Skip to main content
SpringerLink
Log in

Barriers to Eliminating Disparities in Clinical Practice

Lessons From the IOM Report “Unequal Treatment”

  • Chapter
Eliminating Healthcare Disparities in America

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).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Eliminating Racial and Ethnic Disparities in Health (1998). Prepared by co-sponsors Grantmakers in Health for the DHHS conference: “Call to Action: Eliminating Racial and Ethnic Disparities in Health.” Potomac, MD.

    Google Scholar 

  2. Williams, D. R. (1990) Socioeconomic differentials in health: a review and redirection. Soc. Psych. 53, 81–89.

    Article  Google Scholar 

  3. Pincus, T., Esther, R., DeWalt, D. A., and Callahan, L. F. (1998) Social conditions and self management are more powerful determinants of health than access to care. Ann. Intern. Med. 129, 406–411.

    PubMed  CAS  Google Scholar 

  4. Hinkle, L. E., Jr., Whitney, L. H., Lehman, E. W., et al. (1968) Occupation, education, and coronary heart disease. Risk is influenced more by education and background than by occupational experiences in the Bell System. Science 161, 23–46.

    Article  Google Scholar 

  5. Antonovsky, A. (1968) Social class and the major cardiovascular diseases. J. Chronic Dis. 21, 65–106.

    Article  PubMed  CAS  Google Scholar 

  6. Pincus, T. and Callahan, L. F. (1995) What explains the association between socioeconomic status and health: primarily medical access or mind-body variables? Advances 11, 4–36.

    Google Scholar 

  7. Flores, G., Fuentes-Afflick, E., Oxiris, B., et al. (2002) The Health of Latino Children: Urgent Priorities, Unanswered Questions, and a Research Agenda. JAMA 288, 82–90.

    Article  PubMed  Google Scholar 

  8. Andrulis, D. P. (1998) Access to care is the centerpiece in the elimination of socioeconomic disparities in health. Ann. Intern. Med. 129, 412–416.

    PubMed  CAS  Google Scholar 

  9. Health Care Rx: Access for All. Barriers to Health Care for Racial and Ethnic Minorities: Access, Workforce Diversity and Cultural Competence. A Report Prepared by the Department of Health and Human Services and The Health Resources and Services Administration for the Town Hall Meeting on the Physician’s Initiative on Race (1998), Boston, MA.

    Google Scholar 

  10. American College of Physicians-American Society of Internal Medicine (ACP-ASIM) 2000. No Health Insurance? It’s Enough to Make You Sick. Philadelphia, PA: American College of Physicians-American Society of Internal Medicine.

    Google Scholar 

  11. US Census Bureau 2003. Insurance, Access, and Quality of Care Among Hispanic Populations (CWF). The Commonwealth Fund, http://www.cwnf.org accessed, March 2005.

  12. Harris, D. R., Andrews, R., and Elixhauser, A. (1997) Racial and Gender Differences in Use of Procedures for Black and White Hospitalized Adults. Ethnicity Dis. 7, 91–105.

    CAS  Google Scholar 

  13. Peterson, E. D., Shaw, L. K., DeLong, E. R., Pryor, D. B., Califf, R. M., and Mark, D. B. (1997) Racial variation in the use Coronary-Revascularization Procedures. Are the differences real? Do they matter? N. Engl. J. Med. 336, 480–486.

    Article  PubMed  CAS  Google Scholar 

  14. Ayanian, J. Z. and Epstein, A. M. (1991) Differences in the Use of Procedures Between Women and Men Hospitalized for Coronary Hearth Disease. N. Engl. J. Med. 325, 226–230.

    Article  Google Scholar 

  15. Schulman, K. A., Berlin, J. A., Harless, W., et al. (1999) The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization. N. Engl. J. Med. 340, 618–626.

