Blaming health disparities on genetics, cultural attitudes exacerbates inequitable care

The belief among some physicians that patients from underrepresented racial and ethnic groups will have poorer health outcomes because of cultural attitudes or genetics inadvertently reinforces the disparities, according to researchers.

Ebiere Okah, MD, MS, a health equity researcher and assistant professor at the University of Minnesota, said in a press release that people from underrepresented communities face greater risks for poor health outcomes than white people.

“This reality has been used to justify the inclusion of race and ethnicity in medical recommendations, guidelines and algorithms driving treatment thresholds and interventions — often without mention of the mechanisms through which these identities result in poor health,” she said in the release. “Using race without recognizing the social, political and economic factors that contribute to racial inequity can stigmatize racially minoritized people as biologically inferior and normalize their poor health, worsening health disparities by codifying them as inevitable.”

Okah and colleagues conducted a cross-sectional analysis to assess whether attributing racial differences in health outcomes to culture, genetic or social conditions influenced the use of race in clinical practice, or “race-based practice.” Their findings were recently published in the American Journal of Preventive Medicine.

The analysis was based on 2021 survey data from the Council of Academic Family Medicine Education Research Alliance, which included responses from 689 physicians actively practicing in the United States. The survey measured race-based practice using the Racial Attributes in Clinical Evaluation (RACE) scale — a 5-point Likert scale in which higher scores indicate greater use of race-based practice.

Okah and colleagues found that higher RACE scores were linked to a greater belief that, rather than social conditions, differences in genetics (3.57; 95% CI, 3.19-3.95) and culture (1.57; 95% CI, 0.99-2.16) were to blame for racial disparities in health.

“The belief that race provides insight into patients’ genetic disease risk is contentious and has been disavowed by some medical societies,” the researchers wrote.

Notably, the specific belief that social factors may contribute to disparities is not necessarily related to a race-based practice, according to the release; physicians who thought social factors were to blame for racial disparities were neither more nor less likely to use race to guide their care.

“Some physicians may view race as identifying patients in need of supportive services and may rely on race-based algorithms and recommendations to reduce health disparities. These physicians may also believe that exposure to discrimination results in epigenetic changes that warrant race-based tools and guidelines that suggest biological differences between racial groups,” they wrote. “By contrast, physicians may perceive race-based tools and algorithms as minimizing and therefore upholding structural racism by attributing race instead of racism to poor health outcomes. They may also believe that race-based algorithms worsen health disparities.”

Okah and colleagues concluded that more research is needed to understand “how race is differentially applied in clinical care on the basis of the belief in its genetic or cultural significance.”

“The next step in this work is determining how to challenge the belief that race is related to cultural values,” Okah said in the release. “Part of the solution lies in advancing cultural humility as an alternative to cultural competency, acknowledging the cultural diversity that exists within racial groups, and considering the ways in which structural factors create what we perceive to be culture.”

References:

• Okah E, et al. Am J Prev Med. 2023;doi:10.1016/j.amepre.2022.10.019.
• Self-fulfilling prophecy: When physicians associate race and culture with poor health outcomes. https://www.eurekalert.org/news-releases/978866. Published Feb. 9, 2023. Accessed Feb. 9, 2023.