What lies behind race and health? A rethinking of race and health care through a corrective case study

Beyond the neutral image of a health care system and a normalized social order is an assumption about equality that may be influencing how we address health disparities. This study addresses whether a priori assumptions regarding race influence how we think about health and the organization of health care. The primary intent of this study is to engage and anchor the dialogue of health and health care delivery, at once in the past and in the present. A historical case study of a segregated hospital in Virginia is presented, and the organizing system of segregation and racial ideology is analyzed and deconstructed. The founding themes behind racial ideology, theories, and philosophies that were embedded in our culture are discussed. Finally, the analytical lens used by Elizabeth Minnich (1990) to expose the relationship between thinking, knowledge, education curricula, and the exclusion of disempowered groups is applied to biomedicine. This lens focuses on the symbolic representation and outcomes related to the ways in which we think about race and secondarily class and sex/gender. Four conceptual problems are identified: faulty generalization (overgeneralization), circularity of reasoning, mystified concepts, and partial modes of knowing and knowledge systems. This analysis reveals how racial ideology as an organizing system remains below the surface of the biomedical model, and how the American ideologies of individualism and freedom of choice are woven into racial ideology and biomedical thinking in support of this organizing system. Additionally, there is an exploration of how this thinking is a barrier to social equity and justice and, unless corrected, is destined to repeat itself in other systems and theories.