    Article  PubMed  CAS  Google Scholar 

  16. Johnson, P. A., Lee, T. H., Cook, E. F. et al. (1993) Effect of Race on Presentation and Management of Patients with Chest Pain. Ann. Intern. Med. 118, 593–601.

    PubMed  CAS  Google Scholar 

  17. Todd, K. H., Samaroo, N., and Hoffman, J. R. (1993) Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia. JAMA 269, 1537–1539.

    Article  PubMed  CAS  Google Scholar 

  18. Bernabei, R., Gambassi, G., Lapane, K., et al. (1998) Management of Pain in Elderly Patients with Cancer. JAMA 279, 1877–1882.

    Article  PubMed  CAS  Google Scholar 

  19. Todd, K. H., Deaton, C., D’Adamo, A. P., and Goe, L. (2000) Ethnicity and analgesic practice. Ann. Emerg. Med. 35(1), 11–16.

    Article  PubMed  CAS  Google Scholar 

  20. Bach, P. B., Cramer, L. D., Warren, J. L., and Begg, C. B. (1999) Racial differences in the treatment of early-stage lung cancer. N. Engl. J. Med. 341(16), 1198–1205.

    Article  PubMed  CAS  Google Scholar 

  21. Ayanian, J. Z., Cleary, P. D., Weissman, J. S., and Epstein, A. M. (1999) The effect of patients’ preferences on racial differences in access to renal transplantation. N. Engl. J. Med. 341(22), 1661–1669.

    Article  PubMed  CAS  Google Scholar 

  22. Ayanian, J. Z., Weissman, J. S., Chasan-Taber, S., and Epstein, A. M. (1999) Quality of care by race and gender for congestive heart failure and pneumonia. Med. Care 37(12), 1260–1269.

    Article  PubMed  CAS  Google Scholar 

  23. Gornick, M. E., Eggers, P. W., Reilly, T. W., et al. (1996) Effects of Race and Income on Mortality and Use of Services among Medicare Beneficiaries. N. Engl. J. Med. 335, 791–799.

    Article  PubMed  CAS  Google Scholar 

  24. Williams, D. R., Yu, Y., Jackson, J. S., and Anderson, N. B. (1997) Racial differences in physical and mental health: socioeconomic status, stress and discrimination. J. Health Psych. 2, 335–351.

    Article  Google Scholar 

  25. Institute of Medicine (2002). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press.

    Google Scholar 

  26. Berger, J. T. (1998) Culture and ethnicity in clinical care. Arch. Intern. Med. 158, 2085–2090.

    Article  PubMed  CAS  Google Scholar 

  27. Eisenberg, J. M. (1979) Sociologic influences on medical decision making by clinicians. Ann. Intern. Med. 90(6), 957–964.

    PubMed  CAS  Google Scholar 

  28. Stewart, M., Brown, J. B., Boon, H., Galajda, J., Meredith, L., and Sangster, M. (1999) Evidence on patient-doctor communication. Cancer Prev. Control 3(1), 25–30.

    PubMed  CAS  Google Scholar 

  29. Betancourt, J. R., Carrillo, J. E., and Green, A. R. (1999) Hypertension in multicultural and minority populations: linking communication to compliance. Curr. Hypertens. Rep. 1, 482–488.

    PubMed  CAS  Google Scholar 

  30. Commonwealth Fund Health Care Quality survey, 2001 http://www.cmwf.org/surveys [accessed, March 23, 2005].

  31. Seijo, R. (1991) Language as a communication barrier in medical care for Latino patients. Hisp J Behav Sci. 13, 363.

    Article  Google Scholar 

  32. Perez-Stable, E. J., Napoles-Springer, A., and Miramontes, J. M. (1997) The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med. Care 35(12), 1212–1219.

    Article  PubMed  CAS  Google Scholar 

  33. Erzinger, S. (1991) Communication between Spanish-speaking patients and their doctors in medical encounters. Cult. Med. Psychiatry 15, 91.

