Health Care

People of color have higher rates of disease and illness than whites, a fact we explore further in Chapter 13 "Health and Medicine"’s treatment of health and medicine. One question that arises is why their health is worse. Do they have poorer diets, less healthy lifestyles, and the like, or do they receive worse medical care because of their higher poverty and, perhaps, because of institutional discrimination in the health-care industry? We examine these possible answers in Chapter 13 "Health and Medicine", but for now focus on evidence of institutional discrimination based on race and ethnicity.

Several studies use hospital records to investigate whether people of color receive optimal medical care, including coronary bypass surgery, angioplasty, and catheterization. After taking the patients’ medical symptoms and needs into account, these studies find that African Americans are much less likely than whites to receive the procedures just listed. This is true when poor blacks are compared to poor whites and also when middle-class blacks are compared to middle-class whites (B. D. Smedley, Stith, & Nelson, 2003).Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press. In a novel way of studying race and cardiac care, one study performed an experiment in which several hundred doctors viewed videos of African American and white patients, all of whom, unknown to the doctors, were actors. In the videos, each “patient” complained of identical chest pain and other symptoms. The doctors were then asked to indicate whether they thought the patient needed cardiac catheterization. The African American patients were less likely than the white patients to be recommended for this procedure (Schulman, 1999).Schulman, K. A., et al. (1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. The New England Journal of Medicine, 340, 618–626.

Why does discrimination like this occur? It is possible, of course, that some doctors are racists and decide that the lives of African Americans just are not worth saving, but it is far more likely that they have unconscious racial biases that somehow affect their medical judgments. Regardless of the reason, the result is the same: African Americans are less likely to receive potentially life-saving cardiac procedures simply because they are black. Institutional discrimination in health care, then, is literally a matter of life and death.

Mortgages, Redlining, and Residential Segregation

When loan officers review mortgage applications, they consider many factors, including the person’s income and employment and credit history. The law forbids them to consider race and ethnicity. Yet many studies find that African Americans and Latinos are more likely than whites to have their mortgage applications declined (Blank, Venkatachalam, McNeil, & Green, 2005).Blank, E. C., Venkatachalam, P., McNeil, L., & Green, R. D. (2005). Racial discrimination in mortgage lending in Washington, D.C.: A mixed methods approach. The Review of Black Political Economy, 33(2), 9–30. Because members of these groups tend to be poorer than whites and to have less desirable employment and credit histories, the higher rate of mortgage rejections may be appropriate, albeit unfortunate.

To control for this possibility, researchers take these factors into account and in effect compare whites, African Americans, and Latinos with similar incomes and employment and credit histories. Some studies are purely statistical, and some involve white, African American, and Latino individuals who independently visit the same mortgage lending institutions and report similar employment and credit histories. Both types of studies find that African Americans and Latinos are still more likely than whites with similar qualifications to have their mortgage loans rejected (Turner, Freiberg, Godfrey, Herbig, Levy, & Smith, 2002).Turner, M. A., Freiberg, F., Godfrey, E., Herbig, C., Levy, D. K., & Smith, R. R. (2002). All other things being equal: A paired testing study of mortgage lending institutions. Washington, DC: The Urban Institute. We will probably never know whether loan officers are consciously basing their decisions on racial prejudice, but their practices still amount to racial and ethnic discrimination whether the loan officers are consciously prejudiced or not.

There is also evidence of banks rejecting mortgage applications for people who wish to live in certain urban, supposedly high-risk neighborhoods, and of insurance companies denying homeowner’s insurance or else charging higher rates for homes in these same neighborhoods. Practices like these that discriminate against houses in certain neighborhoods are called redlining, and they also violate the law (Ezeala-Harrison, Glover, & Shaw-Jackson, 2008).Ezeala-Harrison, F., Glover, G. B., & Shaw-Jackson, J. (2008). Housing loan patterns toward minority borrowers in Mississippi: Analysis of some micro data evidence of redlining. The Review of Black Political Economy, 35(1), 43–54. Because the people affected by redlining tend to be people of color, redlining, too, is an example of institutional discrimination.

Figure 7.17

Banks have rejected mortgage applications from people who wish to live in certain urban, high-risk neighborhoods. This practice, called redlining, violates the law. Because many of the loan applicants who experience redlining are people of color, redlining is an example of institutional discrimination.

Source: Photo courtesy of Taber Andrew Bain, http://www.flickr.com/photos/88442983@N00/2943913721.

