Informal Segregation in Health Care Delivery: Historical, Anecdotal, and Objective Evidence

Abstract

Over the past several decades, our nation has made limited progress toward achieving health equity. One challenge is that health care delivery remains highly segregated by race and ethnicity. Although formal racial segregation officially ended in the 1960s, informal segregation remains widely practiced, accepted, and even justified. I provide historical, anecdotal, and objective data to demonstrate its persistence. I discuss my 40-year journey in segregated health care systems and a brief review of key studies and research on such segregation. I also highlight how despite the ample evidence, pervasive segregation in health care delivery remains an uncomfortable topic that few want to broach or discuss. I note that greater recognition, visibility, and advocacy are needed to address this unfair, unjust, and pervasive practice. I conclude that in the current political climate, being trustworthy and engaging communities in a meaningful way to eliminate disparities means we cannot remain complacent and silent on some of the most deeply rooted challenges to achieving health equity.