What Others are Doing to Eliminate Health Disparities

Education may be one of the most important tools as part of an overall strategy to eliminate healthcare disparities. Healthcare providers and medical students alike should be aware that racial and ethnic disparities exist in healthcare, often despite providers' best intentions.

Medical student action

• The PRIME project was an initiative of the American Medical Student Association Foundation funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry to create a module called Breaking Barriers that focuses on how barriers to health care negatively impact health, and what people in the healthcare field can do to tear down these barriers.
  
  

  Breaking Barriers I: Introduction to Barriers to Health Care

  Breaking Barriers II: Racial and Ethnic Minorities

  Breaking Barriers III: Lack of Health Insurance | PowerPoint (969 KB)

  Breaking Barriers IV: Lesbian, Gay, Bisexual, Transgender (LGBT) | PowerPoint (349 KB)

  Breaking Barriers V: Barriers to Rural Health Care

  
  
• The Achieving Diversity in Dentistry and Medicine (ADDM) Project addresses issues in medical and dental education, the health workforce, and leadership in medicine and dentistry.

Healthcare providers

Given that stereotypes, bias, and clinical uncertainty may influence clinicians' diagnostic and treatment decisions, education may be one of the most important tools as part of an overall strategy to eliminate health disparities. Cross-cultural education programs have been developed to enhance health professionals' awareness of how cultural and social factors influence healthcare, while providing methods to obtain, negotiate, and manage this information clinically once it is obtained.

• The Providers Guide to Quality and Culture is an excellent resource for learning how to give culturally competent care to individuals from a variety of racial and ethnic backgrounds. Take the Quality and Culture Quiz to find out how culturally aware you are.
  
  
• Other case-based exercises for healthcare providers who want to learn more: Cultural Competency in Medicine and Cross Cultural Issues in Primary Care
  
  
• Toward Culturally Competent Care is a curriculum that focuses on teaching clinicians to recognize cultural differences in patient interactions and use specific communication skills to improve patient care. The materials can be adapted for sequential one-hour sessions or for daylong seminars.
  
  
• A Report of the Sullivan Commission on Diversity in the Healthcare Workforce, "Missing Persons: Minorities in the Health Professions," focuses on means of ensuring more diverse health professionals receive the education and training to better address the health needs of our nation.

Notable sponsors and advocacy organizations

• HHS Secretary Tommy Thompson recently announced $85 million in grants to eliminate racial and ethnic health disparities among minority communities "highly affected" by several diseases, including HIV/AIDS, cancer, and diabetes.
  
  
• The National Center on Minority Health and Health Disparities (NCMHD) promotes minority health and strives to lead, coordinate, support, and assess the NIH effort to reduce and ultimately eliminate health disparities. They envision an America in which all populations will have an equal opportunity to live long, healthy and productive lives. In accordance with this mission, they recently provided $74.5 million to various institutions, and HHS' Office of Minority Health awarded 65 grants totaling $10.5 million - $4.6 million of which is supported by funds from the Minority AIDS initiative - to support state-based efforts to eliminate health disparities.
  
  Much of this money will go toward research on minority health disparities, while some will go to community-based projects that will work to reduce "high-risk" behaviors such as tobacco use, physical inactivity or poor eating habits, as well as to improve healthcare access. Another portion will fund minority health offices in 14 states or go toward supporting the development of "effective and durable" service delivery among community organizations and health departments involved in HIV/AIDS treatment and prevention.
  
  
• The Henry J. Kaiser Family Foundation is a key player in the fight against health disparities. Kaiser has a web page that serves as a clearinghouse for racial and ethnic minority issues. The Kaiser Network provides up-to-date news, references, web casts, and other information about efforts to reduce racial and ethnic disparities in healthcare access. In addition, kaiserEDU gives students and faculty access to data, literature, news and developments regarding major health issues, including the uninsured and health policy issues.
  
  
• The Office of Minority Health operates a resource center that offers great statistics about health care for minorities and provides information about its initiative called Closing the Gap. Founded by the ABC Radio Networks, Closing the Health Gap is an educational campaign that focuses on racial and ethnic minority populations affected by serious diseases and health conditions at far greater rates than other Americans. One of its key elements is the Take A Loved One to the Doctor Day initiative.
  
