Author: Donald A. Barr, MD, PhD
Publisher: Johns Hopkins University Press – 308 pages
Book Review by: Sonu Chandiram

The United States has lower levels of life expectancy and higher rates of infant mortality than nearly all other developed countries, despite all the money Americans spend on health care, the author Dr. Donald Barr, a physician and a sociologist, points out in his Preface.

He also discovered by accident one day, that cancer specialists in California provide bone marrow transplantation, a treatment proven to be effective for multiple myeloma, less often to African Americans than to whites. Why is that the case?

Dr. Barr also found out that African-American men had twice the incidence rate of multiple myeloma than white men, and African-American women had 2.4 times the incidence rate than white women. Was that the effect of not receiving bone marrow transplantation?

He began looking at data to try find out what are the various health disparities among people of different races, ethnicities, and age groups. While doing this, he developed and started teaching a course whose purpose was not just to know the what, but also to get at the why; to not only look into the variations of health care quantity and quality received, but to also find out the causes, and consequences of racial and ethnic disparities in health status and access to health care.

His students were future leaders in law, medicine, and public health, including public health policy-making, so the course was highly important to them, and it became quite well received by them as well. His research and discoveries, his teaching to students and learning from them as well, led to the writing of this important book.

Dr. Barr compiled a lot of material for this book as he looked at health care data relating to not just African Americans and whites but also among American Indians, Asians, and native Hawaiians. He  compiled his findings and organized them into the following eleven chapters:

  1. Introduction to the Social Roots of Health Disparities
  2. What is “Health”? How Should We Define It? How Should We Measure It?
  3. The Relationship between Socioeconomic Status and Health, or “They Call it ‘Poor Health’ for a Reason”
  4. Understanding How Low Social Status Leads to Poor Health
  5. Race, Ethnicity, and Health
  6. Race/Ethnicity, Socioeconomic Status, and Health: Which is More Important in Affecting Health Status?
  7. Children’s Health Disparities
  8. All Things Being Equal, Does Race/Ethnicity Affect How Physicians Treat Patients?
  9. Why Does Race/Ethnicity Affect the Way Physicians Treat Patients?
  10. When, If Ever, Is It Appropriate to Use a Patient’s Race/Ethnicity to Guide Medical Decisions?
  11. What Should We Do to Reduce Health Disparities?

Donald A. Barr, MD, PhD is a professor in the Department of Pediatrics; and education in the Graduate School of Education at Stanford University in Stanford, California. He is the author of Introduction to U.S. Health Policy, also published by Johns Hopkins.