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Will Racial and Ethnic Disparities in Health Be Resolved Primarily Outside of Standard Medical Care?
I agree with almost every point in the position paper (1), including the 6 fronts addressed: increased access to quality health care, patient care, provider issues, systems that deliver health care, societal concerns, and continued research. The first 2 fronts, however, present a “physician-centric” perspective, which implies that the major advances to eliminate racial and ethnic health disparities will emerge from one-on-one encounters in the examination room. This view reflects a “biomedical model” paradigm (2), in which physicians, rather than patients or the society, are responsible for good health. This model is spectacularly successful in high-intensity, acute medical care, the setting of most medical education and training, but has many limitations when applied to general health and chronic diseases.
Perhaps the most convincing evidence of limitations of the biomedical paradigm is seen in the strong associations of socioeconomic status and health (3). Job classification predicted cardiovascular mortality more effectively than cholesterol level, hypertension, or smoking in London civil servants, all of whom had access to the National Health Service (4) …
