“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.”
— Dr. Martin Luther King, Jr.
Ethnic and racial health and health care disparities are persistent and pervasive. Despite a wide range of approaches to address these disparities, they remain largely intact. The Affordable Care Act of 2010 (ACA) is expected to reduce disparities in access to health care and addresses health discrimination. In addition, the Civil Rights Act of 1964, the cornerstone legislation that prohibits discrimination based on race, color, and national origin by recipients of federal funding, and Executive Order 12898 on environmental justice and health can be used to address health disparities. If utilized consistently and applied with renewed efforts, civil rights laws can continue to address health care issues and reduce health disparities. These legal tools cut across diverse federally funded programs and activities. This article examines four health-related areas with disparities based on race, color, or national origin: (1) food stamp programs; (2) physical education in public schools; (3) parks and healthy green land use; and (4) access to health care services for limited English proficiency (LEP) populations. Civil rights laws including Title VI offer tools that attorneys and other stakeholders working with public health professionals, community groups, government agencies, and recipients of federal funds can use to alleviate health disparities. These legal tools are not limited to a litigation strategy. Voluntary compliance with civil rights laws is the preferred means to achieve equal justice goals. Civil rights attorneys continue the struggle to uphold and strengthen these laws.
The following recommendations can help civil rights attorneys, public health professionals, community groups, public agencies, recipients of public funding, foundations and other stakeholders alleviate health inequities through compliance with civil rights laws.
- Of the many avenues to achieve compliance with civil rights laws, voluntary compliance is the preferred means to achieve civil rights goals including health equity.
- Discrimination is a root cause of health disparities, and a comprehensive strategy to eliminate disparities must incorporate a strong civil rights component.
- Stakeholders should work together on a compliance and equity plan for each program or activity by recipients of federal funding that describes what is to be done, analyzes the impact on all communities, analyzes alternatives, includes full and fair participation by diverse communities, and alleviates health inequities.
- Compliance and equity plans should guard against unjustified and unnecessary discriminatory impacts, as well as intentional discrimination, in health programs and activities.
- Federal agencies should ensure compliance with civil rights laws through the many avenues they have available. This includes data collection, analyses, and publication, planning, regulations and guidance documents, review of federal funding applications, contractual assurances of compliance by recipients, compulsory self-evaluations by recipients, compliance reviews after funding, investigation of administrative complaints, full and fair public participation in the compliance and enforcement process, and denial or termination of funding. State and local agencies have similar tools to ensure compliance with federal and parallel state laws.
- Civil rights lawyers should use comprehensive problem-solving strategies: coalition building, planning, data collection and analysis, media, negotiation, policy and legal advocacy out of court, and access to justice through the courts.
- Foundations should support compliance with civil rights laws to ensure health equity, and support organizations for whom racial and ethnic justice is a core value. This can strengthen philanthropic efforts across a range of programs. Funding for organizational capacity is needed. Strategic funding of national, regional or local civil rights and environmental justice groups can have a significant impact.
- Attorneys and public health experts should work together to promote better understanding of the civil rights dimension of the challenge of health disparities, and to show how to address these civil rights concerns.
- Civil rights laws against discrimination in health and other publicly funded programs and activities should be strengthened and not rolled back. This includes the prohibition against unjustified and unnecessary discriminatory impacts, and intentional discrimination.
- It takes a movement. The myriad of strategies of the Civil Rights Movement started the process of dismantling the most egregious forms of Jim Crow health discrimination. A continued health justice movement, drawing on the lessons of history, is needed to seek racial equity and overcome discrimination and structural barriers to a more equitable society.
Download the Policy Report by Michael Rodriguez, MD, MPH; Marc Brenman; Marianne Engelman Lado, JD; and Robert García, JD, Using Civil Rights Tools to Address Health Disparities.