To Address Disparities, Health Services Research Students Must Understand Inequity, Not Just Inequality

I’ll never forget a moment early in my PhD program when, in the midst of a class discussion, I brought up recently published studies showing that black women suffer from higher rates of infant mortality compared to white women, even when controlling for income and education. I vividly remember the pause and facial reaction of my (white male) classmate. 
Too often, research and discussions around health disparities become centered on socioeconomic status; “disparity” becomes a proxy for “poor.” In some ways, this is understandable: Socioeconomic status is inextricably linked to health status, and affordable access to care is a major concern in our field and relatively easy to measure. 
However, as a black woman, I have heard older family members express their desire to deal with medical problems on their own—and even die—before they would be willing to trust a medical provider because of the systemic racism and mistreatment experienced by our community at the hands of the medical establishment. That’s not an affordable access problem. 
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