Intended for healthcare professionals

Education And Debate

Spectre of racism in health and health care: lessons from history and the United States

BMJ 1998; 316 doi: (Published 27 June 1998) Cite this as: BMJ 1998;316:1970
  1. Raj Bhopal, professor (
  1. Department of Epidemiology and Public Health, Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH
  • Accepted 3 March 1998

Inequalities in health and health care in relation to race and ethnicity pose ethical problems of which racism is the most disquieting. 1 2 One controversial inequality is the poor health of African Americans—their life expectancy in 1993 was 7.1 years less than that of white Americans. La Veist et al have shown that the disparity has increased over this century.3 The deficit arises from excess mortality in relation to many causes of death, and is partly explained by differences in income.4


Race—The group a person belongs to as a result of a mix of physical features, ancestry, and geographical origins, as identified by others or, increasingly, as self identified. The importance of social factors in the creation and perpetuation of racial categories has led to a broadening of the concept to include social and political heritage, making its usage similar to ethnicity. Race and ethnicity are increasingly used synonymously

Ethnicity—The group a person belongs to as a result of a mix of cultural factors, including language, diet, religion, ancestry, and race

Racism—A belief that some races are superior to others, used to devise and justify actions that create inequality between racial groups

White—People with European ancestral origins known in the 19th century as caucasoid (in the United States, white includes people from the Middle East and north Africa) Black—People with African ancestral origins (in the United States, excluding some parts of north Africa) and who fall into the racial group known in the 19th century as negroid

African American—People who fall into the category black and live in the United States

Empirical evidence is scarce and hard to interpret, but much public opinion and some scholarly analysis in the United States and the United Kingdom place racism at the hub of …

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