Volume 71 Number 5 October 2004	back to contents

1Institute for Health Policy and 2Multicultural Education, Massachusetts General Hospital, Boston, MA, and 3 Harvard Medical School, Boston, MA.

Address all correspondence to Joseph R. Betancourt, M.D., M.P.H., Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Suite 901, Boston, MA 02114.

Adapted from a Grand Rounds presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY, on March 18, 2003, and updated as of November 2003.

ABSTRACT
BACKGROUND: The United States has achieved dramatic improvements in overall health and life expectancy, largely due to initiatives in public health, health promotion and disease prevention. Academic health centers have played a major role in this effort, given their mission of engaging in research, educating health professionals, providing primary and specialty medical services, and caring for the poor and uninsured. However, national data indicate that minority Americans have poorer health outcomes (compared to whites) from preventable and treatable conditions such as cardiovascular disease, diabetes, asthma, cancer and HIV/AIDS. Two factors contribute heavily to these racial and ethnic disparities in health: minorities are subjected to adverse social determinants, and they are disproportionately represented among the uninsured. In the last twenty years, however, the literature has highlighted the fact that racial and ethnic disparities occur not only in health, but also in health care.

The Institute of Medicine Report, “Unequal Treatment.” The Institute of Medicine (IOM) was asked to determine the extent of racial and ethnic disparities in health care. Their report, entitled “Unequal Treatment,” found that racial and ethnic disparities in health care do exist, and that many sources, including health care systems, health care providers, patients and utilization managers, are contributors.

Recommendations from “Unequal Treatment”: Implications for Academic Health Centers. The IOM Report, “Unequal Treatment,” provides a series of recommendations to address racial and ethnic disparities in health care, targeted to a broad audience (the executive summary and full IOM Report can be found at www.nap.edu under the search heading “Unequal Treatment”). Several of the recommendations speak directly to the mission and roles of academic health centers, and have clear and direct implications for patient care, education, and research.

These recommendations include collecting and reporting health care access and utilization data by patient=s race/ethnicity, encouraging the use of evidence-based guidelines and quality improvement, supporting the use of language interpretation services in the clinical setting, increasing awareness of racial/ethnic disparities in health care, increasing the proportion of underrepresented minorities in the health care workforce, integrating cross-cultural education into the training of all health care professionals, and conducting further research to identify sources of disparities and promising interventions.

CONCLUSION: “Unequal Treatment” provides the first detailed, systematic examination of racial/ethnic disparities in health care, and provides a blueprint for how to address them. The report=s recommendations are broad in scope, yet have direct implications for academic health centers.

KEY WORDS
Institute of Medicine Report, unequal treatment, racial disparities, ethnic disparities, health care, racial minorities, minority health, academic health centers.

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