mckinlay,et al.  Non-medical influences on medical decision-making. , 1996, Social science & medicine.

[88]  D. Schultz,et al.  Third National Incidence Study of Child abuse and Neglect , 1996 .

[89]  Barbara Gandek,et al.  Patient and Visit Characteristics Related to Physicians' Participatory Decision-Making Style: Results from the Medical Outcomes Study , 1995, Medical care.

[90]  M. Cuccaro,et al.  Race and gender differences in the treatment of psychiatric disorders in young adolescents. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[91]  A. Pumariega,et al.  Influence of race on diagnosis in adolescent psychiatric inpatients. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[92]  S. Strakowski,et al.  The effects of race on diagnosis and disposition from a psychiatric emergency service. , 1995, The Journal of clinical psychiatry.

[93]  J. Porter,et al.  The effect of a racially consonant medical context on adjustment of African-American patients to physical disability. , 1994, Medical anthropology.

[94]  Modena E. H. Wilson,et al.  Pediatrician interview style and mothers' disclosure of psychosocial issues. , 1994, Pediatrics.

[95]  C. Neil Macrae,et al.  Stereotypes as energy-saving devices: A peek inside the cognitive toolbox. , 1994 .

[96]  M. Kogan,et al.  Racial disparities in reported prenatal care advice from health care providers. , 1994, American journal of public health.

[97]  J. Holladay,et al.  Race as a factor in inpatient and outpatient admissions and diagnosis. , 1994, Hospital & community psychiatry.

[98]  C. Gatsonis,et al.  Discussion of preferences for life-sustaining care by persons with AIDS. Predictors of failure in patient-physician communication. , 1993, Archives of internal medicine.

[99]  M. Gold,et al.  Racial differentials in the identification of hypercholesterolemia. , 1993, The Journal of family practice.

[100]  K. Todd,et al.  Ethnicity as a risk factor for inadequate emergency department analgesia. , 1993, JAMA.

[101]  I. Mwbowler,et al.  Stereotypes of women of Asian descent in midwifery: some evidence , 1993 .

[102]  W. Hauck,et al.  A randomized clinical trial of nursing care for recovery from cardiac surgery. , 1993, Heart & lung : the journal of critical care.

[103]  A. Thomson The use of stereotypes in the provision of midwifery care. , 1993, Midwifery.

[104]  R. Shelton,et al.  The effects of race and comorbidity on clinical diagnosis in patients with psychosis. , 1993, The Journal of clinical psychiatry.

[105]  Z. Kunda,et al.  Stereotypes and the Construal of Individuating Information , 1993 .

[106]  T. W. Martin,et al.  White therapists' differing perceptions of black and white adolescents. , 1993, Adolescence.

[107]  B. McNeil,et al.  Physicians' liking for their patients: more evidence for the role of affect in medical care. , 1993, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[108]  I. Bowler Stereotypes of women of Asian descent in midwifery: some evidence. , 1993, Midwifery.

[109]  J. Borkan,et al.  Expectations and Outcomes after Hip Fracture among the Elderly , 1992, International journal of aging & human development.

[110]  Kelly Ce Bringing homophobia out of the closet: antigay bias within the patient-physician relationship. , 1992 .

[111]  C. Kelly Bringing homophobia out of the closet: antigay bias within the patient-physician relationship. , 1992, The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha.

[112]  S. Chaiken,et al.  The generality of the automatic attitude activation effect. , 1992, Journal of personality and social psychology.

[113]  D. Roter,et al.  Health education theory: an application to the process of patient-provider communication. , 1991, Health education research.

[114]  D. Gilbert,et al.  The trouble of thinking: Activation and application of stereotypic beliefs. , 1991 .

[115]  M. Stern,et al.  Medical students' perceptions of children: modifying a childhood cancer stereotype. , 1991, Journal of pediatric psychology.

[116]  D. Roter,et al.  The relationship of physician medical interview style to patient satisfaction. , 1991, The Journal of family practice.

[117]  J. Bargh,et al.  Stereotyping based on apparently individuating information: Trait and global components of sex stereotypes under attention overload. , 1991 .

[118]  G. Lewis,et al.  Are British Psychiatrists Racist? , 1990, British Journal of Psychiatry.

