Barriers to eliminating disparities in clinical practice: Lessons from the IOM report "unequal treatment"

Abstract

Over the last 200 yr, the United States has experienced dramatic improvements in overall health and life expectancy largely owing to initiatives in public health, health promotion, and disease prevention. Nevertheless, despite interventions that have improved the overall health of the majority of Americans, racial and ethnic minorities have benefited significantly less from these advances. National data indicates that minority Americans have poorer health outcomes (compared with whites) from preventable and treatable conditions such as cardiovascular disease, diabetes, asthma, cancer, and HIV/AIDS, among others (1). Multiple factors contribute to these "racial and ethnic disparities in health." First and foremost, research has demonstrated that social determinants such as lower levels of education, overall lower socioeconomic status, inadequate and unsafe housing, racism, and living in close proximity to environmental hazards disproportionately impact minority populations and thus contribute to their poorer health outcomes (2-6). One poignant example of the impact of social determinants is the fact that three of the five largest landfills in the country are in African American and Latino communities, thus contributing to some of the highest rates of pediatric asthma among these populations (7). Second, lack of access to care also takes a significant toll, as uninsured individuals are less likely to have a regular source of care, are more likely to report delay in seeking care, and are more likely to report that they have not received needed care-all resulting in experiencing avoidable hospitalizations, emergency hospital care, and adverse health outcomes (8-10). © 2007 Humana Press Inc.