Health Care

People of color have higher rates of disease and illness than whites, a fact explored further in Chapter 12 “Work and the Economy”’s treatment of health and medicine. One question that arises is why their health is worse. One possible answer involves 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 (Smedley, Stith, & Nelson, 2003). 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 et al., 1999).

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, employment, and credit history. The law forbids them to consider race and ethnicity. Yet African Americans and Latinos are more likely than whites to have their mortgage applications declined (Blank, Venkatachalam, McNeil, & Green, 2005). 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, 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. Both types of studies find that African Americans and Latinos are still more likely than whites with similar qualifications to have their mortgage applications rejected (Turner et al., 2002). 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). Because the people affected by redlining tend to be people of color, redlining, too, is an example of institutional discrimination.

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.

Taber Andrew Bain – US Bank – CC BY 2.0.

Mortgage rejections and redlining contribute to another major problem facing people of color: residential segregation. Housing segregation is illegal but is nonetheless widespread because of mortgage rejections and other processes that make it very difficult for people of color to move out of segregated neighborhoods and into unsegregated areas. African Americans in particular remain highly segregated by residence in many cities, much more so than is true for other people of color. The residential segregation of African Americans is so extensive that it has been termed hypersegregation and more generally called American apartheid (Massey & Denton, 1993).

In addition to mortgage rejections, a pattern of subtle discrimination by realtors and homeowners makes it difficult for African Americans to find out about homes in white neighborhoods and to buy them (Pager, 2008). For example, realtors may tell African American clients that no homes are available in a particular white neighborhood, but then inform white clients of available homes. The now routine posting of housing listings on the Internet might be reducing this form of housing discrimination, but not all homes and apartments are posted, and some are simply sold by word of mouth to avoid certain people learning about them.

The hypersegregation experienced by African Americans 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. For several reasons, then, residential segregation is thought to play a major role in the seriousness and persistence of African American poverty (Rothstein, 2012; Stoll, 2008).

Employment Discrimination

Title VII of the federal Civil Rights Act of 1964 banned racial discrimination in employment, including hiring, wages, and firing. However, African Americans, Latinos, and Native Americans still have much lower earnings than whites. Several factors explain this disparity, including the various structural obstacles discussed in Chapter 2 “Poverty”’s examination of poverty. Despite Title VII, however, an additional reason is that people of color continue to face discrimination in hiring and promotion (Hirsh & Cha, 2008). 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 (2003) 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.