Ensnared by Colorblindness: Discourse on Health Care Disparities.

OBJECTIVE

Race consciousness serves as the foundation for Critical Race Theory (CRT) methodology. Colorblindness minimizes racism as a determinant of outcomes. To achieve the emancipatory intent of CRT and to reduce health care disparities, we must understand: 1) how colorblindness "shows up" when health care professionals aim to promote equity; 2) how their colorblindness informs (and is informed by) clinical practice; and 3) ways to overcome colorblindness through strategies grounded in CRT.

DESIGN/SETTING/PARTICIPANTS: We conducted 21 semi-structured interviews with key informants and seven focus groups with personnel employed by a large Minnesota health care system. We coded transcripts inductively and deductively for themes using the constant comparative method. We used a race-conscious approach to examine how respondents' accounts align or diverge from colorblindness.

RESULTS

Evading race, respondents considered socioeconomic status, cultural differences, and patients' choices to be the main contributors to health disparities. Few criticized the behavior of coworkers or that of the organization or acknowledged structural racism. Respondents strongly believed that all patients were treated equally by providers and staff, in part due to race-neutral care processes and guidelines. Respondents also used several semantic moves common to colorblindness to refute suggestions of racial inequality.

CONCLUSIONS

Colorblindness upholds the racial status quo and inhibits efforts to promote health equity. Drawing on CRT to guide them, health care leaders will need to develop strategies to counter personnel's tendency to focus on axes of inequality other than race, to decontextualize patients' health behaviors and choices, and to depend heavily on race-neutral care processes to produce equitable outcomes.