Editorial

Affirmative action: the lessons for health care

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7450.1213 (Published 20 May 2004) Cite this as: BMJ 2004;328:1213
  1. F Sassi, lecturer in health policy (f.sassi@lse.ac.uk)
  1. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  2. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  3. Institute for Health and Aging, University of California at San Francisco, San Francisco, CA 94118, USA
  1. J Carrier, dean of graduate studies
  1. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  2. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  3. Institute for Health and Aging, University of California at San Francisco, San Francisco, CA 94118, USA
  1. J Weinberg, associate adjunct professor of health policy, law, and ethics
  1. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  2. Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE
  3. Institute for Health and Aging, University of California at San Francisco, San Francisco, CA 94118, USA

    Governments are becoming more assertive about reducing ethnic inequalities

    Even the richest multiethnic societies have so far failed to ensure a fair distribution of health and health care among people with different racial and ethnic backgrounds.1 2 Persisting inequalities have been ascribed largely to societies' moral failures and social injustice.1 We discuss here whether the rationale for the use of civil rights remedies such as affirmative action may be extended to the formulation of health policies aimed at addressing disadvantage among minority groups.

    In two landmark rulings in June 2003 the US Supreme Court upheld the use of affirmative action policies in admissions to higher education but rejected a formula based system assigning points to minority status.3 The court had made similar distinctions before on a wide variety of civil rights policies, including voting, mental health treatment, and employment. The proviso has always been that such policies must be “narrowly tailored” to serve a “compelling interest,” and …

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