Time to focus on care disparities

Many minority Americans receive lower quality health care than their white counterparts; physicians have an important role to play in ending that difference.

Editorial. April 14, 2003.

Think about the patients you see in your practice -- the adults with cardiovascular disease, children who have asthma, elderly patients who need flu shots or other preventive care. Now think about the following statistics based on studies sponsored by the Agency for Healthcare Research and Quality:

The odds of not having necessary angiography are 49% higher among African-American patients, compared with white ones.
African-American and Hispanic children with asthma are 31% and 42% less likely, respectively, than their white peers to be using inhaled anti-inflammatory medication, even when they share similar insurance and sociodemographic characteristics.
Only 46% of elderly African-Americans receive flu shots, compared with 68% of whites.

April is Minority Health Month -- an ideal time for the medical profession as a whole and individual physicians to refocus their attention on this problem.

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There is much to be done. An Institute of Medicine report issued in March 2002 concluded that "racial and ethnic minorities tend to receive a lower quality of health care than non-minorities." This holds true even when patient insurance status and income was factored into the equation.

The reasons for the disparities are varied, ranging from the bureaucratic processes used by the health care system to a shortage of minority health professionals, and from language and cultural barriers to stereotyping by health professionals. The consequences can be dire for minority patients -- poor medical outcomes or even early death, the IOM stated.

The report grabbed the media's attention and that of the health care profession. The AMA described it as a "wake-up call."

At a March meeting on developments since the report's debut last year, Alan R. Nelson, MD, chair of the IOM committee on racial health disparities, noted that one of its biggest successes has been in raising awareness of existing inequities.

He pointed to the AMA House of Delegates' passage in December 2002 of a Council on Scientific Affairs report and a resolution that made elimination of racial and ethnic health disparities an "issue of highest priority." The vote builds on the Association's long-standing policy of "zero tolerance" toward racially or culturally biased health care.

Since the December vote, the AMA has developed a strategic plan to accomplish its goal. It involves research on the problem and what tools physicians need to combat it, an awareness campaign, advocacy to keep the issue in the spotlight, and training to enable physicians to become leaders in the fight against health disparities in their communities.

The Association is a partner with the Kaiser Family Foundation and the Robert Wood Johnson Foundation in an effort to understand and address inequality in cardiac care. But for these efforts to work, individual physicians must do their part. AMA programs and resources offer them help.

In conjunction with Minority Health Month, the AMA is offering extra content on its Health Disparities Web page (www.ama-assn.org/go/healthdisparities). There, doctors can find information about health inequities and about AMA efforts, including the Minority Affairs Consortium. The MAC sponsors the Doctors Back to School program, in which minority physicians visit schools to help minority children realize that they could follow the same path and become doctors.

It's this type of individual physician activism that could help enormously in someday making the dream of equal health care for all Americans a reality.