  
• In addition, the Centers for Disease Control also has an Office of Minority Health that supports research and professional development, reports on the health status of racial and ethnic minorities in the U.S., and initiates strategic partnerships with governmental as well as national and regional organizations. In 1984, the U.S. Department of Health and Human Services established a Task Force on Black and Minority Health to study the substantial inequities in the health of U.S. minorities and as a result published the seminal study, the 1985 Report of the Secretary's Task Force on Black and Minority Health, that led to the subsequent creation of this office.
  
  
• Physicians for Human Rights has made racial and ethnic healthcare disparities one of its flagship issues. The research they have done and the resources they have created are some of the best on the web. The Right To Equal Treatment: A Report by the Panel on Racial and Ethnic Disparities in Medical Care presents evidence for the existence of systemic healthcare disparities. This is apparent even after normalizing for such possibly confounding variables as health insurance status, sex, age, income, education, hospital type, stage of disease and concomitant diseases. The report explores some possible causes and future actions to address this injustice. There is a student activism website that provides information on career development, student organizing, multi-media presentations, health and human rights. AMSA collaborates with PHR to encourage medical students to learn about and address health disparities.

Other organizations that have made eliminating health disparities a priority:

• New Jersey is the first state in the nation to take action toward eliminating health disparities by requiring cultural compitency training for medical licensure and cultural compitency curricula implimentation into all state medical schools. Find out more about the passing of NJ Senate Bill S144.
  
  
• The American Medical Association (AMA) has established policies and programs and formed partnerships in an effort to reduce health disparities.
  
  
• The American Public Health Association (APHA) is the largest and oldest multi-disciplinary health professionals' organization in the country. It attempts to influence policy and improve health care. One of their goals is to "leave no one behind: eliminate racial and ethnic disparities in health and life expectancy."
  
  
• Health, Research and Educational Trust (HRET) provides a select list of current articles, presentations and resources that focus on reducing disparities in health care and health outcomes.

Important reports and studies

• The Institute Of Medicine (IOM) was mandated by Congress to study the occurrences of healthcare disparities, and released Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare in 1999. They discovered pervasive evidence for consistent differences in the delivery of health care to racial and ethnic minorities when compared to non-minorities. These differences persisted even when controlled for factors such as health insurance status, socioeconomic condition and disease state. They found these phenomena across a wide range of medical procedures and disease states. IOM concluded with sweeping recommendations for reform. This is the study that every other current article on this topic references first.
  
  
• IOM has also put out a report, Health Literacy: A Prescription to End Confusion. This report examines the emerging field of health literacy, and recommends actions to promote a health literate society.
  
  
• In 1999, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to develop the National Healthcare Disparity Report (NHDR) and requested that AHRQ annually track "prevailing disparities in healthcare delivery as they relate to racial factors and socioeconomic factors in priority populations." The NHDR provides a national overview of racial, ethnic, and socioeconomic disparities in health care in the general U.S. population and among "priority populations" which include both specific population groups as well as geographically-defined groups. The NHDR includes data and analysis on the following: low-income groups; racial and ethnic minority groups; women; children; the elderly; individuals with special healthcare needs; the disabled; people in need of long-term care; people requiring end-of-life care; and place of residence (e.g., rural communities). AHRQ also has a compendium of minority health research and reports on their website.
  
  
• AHRQ has also put out a report, Literacy and Health Outcomes that makes the link between health literacy and health disparities.

Recommended Reading

• Waking Up in America, by Pedro Greer, Simon and Schuster, 1999.
  
  
• The Spirit Catches You and You Fall Down, by Anne Fadiman, Farrar, Straus, and Giroux, 1997.
  
  
• Cultural Diversity in Health and Illness, by Rachel Spector, Prentice Hall, 2003.
  
  
• Promoting Health in Multicultural Populations: A Handbook for Practitioners, edited by Robert M. Huff and Michael V. Kline, Sage Publication, 1999.
  
  
• At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States, by Lu Ann Aday, Jossey-Bass, Inc., 2001.

Recommended Films

• Miss Evers' Boys. Emmy Award-winning exposé about the infamous Tuskegee Study, in which Nurse Evers describes a federally funded program to treat black syphilis patients.

Copyright ©2008 American Medical Student Association
(800) 767-2266 • amsa@amsa.org

© All materials on this site are intended for the express use of health science students. Other use or reproduction of these materials requires written authorization from the American Medical Student Association.