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For many in the U.S. health care establishment and the media, the March 2002 release of “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” by the Institute of Medicine brought unexpected news. The 562-page report, which reviewed more than 100 studies, concluded that minorities who have the same incomes, insurance coverage and medical conditions as Whites receive decidedly poorer care.
“Within the committee itself, we were amazed, surprised and shocked at the evidence of disparities,” says Dr. Alan Nelson, the chair of the committee that oversaw the writing of the report.
“To the extent that doctors are shaping their treatments based on subconscious biases or false stereotypes about how Blacks or Hispanics will respond to their ailments or their treatments, the only lasting cure will be greater awareness and education for the medical profession,” trumpeted a New York Times editorial in response to the report.
The news, however, did not surprise African American health officials and researchers who have been active in trying to bring health disparities to the attention of the public over the last decade. This report is getting a great deal of attention because it included considerable evidence that when Blacks and Latinos have equal incomes and insurance coverage to Whites they still suffer from racial bias in the American health care system, according to minority health officials. 
Among findings from the studies included in the report, minorities are less likely to be given appropriate heart medications or to undergo bypass surgery. Minorities are less likely to receive kidney dialysis or transplants. Several studies revealed significant racial differences in who receives appropriate cancer diagnostic tests and treatments. Minorities also are less likely to receive the most sophisticated treatments for HIV infection, which could forestall the onset of AIDS. In contrast to getting sophisticated treatments, minorities are more likely to receive certain less-desirable procedures, such as lower limb amputations for diabetes, according to the report.
“The real challenge lies not in debating whether disparities exist, because the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them,” says Nelson.
Nelson is a retired physician and a former president of the American Medical Association, and current special adviser to the chief executive officer of the American College of Physicians-American Society of Internal Medicine in Washington.
Recommendations in the report call for more research to identify sources of racial and ethnic health care disparities as well as intervention strategies. The future research should include an aggressive effort to better understand the prevalence and influence of bias, prejudice, stereotyping and clinical uncertainty on the part of health care providers. To ensure that tracking progress in decreasing disparities, the report recommends hospitals collect and report data on health care access and utilization by patients’ race, ethnicity, socioeconomic status and primary language. 

— By Ronald Roach

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