AHRQ Summit—Improving Health Care Quality for All Americans
Eliminating Health Care Disparities
Panel 2
Office of Minority Health
Garth N. Graham, M.D., M.P.H.
Deputy Assistant Secretary for Minority Health
Department of Health and Human Services
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The Office of Minority Health (OMH) reaches across the leadership levels of other agencies in the Department of Health and Human Services to address health care disparities with a community-based focus.
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The issue of health care disparities was first raised to national attention in 1985 with the publication of a landmark report on black and minority health by Margaret Heckler. That report prompted the development of the Office on Minority Health.
Since the founding of the Office of Minority Health in 1985, we have made significant strides in integrating the lexicon of disparities into public health and improving health outcomes for minorities. However, important disparities remain.
We must continue to link the issue of disparities with that of health care quality
Today, we can look back at the changes and remaining challenges that face us 20 years later. One of the lessons we draw from those comparisons is that we must continue to link the issue of disparities with that of health care quality. We cannot solve one without the other.
OMH is very grassroots based and has a community-based focus. Its role is to coordinate minority health issues and activities across the entire Department.
The Department of Health and Human Services oversees a budget that is equivalent to the national budgets of many countries. We are an enormous force, and we understand the strength of reaching across agencies to partner and develop a strategic mission for addressing disparities.
OMH has developed a 20-year strategic plan to address health care disparities
With high-level members across the agencies, OMH has developed a strategic plan to address the next 20 years. It includes:
- Improved data collection on race and ethnicity across the Department.
- Better information dissemination to minority communities.
- Increased cultural competence and health literacy.
- Greater workforce diversity among health care providers.
- Greater use of information technologies, practical tools, and capabilities.
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American Medical Association
John C. Nelson, M.D., M.P.H., FACOB, FACPM
President and Executive Committee Member
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Individual physicians need to take on issues of health care quality and disparities in their own practices and recognize the importance of culture and diversity in their encounters with patients.
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We must make physicians understand that issues regarding health care quality and disparities are not someone else's problem. They must be confronted by every doctor in his or her own practice.
Ethics demand that we do something about health disparities
Our model of medical practice involves three interlocking circles which represent ethics, evidence base, and caring about patients. The Commission to End Health Care Disparities, sponsored by 37 different medical organizations, is dedicated to integrating the recognition of health disparities into this model—using evidence-based knowledge to give physicians the knowledge and tools for identifying disparities in their own practices.
Change must happen at the level of the individual practitioner as well. We must motivate our colleagues to bring about transformations in their own practices so that disparities become a thing of the past.
We need to challenge individual physicians to recognize and be sensitive to the importance of culture and diversity in their daily encounters with patients. We must recognize disparities within our own patient base, love our patients, and transform our practices to take on the issue of health disparities.
Past discrimination and exclusionism must be recognized and corrected
In 1895, the National Medical Association was formed because the American Medical Association (AMA) refused to admit African Americans. I would like to offer an apology, on behalf of the AMA, for its onetime policy of excluding black physicians.
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National Hispanic Medical Association
Elena Rios, M.D., M.S.P.H.
President
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The National Hispanic Medical Association is creating a common network through which Hispanic health care providers can address health policies and disparities to improve the health of Latinos.
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Latinos represent 2-5 percent of the U.S. population of nurses, dentists, doctors, and other health care providers. While they represent a great diversity of Hispanic populations and cultures, they are now coming together in a common network to address health policies and disparities to improve the health of Latinos.
Although representing only a small proportion of the total population, there are many Hispanic physicians in the United States. This generation of providers represents the first critical mass of Hispanic doctors to have been educated in this country. There are few role models within this group, and the ones that do exist need to be supported to promote leadership.
The National Hispanic Medical Association taking up the challenges of the AHRQ quality and disparities reports. Its mission is to improve the health of Hispanics and the underserved.
The Association collaborates with the Hispanic Students Association and the more than 20 different Hispanic medical societies around the country to:
- Build a common network so that Hispanic health care providers can address the challenges of the AHRQ quality and disparities reports with a common voice.
- Promote leadership among Hispanic students and providers.
- Encourage students and residents interested in careers in health care services research.
The National Hispanic Medical Association is also promoting increased awareness of Hispanic health issues among non-Hispanic providers by sharing approaches that have been shown to work in Latino communities in the United States.
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Commission To End Health Care Disparities
Randall W. Maxey, M.D., Ph.D.
Co-Chair
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Health care disparities must be placed in a broader context of socioeconomic disparities, racism, culture, empowerment, and family life.
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Health care disparities are just the tip of the iceberg. They are a sign of broader socioeconomic issues and of equally important issues of culture, family, and empowerment:
- We must focus on disease prevention and health promotion.
- We must look among families, parents, and communities to see what else we can do to address disparities.
- We must remember that parenting is one of the most important pieces of health protection.
The Health Education and Risk Reduction Opportunities Project, or HERRO, is counseling and working with parents to address food and lifestyle behaviors to promote healthier lives.
Nothing happens simply because we generate data
If, in 5 years, all we have to show for our efforts are more data, we will have failed. The data are just a jumping-off point. We need more involvement from minorities to cull out the data from these quality and disparity reports, analyze evidence-based findings, and address real change.
We do not have a national body to mandate change, so we need to get down to the actual practice level, with examples such as the use of different beta-blockers which are more effective in certain populations.
We need to bring in policymakers to make change happen. We need coalitions of people to affect change.
Fear and good health do not exist in the same place
Unfortunately, fear is pervasive in the black community due to racism and discrimination. I can say this as both a physician and a patient who has had to face radical treatment for prostate cancer.
As young revolutionary angry with the American Medical Association's (AMA's) exclusion of black physicians, I recognize and appreciate the enormous importance of John's apology on behalf of the AMA for its former discrimination against black physicians.
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Discussion
The strategy for addressing disparities must go beyond socioeconomic status
We cannot simply use low socioeconomic status (SES) and financial vulnerability as a strategy for addressing disparities. Although low SES correlates with race and ethnicity, if you use SES only as a defining factor, you lose much of the picture. For some groups or conditions, poverty is not the explanation.
For example, the average black male physician dies at age 54. Infant mortality rates are higher among black women, even those that have high SES. It is not just an issue of socioeconomic status. We have good data on the Medicare population that show disparities go beyond SES.
Equally important from a policy perspective is the fact that we cannot correct social inequities quickly. We can, however, address the disparities in health care quality. We have the evidence base that says how we can do it. We must identify and use models and evidence-based practices to reduce disparities.
We need to address disparities within our health care financing system
Certain drugs that may be more effective in African American populations are not necessarily those that are reimbursed by Medicaid or Medicare.
Two of the tasks of the QIOs are to identify disparities in care within institutions and to report racial and ethnic disparities that reveal even greater gaps in quality improvement.
We need policymakers and coalitions of people to make change happen
Our government leaders must act as ambassadors for a culture of quality, to address both quality improvement and disparities. They must engage and involve the population. After all, they also belong to our communities.
The National Conference of State Legislatures held a disparities conference which included black and Hispanic legislators. They put together a list of legislative bills organized by disease and minority health status.
The National Hispanic Health Foundation has developed small Hispanic health research institutes to push forward the knowledge base and to develop education and outreach to use that knowledge effectively.
There will be no majority population in the next generation, because of changing demographics. We must address disparities now, or we will be discussing them after the fact, facing constraints such as congressional mandates.
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