Programs seek solutions to health disparities

With the existence of health disparities linked to race and ethnicity now a reasonably well-quantified problem and some of the factors causing the gap better understood, advocates are attempting to convert this knowledge into action.

For example, the Robert Wood Johnson Foundation this fall launched three new national initiatives that will identify and test specific interventions in real-world clinical settings.

"It is time to move beyond documenting the unacceptable existence of these gaps in care and shift our focus to developing and testing solutions," said Risa Lavizzo-Mourey, MD, CEO and president of the Robert Wood Johnson Foundation.

One initiative features a "learning network" that will allow 10 hospitals to test new ideas, share information and quantify results to address differences in the care of cardiac patients. Another will provide grants to address race and ethnicity as a part of quality improvement initiatives. This approach is expected to examine the standard of care for cardiovascular disease, depression and diabetes. The third will analyze the results of these and other disparity projects and distribute the information.

Overall, experts agree that efforts like these are appropriate next steps that could take the understanding gained and apply it.

"We are moving away from generalizing to look at the specifics of what makes a difference," said John F. Schneider, MD, PhD, chair of the American Medical Association's Council on Scientific Affairs and Public Health and a member of the Commission to End Health Care Disparities, launched earlier this year by the AMA in conjunction with the National Medical Assn. and the National Hispanic Medical Assn.

But some experts expressed caution that although disparities have been increasingly quantified, separating out what is caused by race or ethnicity and what is caused by socioeconomic status is less clear -- a factor that could confound interventions.

"It's important to think about some of the conceptual and methodological problems that exist in our research," said Thomas LaVeist, PhD, a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "Much of what we know comes from large data sets." These don't take into account racial segregation nor do they separate race and class, he added.

Dr. LaVeist was speaking at a day-long conference held in October at the University of Chicago. It was funded in part by these Robert Wood Johnson initiatives as well as the Centers for Disease Control and Prevention and the University of Illinois at Chicago.

Other factors

Debate also surrounds how much of an impact interventions that address disparities in health care delivery will have on disparities in individual health status. Many advocate for a more comprehensive approach that takes poverty, employment and education into consideration.

Some physicians countered, though, that although there were many issues that needed to be addressed outside of the health care setting, doctors could make a significant dent in the disparities that occur in their realm.

"There's minimal difference in the prevalence of asthma, but there's significant difference in outcomes," said Sandra Thomas, MD, assistant commissioner for epidemiology at the Chicago Dept. of Public Health. "People die from asthma because of this, and that is so strongly influenced by health care."

Meanwhile, the AMA released Nov. 22 a new resource for physicians. The kit, "Working Together to End Racial and Ethnic Disparities: One Physician at a Time," includes a facilitation guide to help doctors work to improve the quality of care for all patients. It also contains a DVD and CD-ROM with facts on the components of health care disparities such as cultural competence and health literacy.

It is available to AMA members for $10 and non-members for $15 by phone at 800-621-8335 or online (link).