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Subcommittee Examines Racial and Ethnic Health Disparities

On May 21, the House Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources held a hearing to discuss findings from the Institute of Medicine’s (IOM) recent report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. According to the IOM’s report, racial and ethnic populations tend to receive lower quality health care than whites, even when age, income, insurance status, and severity of health conditions are comparable. Subcommittee Chair Mark Souder (R-IN) noted that the issues addressed in the report “should be of concern to all Americans.”

Agreeing with Rep. Souder, Ranking Member Elijah Cummings (D-MD) said that “we are dealing with a national civil rights issue of the highest order and must address it in those terms.”

Explaining the Public Health Service’s Office of Minority Health’s (OMH) role in eliminating health disparities, Dr. Nathan Stinson noted that there are “multiple cross-cutting activities” taking place within the Department of Health and Human Services. He added that the OMH “has taken an advisory and leadership role in the department’s coordinated efforts that relate to disease prevention, health promotion, and improved access to quality health care for the underserved populations.”

Dr. Stinson also explained that the OMH’s mission to “improve the health of racial and ethnic minority populations through the development of health policies and programs that address health disparities and gaps” is important “in light of the increasing racial, ethnic, cultural, and linguistic diversity of the U.S. population, the major changes underway in the health care industry, and the challenges of adequately addressing the health care needs of the U.S. while controlling the associated costs.”

Speaking on behalf of the National Hispanic Medical Association, Dr. Elena Rios said that Hispanics make up 14 percent of the U.S. population and by 2050, “one out of every four Americans will be of Hispanic origin.” However, she explained, many Hispanic patients face challenges, including “language needs, literacy levels, lower levels of poverty and education,” and not knowing “of public health programs or how to follow complex treatment regimens, drug labels, where to go for further tests, x-rays, or specialty care in a health system.” In order to reduce these disparities in health care, Dr. Rios recommended more funding to increase the number of minority students attending medical school, teaching “cultural competence” to all future physicians, and providing interpreter services for patients who do not speak English.

Dr. Lisa Cooper of The John Hopkins University discussed her study from the past decade on patient-physician relationships and how communication between patients and physicians “can either contribute to, or ameliorate racial and ethnic disparities in health care.” She also expressed her support for three of the recommendations found in the IOM’s report to “integrate cross-cultural education into the training of all current and future health professionals, to increase the number of individuals from underrepresented ethnic and racial minorities among health professionals,” and “to conduct further research to identify sources of ongoing racial and ethnic disparities and assess promising interventions.”

Dr. Cooper stressed that “high quality health care is an important determinant of health status,” and the research “will play a pivotal role in improving the health status of the entire American public.”

In his testimony, Dr. Thomas LaVeist of The John Hopkins University said that the creation of the National Center on Minority Health and Health Disparities (NCMHD) of the National Institutes of Health (NIH) “is among the most important improvements to our nation’s healthcare infrastructure in decades.” In 2000, the NCMHD was established under the Minority Health and Health Disparities Research and Education Act (P.L. 106-525). The center is important, he noted, because “we have been leaders in furthering knowledge in health status,” but “less attentive—and some might even say accepting—of pervasive disparities in health.” Dr. LaVeist also expressed his support of a health care discrimination monitoring and enforcement system, saying, “Such a system will help us to move toward equality in healthcare quality and likely reduce disparities in healthcare outcomes and health status.

The NCMHD’s Dr. John Ruffin noted that with the support of “constituents within and beyond the NIH community, we are able to identify the issues and gaps in minority health and explore the approaches that would help to make health disparities a historical phenomenon.”

Another witness, Dr. Carolyn Clancy of the Agency for Healthcare Research and Quality, said the agency “is moving forward with important initiatives,” in part, because of its Excellence Centers to Eliminate Ethnic and Racial Disparities in Healthcare (EXCEED) research program. EXCEED was awarded five-year grants in FY2000 as part of a collaborative effort with the NIH, the Health Resources and Services Administration, and a number of national and local foundations. Through the program, the centers analyze reasons for disparities and identify and evaluate the effectiveness of strategies for reducing and eliminating them.

Ruben King-Shaw, Jr. of the Centers for Medicare and Medicaid Services (CMS) said that CMS also has taken actions to address disparities that fall into four major categories: outreach and education, quality improvement projects, research, and demonstrations. He added, “We have more to do and are committed to working…to achieve our shared goals.”

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