Renee R. Parsons, BSW¹, Kevin M. Gorey, PhD, MSW¹, Uzo Anucha, PhD¹, and Reza Nakhaie, PhD². (1) School of Social Work, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada, 519 253-3000, ext. 3085, reneeparsons7@yahoo.ca, (2) Department of Sociology and Anthropology, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada

Contemporary health care reforms in the US and Canada have been consistent with conservative welfare reforms. Their foundation was laid by theorizing that emphasized personal, biologically-mediated (genetic) characteristics. And practically, they have emphasized costs, rather than benefits or outcomes. Other theorists have advanced social-structural explanations for the health of populations (equitable opportunities for education and health care [insurance]). A meta-analysis of 89 American or Canadian studies (1985 to 2003) on the determinants of a common and public health significant health outcome—breast cancer survival—provided a sentinel test of these theoretical alternatives. The sample-weighted fixed effects (Mantel-Haenszel odds ratios) of these historical cohort studies were: (1) The strength of racial group (African American)-survival (OR = 1.49) and social class-survival (OR = 1.59) associations in the US (market-driven, insurance-based) were much larger than those observed in Canada (universal coverage, single payer), that were, in aggregate, not even significant in a statistical sense. (2) The US social class-survival association was larger among younger, non-Medicare eligible women (OR = 1.82). And (3), Regression adjustments identified the primacy of social (income, type insurance), rather than personal or biological factors (lifestyle, tumor characteristics), in explaining these phenomena. These findings are consistent with so-called liberal social welfare theory. Moreover, they clearly demonstrate that race is primarily a social construction in American life. And finally, they provide hope. Racial group and class inequities that persist in America are probably completely solvable through social policies that guarantee truly equitable distributions of America’s health care and other social resources.

Learning Objectives:

• To be able to articulate how contemporary health care policy changes have differentially affected diverse people (people of color, the poor, the uninsured) in the United States and Canada.
• To be able to articulate the evidence that empirically indicts American health care as implicitly or institutionally racist and classist.
• To understand how meta-analsis and the systematic review of historical cohort studies can provide practical evidence to empirically steer future social policies.

Keywords: Health Care Access, Ethnic Minorities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.