An Introduction to the Politics of Science: Culture, Race, Ethnicity, and the Supplement to the Surgeon General's Report on Mental Health

Abstract

In Mental Health: Culture, Race, and Ethnicity (U.S. Department of Health and Human Services [USDHHS] 2001), the widely anticipated Supplement to Mental Health: A Report of the Surgeon General (USDHHS 1999), Dr David Satcher declared that clear ethnic disparities exist with regard to mental health service provision and the underlying science base. As a result, the report asserted that compared to the white majority, “racial and ethnic minorities bear a greater burden from unmet mental health needs and thus suffer a greater loss to their overall health and productivity” (USDHHS 2001: 3). These ethnic disparities were examined in the context of cultural and social systems that shape the ways in which patients and systems of care interact. By focusing on not only the existence of disparities but also the sociocultural contexts and the devastating consequences of those disparities, the Supplement has raised public awareness and stimulated an outpouring of legislative, scientific, and community efforts to respond to this national crisis. Yet for many of us, the messages of the Supplement do not represent groundbreaking news. Indeed, many readers of Culture, Medicine and Psychiatry have themselves contributed to the available science base documenting the existence and correlates of racial inequities in health status and health care. So why now all the buzz about a problem we have known about for decades? The answer to this question points to the political power behind the Office of the Surgeon General in general, and the politics of science and mental health care in particular. In this special issue of Culture, Medicine and Psychiatry, principal players involved in the writing and development of Mental Health: Culture, Race, and Ethnicity reflect on the process through which the Supplement came to be, conflicts that arose between key stakeholders in the project, vital compromises that were made, and the ideological battles that will continue to be fought long after the report fades from the headlines. Because of the politically sensitive nature of these disagreements, as well as individuals’ desire to affirm the importance of the final product, the conflicts and compromises that occurred behind the scenes are sometimes described by our contributors in oblique terms. Nevertheless, these leaders of the minority mental health field offer important insights into debates central to the health disparities movement and the development of the Supplement itself, such as standards for what constitutes scientific evidence, the meaning and uses of ethnic and racial