Abstract

Racial and ethnic inequities in health abound in many disease categories. African-American communities suffer from an increased burden of illness, with higher incidence and mortality rates and more severe morbidity in cerebrovascular disease, heart disease, several cancers, diabetes, and many other ailments. Healthy People 2010, the federal government’s health plan, calls for eliminating health disparities by race, ethnicity, gender, education, income, disability, geographic location, or sexual orientation. Research aimed at increasing our understanding of these health disparities and designing and evaluating interventions to improve African-American health is hampered by a liberal, classless approach. The authors argue for a theoretical framework in this research that recognizes that class exploitation sets the stage for and interacts with racial discrimination to determine racial inequities in health. African Americans are sicker and dying at a faster rate than white Americans from a number of diseases. As noted in Healthy People 2010 (1), the infant mortality rate for African Americans is more than double that of whites. Coronary heart disease death rates are more than 40 percent higher for African Americans than for whites. African Americans die at a 30 percent higher rate than do whites from cancers, as well. The death rate from HIV/AIDS for African Americans is more than seven times that for whites. These inequities, as well as similar disparities for other racial and ethnic minorities, are reprehensible and have been decried from the White House to physicians ’ offices across the country. In 2000, the U.S. Congress established the National Center for Minority Health and Health Disparities at the National Institutes of Health to help spearhead NIH efforts to study the causes of these health inequities. Congress also requested an Institute of Medicine study to assess