The denial of mortgages and homeowner’s insurance contributes to an ongoing pattern of residential segregation, which was once enforced by law but now is reinforced by a pattern of illegal institutional discrimination. Residential segregation involving African Americans in northern cities intensified during the early 20th century, when tens of thousands of African Americans began migrating from the South to the North to look for jobs (Massey & Denton, 1993).Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press. Their arrival alarmed whites, who feared the job competition from the migration and considered African Americans their biological inferiors. Mob violence against African Americans and bombings of their houses escalated, and newspapers used racial slurs routinely and carried many stories linking African Americans to crime. Fear of white violence made African Americans afraid to move into white neighborhoods, and “improvement associations” in white neighborhoods sprung up in an effort to keep African Americans from moving in. These associations and real estate agencies worked together to implement restrictive covenants among property owners that stipulated they would not sell or rent their properties to African Americans. These covenants were common after 1910 and were not banned by the U.S. Supreme Court until 1948. Still, residential segregation worsened over the next few decades, as whites used various kinds of harassment, including violence, to keep African Americans out of their neighborhoods, and real estate agencies simply refused to sell property in white neighborhoods to them.

Because of continuing institutional discrimination in housing, African Americans remain highly segregated by residence in many cities, much more so than is true for other people of color. Sociologists Douglas S. Massey and Nancy A. Denton (1993)Massey, D. S., & Denton, N. A. (1993). American apartheid: Segregation and the making of the underclass. Cambridge, MA: Harvard University Press. term this problem “hypersegregation” and say it is reinforced by a pattern of subtle discrimination by realtors and homeowners that makes it difficult for African Americans to find out about homes in white neighborhoods and to buy them. Realtors, for example, may tell African American clients that no homes are available in white neighborhoods. Housing “audits,” in which white and African American couples of similar economic standing each inquire at a real estate agency about housing in white neighborhoods, confirm this practice: the white couples are told about houses for sale or apartments for rent, and the African American couples are told that none exist. Today, the routine posting of housing listings on the Internet might be reducing this form of housing discrimination, but not all houses and apartments are posted, and some are simply sold by word of mouth to avoid certain people finding out about them.

The hypersegregation that African Americans experience, say Massey and Denton, cuts them off from the larger society, as many rarely leave their immediate neighborhoods, and results in “concentrated poverty,” where joblessness, crime, and other problems reign. Calling residential segregation “American apartheid,” they urge vigorous federal, state, and local action to end this ongoing problem.

Employment Discrimination

Title VII of the federal Civil Rights Act of 1964 banned racial discrimination in employment, including hiring, wages, and firing. Table 7.2 "Median Weekly Earnings of Full-Time Workers, 2008" presents weekly earnings data by race and ethnicity and shows that African Americans and Latinos have much lower earnings than whites. Several factors explain this disparity, including the various structural obstacles discussed in Chapter 6 "Social Stratification"’s examination of poverty. Despite Title VII, however, an additional reason is that African Americans and Latinos continue to face discrimination in hiring and promotion (Hirsh & Cha, 2008).Hirsh, C. E., & Cha, Y. (2008). Understanding employment discrimination: A multilevel approach. Sociology Compass, 2(6), 1989–2007. It is again difficult to determine whether such discrimination stems from conscious prejudice or from unconscious prejudice on the part of potential employers, but it is racial discrimination nonetheless. A now-classic field experiment documented such discrimination. Sociologist Devah Pager (2007)Pager, D. (2007). Marked: Race, crime, and finding work in an era of mass incarceration. Chicago, IL: University of Chicago Press. had young white and African American men apply independently in person for entry-level jobs. They dressed the same and reported similar levels of education and other qualifications. Some applicants also admitted having a criminal record, while other applicants reported no such record. As might be expected, applicants with a criminal record were hired at lower rates than those without a record. However, in striking evidence of racial discrimination in hiring, African American applicants without a criminal record were hired at the same low rate as the white applicants with a criminal record. Other evidence of racial discrimination in employment abounds. As just one example, in 1996 a major oil company, Texaco, agreed to a $176 million settlement after it was sued by African American employees for rampant discrimination in its promotion practices. Texaco executives had also been caught on tape uttering racial slurs at a meeting where they were discussing the lawsuit (Hammonds, 1996).Hammonds, K. H. (1996, December 16). Texaco was just the beginning: Expect more civil rights tangles with corporate America. Business Week, pp. 34–35.