Striving for Equality, But Settling for the Status Quo in Health Care: Is Title VI More Illusory Than Real?


A plethora of empirical studies, such as the Institute of Medicine’s Unequal Treatment report, have shown that racial inequities in health care continue at the same level as in the Jim Crow Era. Innumerable reasons have been offered to explain the continuation of these health inequities, including racial discrimination. Congress enacted Title VI of the Civil Rights Act of 1964 to put an end to racial discrimination in health care, but it still persists. Given the regulation and enforcement mechanisms established under Title VI explicitly aimed at remedying racial discrimination such as that directed at elderly African-Americans it is unbelievable that these practices continue. Thus, one must ask whether the protections offered by Title VI are more illusory than real in the health care industry? Based on a review of the empirical data and governmental action in this area the answer seems to be that Title VI offers little more protection against racial discrimination than a broken umbrella during a hurricane.

In this article, I use empirical data to examine the United States’ failure to provide African-Americans with equal access to quality health care by using the problems with the long-term care system as a case study. Section II reviews the history of de jure discrimination in health care institutions. The government’s solution to eradicate racial discrimination in health care is examined in Section III. The continuation of de facto racial discrimination in health care is examined in Section IV, and the failure of the government to eradicate this discrimination is discussed in Section V. Finally, Section VI suggests solutions to induce the government and the health care industry to diligently enforce Title VI.

In the past, health scholars have written articles concerning racial inequities in health care based on data analysis, while legal scholars have written articles regarding the inadequacies of government enforcement and private rights of actions under Title VI. However before this article, no one has combined data analysis with case law to show that government enforcement of Title VI is not effective in preventing racial discrimination in health care, particularly in the long-term care system.


Health, Race, Title VI, Nursing Home, Discrimination

Publication Date


Document Type


Place of Original Publication

Rutgers Law Review

Publication Information

59 Rutgers Law Review 429 (2007)

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