    Article  PubMed  CAS  Google Scholar 

  34. Crane, J. A. (1997) Patient Comprehension of doctor-patient communication on discharge from the emergency department. J. Emerg. Med. 15(1), 1–75.

    Article  PubMed  CAS  Google Scholar 

  35. Carrasquillo, O., Orav, E. J., Brennan, T. A., and Burstin, H. R. (1999) Impact of language barriers on patient satisfaction in an emergency department. J. Gen. Intern. Med. 14(2), 82–87.

    Article  PubMed  CAS  Google Scholar 

  36. Baker, D. W., Hayes, R., and Fortier, J. P. (1998) Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med. Care 36, 1461–1470.

    Article  PubMed  CAS  Google Scholar 

  37. Baker, D. W., Parker, R. M., Williams, M. V., Coates, W. C., Pitkin, K. (1996) Use and effectiveness of interpreters in an emergency department. JAMA 275, 783–788.

    Article  PubMed  CAS  Google Scholar 

  38. Hornberger, J., Itakura, H., and Wilson, S. R. (1997) Bridging language and cultural barriers between physicians and patients. Public Health Rep. 112(5), 410–417.

    PubMed  CAS  Google Scholar 

  39. McKinlay, J. B., Potter, D. A., and Feldman, H. A. (1996) Non-medical influences on medical decisonmaking. Soc. Sci. Med. 42(5), 769–776.

    Article  PubMed  CAS  Google Scholar 

  40. Hooper, E. M., Comstock, L. M., Goodwin, J. M., and Goodwin, J. S. (1982) Patient characteristics that influence physician behavior. Med. Care 20(6), 630–638.

    Article  PubMed  CAS  Google Scholar 

  41. van Ryn, M. and Burke, J. (2000) The effect of patient race and socio-economic status on physician’s perceptions of patients. Soc. Sci. Med. 50, 813–828.

    Article  PubMed  Google Scholar 

  42. Weisse, C. S., Sorum, P. C., Sanders, K. N., and Syat, B. L. (2001) Do gender and race affect decisions about pain management? J. Gen. Intern. Med. 16, 211–217.

    Article  PubMed  CAS  Google Scholar 

  43. Schulman, K. A., Berlin, J. A., Harless, W., et al. (1999) The effect of race and sex on physicians’ recommendations for cardiac catherization. N. Engl. J. Med. 340, 618–626.

    Article  PubMed  CAS  Google Scholar 

  44. Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., et al. (1999) Race, gender, and partnership in the patient-physician relationship. JAMA 282(6), 583–589.

    Article  PubMed  CAS  Google Scholar 

  45. Einbinder, L. C. and Schulman, K. A. (2000) The effect of race on the referral process for invasive cardiac procedures. Med. Care Res. Rev. 1, 162–177.

    Article  Google Scholar 

  46. Eisenberg, J. M. (1979) Sociologic influences on medical decision making by clinicians. Ann. Intern. Med. 90(6), 957–964.

    PubMed  CAS  Google Scholar 

  47. Morales, L. S., Cunningham, W. E., Brown, J. A., Liu, H., and Hays, R. D. (1999) Are Latinos less satisfied with communication by health care providers? J. Gen. Intern. Med. 14, 409–417.

    Article  PubMed  CAS  Google Scholar 

  48. Rathore, S. S., Lenert, L. A., Weinfurt, K. P., et al. (2000) The effects of patient sex and race on medical students’ ratings of quality of life. Am. J. Med. 108, 561–566.

    Article  PubMed  CAS  Google Scholar 

  49. Chen, J., Rathore, S. S., Radford, M. J., Wang, Y., and Krumholz, H. M. (2001) Racial differences in the use of cardiac catheterization after acute myocardial infarction. N. Engl. J. Med. 344, 1143–1449.

