Health disparities, particularly disparities associated with race or ethnicity, have become a major focus for research and intervention in the United States. The degree to which health disparities are related to access issues, such as differential rates of insurance, rather than more insidious forces, such as institutional or individual racism, is both hotly debated and politicized ΝBloche, 2005Ν. The debate about what underlies health disparities in the U.S. is informed by little data, however, and existing data have been interpreted differently. For instance, the conclusions of a recent Institute of Medicine task force report suggesting that elements of racial injustice play a significant role in differential health outcomes in the U.S. ΝSmedley, Stith, & Nelson, 2003Ν have been criticized sharply ΝEpstein, 2005Ν. At this point, the degree to which health disparities can be accounted for by racism remains debatable. On the other hand, the history of racism in the United States, and, in particular, mistrust by African-Americans of research conducted by mostly Caucasian scientists should be considered in planning research trials both in the U.S. and abroad ΝHussain-Gambles, Atkin, & Leese, 2004Ν. If health disparities are to be effectively addressed, research on the roots of these disparities must be conducted, and cultural divisions, such as mistrust stemming from the history of racial oppression in the U.S., must be addressed in the planning stages.
Mental health interventions, which generally require high degrees of participatory dialogue, are particularly influenced by perceptions of trust. When individuals perceive discrimination, they may be less likely to engage in the kind of participatory dialogue necessary for psychotherapeutic intervention. For the practitioner working with infants and their caregivers, participatory dialogue is particularly critical. There is intriguing, albeit limited, data that one factor influencing the degree to which individuals perceive their health care experiences to be participatory is race. Cooper-Patrick et al. Ν1999Ν found that African-Americans rated their health care visits as less participatory than whites overall, even when basic demographic factors, health status, and length of relationship with the physician were controlled for. Furthermore, patients whose physician was of the same race rated their visits as significantly more participatory than those whose physician was of a different race. Population-based studies reveal that African-Americans in the U.S. receive roughly half as many outpatient