The logic of identity and resemblance in culturally appropriate health care

Abstract

Greater diversity in the health care workforce is frequently proposed as a means of addressing health disparities between minority and majority populations in the USA by improving health care access and quality for minority groups. 'Culturally appropriate' health care programs that include ethnic resemblance between physician and patient are emerging as new technologies of knowledge and power in a wide range of health care settings. Based on participant-observation research and interviews with patients and health care providers at a federally funded New England clinic, this article uses theories of cultural identity supported by ethnographic examples to examine arguments in favor of patient-provider resemblance. While ethnic identity is often assumed to incorporate cultural expertise or competence, in practice, developing and maintaining such expertise is the result of repeated performances developed in part through didactic trainings described herein. Claims for the efficacy of patient-provider resemblance in addressing disparities in quality of care mobilize notions of specificity, difference and recognition that both depend on and construct racialized ethnic identities. Proposed as a means to expand access to health care, resemblance programs nonetheless perpetuate segregation in health care by relying on minority health care providers to care for the minority poor. Both patients and health care providers I interviewed perceived benefits associated with ethnic resemblance, yet also articulated critiques of the essentialized notions of identity that render ethnicity automatically efficacious. Following Laclau, I argue that an exclusive focus on physician-patient resemblance constructs ethnicity as 'mere particularity' and in so doing helps to obscure the relations of power and inequality that produce the very health disparities that resemblance is meant to solve.