What do we mean by 'racism'? Conceptualising the range of what we call racism in health care settings: A commentary on Peek et al.

0277-9536/$ e see front matter 2010 Elsevier Ltd. doi:10.1016/j.socscimed.2010.03.020 This commentary briefly explores the conceptual issues that underlie studies of race and racism in health care. First, what do we mean by racism in the contemporary medical context? Second, is there a model of racism that can encompass the range of what is referred to as racism? That is, is it possible to conceptualise everything that is meant by racism, from features of interpersonal communication to population-level inequalities, in a single model? In their article “Race and Shared Decision-Making: Perspectives of African-Americans with Diabetes” Peek et al. (2010) explore how patients’ perceptions of race may influence decision-making in a medical context. A model of shared decision-making (‘Information-sharing, Deliberation or Physician recommendation and Decision-making’) is posited as an intervention capable of reducing disparities in disease outcome. Racialised inequalities in rates of diabetes diagnosis, complication, disease management and quality of outcome are well documented and require urgent remedial attention. Previous research has shown that methods of shared decision-making do not work as well with minority ethnic patients as with majority ethnic patients (e.g. Cooper et al., 2003; CooperPatrick et al., 1999). Peek et al. explore how Black people in the US with diabetes view the role of race in decision-making about medical care with their doctors, using a combination of in-depth interviews and focus groups. None of the 24 people who were interviewed reported experiencing any ‘discrimination or other race-related encounters’ and most of them said that race did not play an important role in