Serving some and serving all: how providers navigate the challenges of providing racially targeted health services

ABSTRACT

Objectives: Racially targeted healthcare provides racial minorities with culturally and linguistically appropriate health services. This mandate, however, can conflict with the professional obligation of healthcare providers to serve patients based on their health needs. The dilemma between serving a particular population and serving all is heightened when the patients seeking care are racially diverse. This study examines how providers in a multi-racial context decide whom to include or exclude from health programs.

Design: This study draws on 12 months of ethnographic fieldwork at an Asian-specific HIV organization. Fieldwork included participant observation of HIV support groups, community outreach programs, and substance abuse recovery groups, as well as interviews with providers and clients.

Results: Providers managed the dilemma in different ways. While some programs in the organization focused on an Asian clientele, others de-emphasized race and served a predominantly Latino and African American clientele. Organizational structures shaped whether services were delivered according to racial categories. When funders examined client documents, providers prioritized finding Asian clients so that their documents reflected program goals to serve the Asian population. In contrast, when funders used qualitative methods, providers could construct an image of a program that targets Asians during evaluations while they included other racial minorities in their everyday practice. Program services were organized more broadly by health needs.

Conclusion: Even within racially targeted programs, the meaning of race fluctuates and is contested. Patients’ health needs cross cut racial boundaries, and in some circumstances, the boundaries of inclusion can expand beyond specific racial categories to include racial minorities and underserved populations more generally.

KEYWORDS:

• Racially targeted interventions
• HIV/AIDS
• race/ethnicity
• Asian American
• organizations
• ethnography

Acknowledgements

I would like to thank Stefan Timmermans, Ching-Kwan Lee, Rogers Brukaber, Winston Chou, Susan Watkins, Tara McKay, Thomas Hannan, and Hyeyoung Oh for providing helpful comments on earlier versions of this article. I also appreciate feedback from members of the UCLA Health Working Group, the UCLA Comparative Analysis Seminar, and the anonymous reviewers of Ethnicity and Health. My sincere thanks to the people I met during the course of my fieldwork who generously shared their time and stories with me.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1. The organization and all names used in this article are pseudonyms.

2. The Asian and Pacific Islander categories are used by the organization and funding agencies in my case study to represent one group. Because ‘Asian’ commonly connotes both categories, I will use this term to be more concise.