Just Medicine: A Cure for Racial Inequality in American Health Care

Nonfiction | Book | Adult | Published in 2015

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Summary

Background

Chapter Summaries & Analyses

Introduction-Chapter 1

Chapters 2-4

Chapters 5-7

Chapter 8-Conclusion

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Key Figures

Dayna Bowen Matthew

Dayna Bowen Matthew is a scholar of law and expert in public health who specializes in the study of racial and ethnic health disparities in the United States. Matthew received her Bachelor of Arts from Harvard-Radcliffe College and her Doctor of Law title from the University of Virginia School of Law. Furthermore, she obtained her PhD in Health and Behavioral Sciences from the University of Colorado at Denver.

Currently, Matthew is a law professor and, since July 2020, serves as the Dean of George Washington University Law School, focusing on health law and civil rights. In her academic research and advocacy work, she combines legal analysis with public health frameworks, seeking to address the systemic inequities in healthcare delivery and health outcomes that disproportionately affect marginalized communities. She is a longstanding advocate for vulnerable communities and, along with her legal and academic work, she has been involved in many projects that seek to address the health and environmental discrimination of BIPOC populations.

Based on her research, legal practice, and advocacy work, Matthew published her first book Just Medicine: A Cure for Racial Inequality in American Healthcare, in 2015. In the book, as in many of her public lectures, Matthew argues that implicit bias among healthcare providers significantly contributes to the disparities in treatment and health outcomes seen between white patients and patients of color. Matthew draws on legal, medical, and social science research to propose systemic reforms aimed at addressing these biases, advocating for policy changes that hold healthcare institutions accountable for discriminatory practices.

Thomas R. Frieden

Thomas R. Frieden (born 1960) is a physician who specializes in public health and infectious diseases. A notable figure in public health, Frieden served as director of Centres for Disease Control and Prevention—the leading agency monitoring public health in the US. Currently, Frieden is the CEO and president of Resolve to Save Lives—a global non-for-profit organization focusing on health equity and disease prevention.

Frieden is also recognized for his advocacy work, such as his tobacco control campaigns. Frieden contributed numerous scientific articles, focusing on a broader, systemic, and educational approach to public health and disease prevention. Among his contributions is the paper that Matthew cites in Just Medicine, titled “A Framework for Public Health Action: The Health Impact Pyramid,” (2010) published in the American Journal of Public Health (175). In this paper, Frieden develops the Health Impact Pyramid, a conceptual model that illustrates different levels of public health interventions, with the broader structural changes at the base having the greatest potential to improve health outcomes, while individualized clinical and educational interventions sit at the top with more limited impact. Frieden emphasizes that addressing the fundamental social determinants of health—such as housing, education, and employment—can lead to the most significant reductions in health disparities, as these structural interventions impact larger segments of the population. The Health Impact Pyramid brings into focus the necessity of prioritizing broader societal changes in order to improve overall public health.

Matthew uses Frieden’s Health Impact Pyramid in Just Medicine to critique the current approaches to reducing healthcare disparities. Matthew points out that many interventions aimed at eliminating disparities, such as educational reforms targeting implicit bias in physicians, fall within the upper tiers of Frieden’s pyramid. Matthew’s application of Frieden’s framework serves to reinforce her argument for more structural solutions to health disparities. Such solutions, she argues, would address the underlying causes of healthcare disparities on the lower levels of the pyramid, such as access to infrastructure, education, and healthy food.

David Oppenheimer

David Oppenheimer is a Professor of Law at the University of California, Berkeley. His research focuses on anti-discrimination law, about which he has published extensively. In 2005, he co-authored White-Washing Race: The Myth of a Color-Blind Society, which won the Gustavus Myers Outstanding Book Award and the Benjamin L. Hooks Outstanding Book Award. In this book, the authors draw on contemporary scholarship to argue that racism remains prevalent in most American institutions.

Matthew draws on Oppenheimer’s 1993 paper “Negligent Discrimination,” which addresses the need to reform employment discrimination law under Title VII of the Civil Rights Act—intended to protect employees from discrimination—by proposing the application of a negligence standard of care. Oppenheimer’s approach promotes the idea that organizations should be incentivized to proactively address the conditions that allow discrimination to flourish.

Matthew wishes to address the same issues that Oppenheimer focuses on regarding employment law in healthcare, highlighting The Importance of Legal Reforms that Address Implicit Bias. As Oppenheimer does, Matthew also advocates for the idea that law and policy must focus on eliminating discriminatory practices at the institutional level. Ultimately, Matthew wishes to reform article VI of the Civil Rights Act by including negligent discrimination to control for discrimination in healthcare institutions.