    Article  Google Scholar 

  50. Finucane, T. E. and Carrese, J. A. (1990) Racial bias in presentation of cases. J. Gen. Intern. Med. 5, 120–121.

    Article  PubMed  CAS  Google Scholar 

  51. Wennberg, J. E. (1999) Understanding geographic variations in health care delivery. N. Engl. J. Med. 340, 32–39.

    Article  Google Scholar 

  52. Fiske, S. T. and Taylor, S. E. (1991) Social Cognition (2nd ed.), New York: McGraw-Hill.

    Google Scholar 

  53. Fiske, S. T., Gilbert, D. T., Fiske, S. T., and Lindzey, G. Stereotyping, Prejudice, and Discrimination (chapter). In: Gilbert, D. T., Fiske, S. T. et al., (eds.) The Handbook of Social Psychology, Vol. 2 (4th ed.), New York: McGraw-Hill pp. 357–411.

    Google Scholar 

  54. van Ryn, M. and Fu, S. S. (2003) Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am. J. Public Health 93, 248–255.

    PubMed  Google Scholar 

  55. Macrae, C. N., Milne, A. B., and Bodenhausen, G. V. (1994) Stereotypes as energy saving-devices: A peek inside the cognitive toolbox. J. Pers. Soc. Psychol. 66(1), 37–47.

    Article  Google Scholar 

  56. Geiger, H. J. (2001) Racial Stereotyping and Medicine: The Need for Cultural Competence. CMAJ 164(12), 1699–1700.

    PubMed  CAS  Google Scholar 

  57. Branch, W. T. Jr. (1998) Professional and moral development in medical students: the ethics of caring for patients. Trans. Am. Clin. Climatol. Assoc. 109, 218–229; discussion 229 and 230.

    PubMed  Google Scholar 

  58. The Henry J. Kaiser Family Foundation (1999). Race, Ethnicity, and Medical Care: Improving Access in a Diverse Society. http://www.kff.org (Accessed January 12, 2006)

  59. Institute for Medicine (2000). “To Err is Human: Building a Safer Health System”. Washington, DC: National Academy Press. http://www.nap.org (Accessed January 12, 2006)

    Google Scholar 

  60. Dracup, K. and Bryan-Brown, C. W. (2002) On notebooks and trust. Am. J. Crit. Care 11(2), 96, 98, 100.

    PubMed  Google Scholar 

  61. Berens, M. J. (2000) Nursing mistakes Kill, injure thousands. Chicago Tribune.

    Google Scholar 

  62. Rock, A. (2001) How hospitals are gambling with your life. Reader’s Digest 151–168.

    Google Scholar 

  63. Peterson, L. A. (2002) Racial Differences In Trust: Reaping What We have Sown. Med. Care 40(2), 81–84.

    Article  Google Scholar 

  64. Thom, D. H. and Campbell, B. (1997) For the Stanford Trust Study Physicians. Patient-Physicians Trust: An Exploratory Study. J. Fam. Pract. 44, 169–176.

    PubMed  CAS  Google Scholar 

  65. Safran, D. G., Taira, D. A., Rogers, W. H., Kosinski, M., Ware, J. E., and Tarlov, A. R. (1998) Linking Primary Care Performance to Outcomes of Care. J. Fam. Pract. 47, 213–220.

    PubMed  CAS  Google Scholar 

  66. Gamble, V. (1997) Under the shadow of Tuskegee: African-Americans and health care. Am. J. Public Health 87(11), 1773–1778.

    Article  PubMed  CAS  Google Scholar 

  67. Corbie-Smith, G. (1999) The continuing legacy of Tuskegee Syphilis Study: considerations for clinical investigation. Am. J. Med. Sci. 317, 5–8.

    Article  PubMed  CAS  Google Scholar 

  68. Brandt, A. M. (1978) Racism and research: the case of the Tuskegee syphilis study. Hastings Cent. Rep. 8, 21–29.

    PubMed  CAS  Google Scholar 

  69. Race, Ethnicity and Medical Care (2005). A Survey of Public Perceptions and Experiences (KFF) Kaiser Family Foundation, http://www.kff.org accessed, March 11 2005.

