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Civil rights-era efforts to end disparities in health care in federally financed health programs faced three successively more difficult challenges: (1) ending Jim Crow practices, (2) eliminating more subtle forms of segregation, and (3) assuring nondiscriminatory treatment in integrated settings. Federal efforts peaked with the implementation of the Medicare program. Visible symbols of Jim Crow disappeared, and most crude disparities in access were eliminated. The unfinished parts of the civil rights-era agenda, the persistence of more subtle forms of segregation, and the failure to assure nondiscriminatory treatment pose major challenges to current efforts to eliminate health care disparities.
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This article offers a brief history of healthcare civil rights, describes a range of healthcare issues that have a civil rights component, and discusses the need for an expanded civil rights framework to guide the provision of health care. Unequal health care based on race and ethnicity has received renewed attention over the past several years, but healthcare discrimination based on socioeconomic status, disability, age, and gender also deserve careful attention.
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In the U.S.A. serious differences in the health status between black and white citizens continue to exist. Black Americans are less healthy and receive less health care than while Americans. The discrimination is examined as a civil rights issue with focus on both the policy and judicial perspectives of the application of Title VI of the Civil Rights Act of 1964 and the implementative effects of the Hill-Burton Act of 1946. The application, and compliance and enforcement, of civil rights to health care is complicated by a captivity process involving Federal agencies, by corporate medical rights emphasizing a business approach to health care, and by a liberal pluralistic political arena in which certain influential groups prevail over others. In order for black health status and care to improve in the U.S.A., blacks must continue to utilize the judicial system to seek redress of health care inequities. Second, they must utilize their demonstrated political power to demand better treatment from the medical establishment.
On February 10, 1998, voters in Maine repealed a law providing civil rights protection for gay men and lesbians. This article provides an analysis of the argument strategies used by both parties to the dispute, shedding light on the particular tactics that contributed to the repeal. Felstiner, Abel, and Sarat's (1981) sociolegal theory of naming, blaming, and claiming is offered as a lens to examine conservatives' anti-gay rights arguments in the campaign. The theory helps demonstrate how conservatives' argument patterns created narratives that successfully appealed to disparate audiences in Maine, thus garnering sufficient voter support to pass the appeal referendum. I also define weaknesses in GLBT supporters' counter-arguments using this theoretical perspective. Finally, I offer suggestions for argument strategies in future campaigns that could strengthen uncommitted voters' support for gay civil rights initiatives.
The history of health care discrimination as well as ongoing, extensive evidence of racial disparities argue for continued vigilance in the area of health care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by health entities receiving federal financial assistance. Title VI health litigation is difficult because of complex issues of proof as well as confounding problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served. This has important implications for claims involving discrimination by managed care organizations. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evaluation are warranted.
Title VI of the 1964 Civil Rights Act prohibits discriminatory conduct by recipients of federal financial assistance. The law has been used in the past to challenge discrimination in health care. The evolution of the health care system from fee-for-service to managed care holds much promise for minority persons, who historically have faced serious, extensively documented barriers to health care access. However, managed care providers, like their fee-for-service counterparts, may perpetuate past discriminatory practices in new ways. Understanding new forms of discrimination is important at this stage of the development of managed care, when program design and policy action can most effectively prevent the occurrence of such practices.
Beginning in 1982 the Reagan administration tried to impose federal regulations (based on the civil rights approach of Section 504) on the medical treatment of handicapped newborns in the nation's hospitals. After issuing three sets of regulations, the administration found itself rebuffed by the courts and in ill repute with providers and parts of the public, especially after its widely publicized intervention in the case of Baby Jane Doe illustrated the pitfalls of federal regulation in complex medical decisions. Congress, however, soon enacted legislation employing different means to protect handicapped newborns. The episode offers insights into the dynamics of the U.S. system of separated powers, the limitations of the "civil rights" approach, and the importance of negotiating structures for the resolution of private moral dilemmas with public implications.
Social services remain largely unresponsive to the values and needs of Latino families, who often need Spanish-language services. This article discusses access to linguistically appropriate services, not just as a culturally competent practice, but also as a civil rights issue. Spanish speakers have protection from discrimination in federally funded human services under Title VI of the Civil Rights Law of 1964. The article discusses implications for all aspects of private and public child welfare, including investigations, foster care, family preservation, adoption, and quality assurance.
In 1964, Claude and Jeanne Nolen, who were white, joined an interracial NAACP team intent on desegregating local restaurants in Austin, Texas as a test of the recently passed Civil Rights ACt. Twenty-five years later, the Nolens pleaded "no contest" in a courtroom for their continued social activism. This time the issue was not racial segregation, but rather criminal trespassing for blockading abortion clinics with Operation Rescue. The Nolens served prison sentences for direct action protests that they believe stemmed from the same commitment to Christianity and social justice as the civil rights movements. Despite its relationship to political and cultural conservatism, the anti-abortion movement since Roe v. Wade (1973) was also a product of the progressive social movements of the turbulent sixties. Utilizing oral history interviews and organizational literature, the article explores the historical context of the anti-abortion movement, specifically how the lengthy struggle for racial justice shaped the rhetoric, tactics, and ideology of the anti-abortion activists. Even after political conservatives dominated the movement in the 1980s, the successes and failures of the sixties provided a cultural lens through which grassroots anti-abortion activists forged what was arguably the largest movement of civil disobedience in American history.
For 44 years Dr Hugo A. Owens was a distinguished practitioner and community leader in Portsmouth and Chesapeake, Virginia, and also served for a time as president of the National Dental Association. Besides his proclivity for dentistry, he was driven by two other passions: politics and civil rights. In 1970 he was one of the first African Americans ever elected to the Chesapeake City Council. He was reelected for the next term and appointed vice mayor, a position he held for 8 years. His political successes were preceded by his activities as a civil rights leader, which began in 1950 and lasted through the 1960s. In a remarkable series of negotiations and litigations, Dr Owens was the prime mover in the desegregation of the city of Portsmouth. In all three "careers," Dr Owens used dentistry as a home base for the expression of his activist philosophy of providing help for others when they were unable to help themselves.