Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)


Public Policy

First Advisor

Michael Johnson

Second Advisor

Amy E. Smith

Third Advisor

Robert Weech-Maldonado


This dissertation answers three disparate but interrelated research questions at the intersection of race, class, hospital cultural competence, and COVID-19 disparities. It will look at historical factors and use social science techniques to examine questions about the present. The first research question this dissertation will answers is, how did race and class play a role in the origin and evolution of hospitals? The historical record we review shows that hospitals were actually founded on class, racial, and ethnic boundaries. We will also pay special attention to the rise and fall of the Black hospital over the twentieth century. To use historical accounts in a social science and policy context requires us to first probe the boundaries of history and social science, and how existing attempts to combine history and social science might not always suit the needs of given research questions. The second research question this dissertation answers is, do minorities attend culturally competent hospitals in the present? Specifically, are minority serving hospitals (MSH) or safety-net hospitals (SNH)—where minorities tend to receive their care—more culturally competent than their counterparts? To examine this, we explore different definitions of these types of hospitals, and offer our own definition for minority serving hospitals. We also look at the overlap between MSH and SNH, finding there is less overlap than commonly thought. We find that minority-serving hospitals are more culturally competent than their counterparts, and safety-net hospitals are if they belong to a specific national organization. The third research question this dissertation answers is if culturally competent hospitals saw fewer COVID-19 disparities. COVID-19 disparities have been glaring. We attempt to shed new light on disparities by again turning to history to see how disparities have played out in past pandemic and disasters. It was during the most recent pandemic prior to COVID-19, H1N1 in 2009-2010, that best practices using cultural competence were suggested to prevent disparities when the next pandemic arrived. It was also around this time that a conceptual framework was developed to explain disparities. We will apply both the recommendations suggested and the conceptual framework developed to examine COVID-19 disparities. We did not find culturally competent hospitals to reduce disparities, but did find that hospital resources in general did reduce disparities, which has implications for the social determinants of health literature and public policy.


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