Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?
Michelle van Ryn, PhD, MPH and
Steven S. Fu, MD, MSCE
Michelle van Ryn is with the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, and the Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis. Steven S. Fu is with the Center for Chronic Disease Outcomes Research, Section of General Internal Medicine, Minneapolis Veterans Affairs Medical Center, and the Department of Medicine, University of Minnesota.
Correspondence: Requests for reprints should be sent to Michelle van Ryn, PhD, MPH, Minneapolis VAMC/Center for Chronic Disease Outcomes Research, One Veterans Dr (152/2E), Minneapolis, MN 55417 (e-mail: vanryn{at}epi.umn.edu).
There is extensive evidence of racial/ethnic disparities inreceipt of health care. The potential contribution of providerbehavior to such disparities has remained largely unexplored.Do health and human service providers behave in ways that contributeto systematic inequities in care and outcomes? If so, why doesthis occur?
The authors build on existing evidence to provide an integrated,coherent, and sound approach to research on providerscontributions to racial/ethnic disparities. They review theevidence regarding provider contributions to disparities inoutcomes and describe a causal model representing an integratedset of hypothesized mechanisms through which health care providersbehaviors may contribute to these disparities.
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