In Reply I appreciate the attention Dr Hardeman and colleagues have given to my Viewpoint, but I do not believe that my position can be seen as pitting black individuals against white individuals, nor did I suggest that burden should be favored over rate differences. I agree that racism is a socially defined determinant of health and that structural racism needs to be seriously addressed as a component of population health policy. But considering burden along with rate uncovers the parallel structural classism that Isenberg chronicled in her book, White Trash: The 400-Year Untold History of Class in America,1 which profoundly affects poor white individuals as well.
Kindig DA. Race vs Burden in Understanding Health Equity—Reply. JAMA. 2017;317(20):2133–2134. doi:10.1001/jama.2017.4620
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