[119]  R. Klatzky,et al.  Traits and social stereotypes : efficiency differences in social information processing , 1990 .

[120]  K. Sher,et al.  Labeling the child of an alcoholic: negative stereotyping by mental health professionals and peers. , 1990, Journal of studies on alcohol.

[121]  H. Theron,et al.  Effect of patients' expectations on recovery from acute tonsillitis. , 1990, Family practice.

[122]  R. C. Gardner,et al.  An intergroup perspective on stereotype organization and processing , 1989 .

[123]  M. Stern,et al.  Childhood cancer stereotype: impact on adult perceptions of children. , 1989, Journal of pediatric psychology.

[124]  T. Revenson,et al.  Compassionate stereotyping of elderly patients by physicians: revising the social contact hypothesis. , 1989, Psychology and aging.

[125]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[126]  M. Coleman,et al.  Nursing students' stereotypes of married and unmarried pregnant clients. , 1988, Research in nursing & health.

[127]  S H Kaplan,et al.  Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. , 1988, Journal of general internal medicine.

[128]  S. Wassertheil-Smoller,et al.  Sex bias in considering coronary bypass surgery. , 1987, Annals of internal medicine.

[129]  J. S. St. Lawrence,et al.  Medical students' attitudes toward AIDS and homosexual patients. , 1987, Journal of medical education.

[130]  J. S. St. Lawrence,et al.  Stigmatization of AIDS patients by physicians. , 1987, American journal of public health.

[131]  T. Coates,et al.  The effectiveness of smoking cessation advice given during routine medical care: physicians can make a difference. , 1987, American journal of preventive medicine.

[132]  S. Zyzanski,et al.  Patient satisfaction with the clinical encounter: social psychological determinants. , 1987, Social science & medicine.

[133]  J. Dovidio,et al.  Prejudice, Discrimination, and Racism , 1986 .

[134]  C. Maynard,et al.  Blacks in the coronary artery surgery study (CASS): race and clinical decision making. , 1986, American journal of public health.

[135]  D. Hamilton,et al.  Stereotypes and stereotyping: An overview of the cognitive approach. , 1986 .

[136]  Lee Jussim,et al.  Self-fulfilling Prophecies: a Theoretical and Integrative Review , 1986 .

[137]  S. Kaplan,et al.  Expanding patient involvement in care. Effects on patient outcomes. , 1985, Annals of internal medicine.

[138]  A. Epstein,et al.  Effects of patients' socioeconomic status and physicians' training and practice on patient-doctor communication. , 1985, The American journal of medicine.

[139]  B. Gerbert,et al.  Perceived likeability and competence of simulated patients: influence on physicians' management plans. , 1984, Social science & medicine.

[140]  P. Benson Factors Associated With Antipsychotic Drug Prescribing by Southern Psychiatrists , 1983, Medical care.

[141]  J. Darley,et al.  A hypothesis-confirming bias in labeling effects. , 1983 .

[142]  J. Goodwin,et al.  Patient Characteristics That Influence Physician Behavior , 1982, Medical care.

[143]  Anne Locksley,et al.  Social stereotypes and judgments of individuals: An instance of the base-rate fallacy , 1982 .

[144]  G. Moskowitz Cognitive social psychology : the Princeton Symposium on the Legacy and Future of Social Cognition , 1981 .

[145]  D. Hamilton Cognitive Processes in Stereotyping and Intergroup Behavior , 1981 .

[146]  J. Flaherty,et al.  Measuring racial bias in inpatient treatment. , 1980, The American journal of psychiatry.

[147]  J. Schofield,et al.  Racial and behavioral cues in black and white children's perceptions of ambiguously aggressive acts. , 1980, Journal of personality and social psychology.

[148]  D. O. Lewis,et al.  Some evidence of race bias in the diagnosis and treatment of the juvenile offender. , 1979, The American journal of orthopsychiatry.

[149]  B. Duncan,et al.  Differential social perception and attribution of intergroup violence: testing the lower limits of sterotyping of blacks. , 1976, Journal of personality and social psychology.

[150]  Mark P. Zanna,et al.  The Nonverbal Mediation of Self-Fulfilling Prophecies in Interracial Interaction. , 1974 .

[151]  H. Triandis The analysis of subjective culture , 1973 .