Ending unequal treatment

In 2002, the Institute of Medicine put on paper what many physicians and other health care professionals no doubt long had suspected or encountered: Racial minorities received lower quality health care than whites.

The landmark IOM report showed, for example, significant racial differences in who received cancer diagnostic tests and treatments. Authors of the report recommended, among other things, that increasing awareness among physicians, policymakers and others could help reduce disparities in care.

Inspired by the call to action, the Commission to End Health Care Disparities was formally organized and held its first meeting in July 2004. The American Medical Association, National Medical Assn. and National Hispanic Medical Assn. teamed up to create the commission. Five years later, the commission is still uniting organizations (more than 65 are active in the commission) and promoting efforts to attain quality care for ethnic and racial minorities. It is doing so by bringing attention to disparities, fostering work force diversity, and increasing education and training.

At its most recent meeting, held earlier in September in El Paso, Texas, attendees discussed and focused attention on issues such as obesity, diabetes and border health care.

From its start, the commission established itself as a clearinghouse in which member organizations disseminated new strategies and information to their physician members across the nation. It also has played a role in prodding government officials to do their part.

In 2007, the commission released the document "Addressing Health Care Disparities: Recommended Goals, Guiding Principles, and Key Strategies for Comprehensive Policies," which included 10 core principles to guide policy development and implementation. Among letters crafted by the commission was one to the Dept. of Health and Human Services encouraging federal action to reduce or eliminate sodium in many foods. Lower sodium intake, the commission said, can help reduce hypertension, which disproportionately affects African-Americans.

In its efforts to get physicians more involved in reducing disparities, the commission developed a slide kit and DVD, used at state and local medical organization meetings, that address disparities and provide solutions to improve physician-patient communication. Meanwhile, the commission developed issue briefs, including one that discussed the impact of pay-for-performance programs on the quality of care for minority patients. The commission also helped provide research that led to the AMA's July 2008 public apology for its history of racial inequality toward black physicians.

In an April letter to President Obama, commission co-chairs urged the president to ensure that health system reform legislation work to end disparities. Any reform plans, they said, should include access to high-quality coverage, increased diversity and cultural competence in the health care work force, and collection of data to detect and understand causes of disparities.

Despite the big-picture mandate of the organization, it has not lost sight of the role of individuals to make a change. At its El Paso meeting, the commission's efforts to increase diversity in the work force included a visit by about 20 physicians and medical students who talked about careers in medicine to 600 students at a local high school.

There is a great need for minority students to pursue medicine: only 7% of physicians are African-American, Hispanic or American Indian, although these groups make up about 25% of the U.S. population. The Commission to End Health Care Disparities has provided a way for organized medicine and others to address long-standing sensibilities and practices that lead to unequal treatment for patients in minority groups. It stands for progress in a fight that is far from over but must be won if this is to be a truly just society -- and all patients can get the quality of care they deserve.