Eliminating health care disparities: You can make a difference

A series of studies recently published in the New England Journal of Medicine cast a long shadow over the ongoing fight to eliminate health care disparities.

The studies, which compared the care black Americans are receiving with the care received by whites, found that such disparities are still very much a part of this country's health care system. They show that disparities have narrowed in some areas, including use of beta-blockers and aspirin to treat heart attacks. But the research also found that the gap remained or widened for surgical procedures and treatment of chronic conditions. The NEJM articles follow a federal government report released in July that found that Hispanic children trail white children in the rate at which they receive the combined immunization series.

The American Medical Association and several other medical organizations are committed to reducing this gap. One way they are doing this is through the Commission to End Health Care Disparities. The commission is using four strategies: increasing awareness of disparities, promoting better data gathering, promoting work force diversity and increasing education and training.

Another way the Association hopes to get at the problem is through the ethics opinion drafted by its Council on Ethical and Judicial Affairs and passed by the AMA House of Delegates in June. As other CEJA reports have addressed important issues in the past, this timely examination of the issue in terms of professionalism provides a close look at the reasons for health care disparities and a path physicians can take to help eliminate them.

The report notes that health care disparities represent a significant challenge for all physicians, who are already ethically committed to serve all patients equally. The report's recommendations key in on the ethical obligations of individual physicians, as well as the profession of medicine, as they pertain to these disparities.

CEJA endorses physician participation in the broad discussion of the issues in medical schools, in medical journals and at professional conferences. But it is by considering and implementing the recommendations aimed at individual physicians -- specifically delivering patient-centered care -- that physicians could make an immediate impact.

CEJA notes that this approach to care is an essential component of the Code of Medical Ethics. It is characterized by patient participation in decision-making, emphasis on communication and an understanding of each patient's cultural or religious factors that influence their health beliefs and their level of involvement in their own health care.

The report also calls on physicians to participate in efforts that encourage diversity and to strive to offer the same quality of care to all their patients. It also recognizes that disparities are not just a physician problem and asks physicians to help other health care professionals work on the issue. The AMA, in conjunction with the Commission to End Health Care Disparities, is preparing a kit that will help individual physicians take on the issue. "One Physician at a Time: Addressing Racial and Ethnic Disparities" will guide physicians in how to begin discussion on the issue as well as provide workable solutions for addressing disparities that may be relevant to practice. The kit will be available in late fall. Information on the subject is also available on the AMA's Web site (link).

Following the CEJA report recommendations and using the disparities kit are two concrete ways for individual physicians to act on health disparities. It is important for every physician to consider participating in this effort. America's physicians are an essential link in making sure this problem is resolved.