  70. National Survey of Physicians, Part One: Doctors on Disparities in Medical Care. (KFF). Kaiser Family Foundation, http://www.kff.org. accessed, March 11 2005.

  71. Corbie-Smith, G., Thomas, S. B., and St. George, D. M. (2002) Distrust, Race, and Research. Arch. Intern. Med. 162, 2458–2463.

    Article  PubMed  Google Scholar 

  72. Arday, S. L., Arday, D. R., Monroe, S., and Zhang, J. (2000) HCFA’s Racial and Ethnic Data: Current Accuracy and Recent Improvements. Health Care Financ. Rev. 21(4), 107–116.

    PubMed  CAS  Google Scholar 

  73. Manson, A. (1988) Language concordance as a determinant of patient compliance and emergency room use in-patients with asthma. Med. Care 26, 1119–1128.

    Article  PubMed  CAS  Google Scholar 

  74. Physicians by Race/Ethnicity 2000. AMA Physician Characteristic and Distribution in the US 2002–2003 ed, total. http://www.ama-assn.org/ama/pub/category/2672.html. (Accessed November 16, 2005)

  75. Distribution of US Medical School Faculty by Race/Ethnicity, 1980 to 2001. AAMC Faculty Roster System, December 2001. http://www.aamc.org/data/facultyroster/usmsfol/start.htm. Accessed November 16, 2005.

  76. US Medical School Graduated, 2001. AAMC Student Record System, April 2002. http://www.aamc.org/programs/srs/start.htm. Accessed November 16, 2005.

Download references

Author information

Authors and Affiliations

  1. The Disparities Solutions Center, USA

    Joseph R. Betancourt M.D., M.P.H. (Director, Senior Scientist, Director of Multicultural Education and Assistant Professor of Medicine)

  2. The Institute for Health Policy, USA

    Joseph R. Betancourt M.D., M.P.H. (Director, Senior Scientist, Director of Multicultural Education and Assistant Professor of Medicine)

  3. Massachusetts General Hospital, USA

    Joseph R. Betancourt M.D., M.P.H. (Director, Senior Scientist, Director of Multicultural Education and Assistant Professor of Medicine)

  4. Harvard Medical School, Boston, Massachusetts

    Joseph R. Betancourt M.D., M.P.H. (Director, Senior Scientist, Director of Multicultural Education and Assistant Professor of Medicine)

  5. Department of Multicultural Education, Massachusetts General Hospital, Boston, Massachusetts

    Angela Maina B.S.

Authors
  1. Joseph R. Betancourt M.D., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela Maina B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The David Geffen School of Medicine at UCLA, USA

    Richard Allen Williams MD (Clinical Professor of Medicine, President/CEO and Chairman of the Board) (Clinical Professor of Medicine, President/CEO and Chairman of the Board)

  2. The Minority Health Institute, Inc., Los Angeles, California

    Richard Allen Williams MD (Clinical Professor of Medicine, President/CEO and Chairman of the Board) (Clinical Professor of Medicine, President/CEO and Chairman of the Board)

  3. Institute for the Advancement of Multicultural and Minority Medicine, Washington, DC

    Richard Allen Williams MD (Clinical Professor of Medicine, President/CEO and Chairman of the Board) (Clinical Professor of Medicine, President/CEO and Chairman of the Board)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Humana Press Inc.

About this chapter

Cite this chapter

Betancourt, J.R., Maina, A. (2007). Barriers to Eliminating Disparities in Clinical Practice. In: Williams, R.A. (eds) Eliminating Healthcare Disparities in America. Humana Press. https://doi.org/10.1007/978-1-59745-485-8_5

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-485-8_5

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-934115-42-8

  • Online ISBN: 978-1-59745-485-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation