Nurses who are familiar with the U.S. Department of Health and Human Services’ national initiative to eliminate racial and ethnic disparities in health by 2010 are already well aware that accomplishing these goals will be no small task. Now two groundbreaking new reports on the status of minority health care in the U.S. not only confirm that fact but also present disturbing evidence that the gap of unequal health outcomes between Caucasian Americans and Americans of color may be even wider and deeper than experts had originally believed.

“Minority Americans lag behind whites in nearly every measure of health care” is the sobering conclusion of Diverse Communities, Common Concerns: Assessing Health Care Quality for Minority Americans, a study by The Commonwealth Fund, a private foundation supporting independent research on health and social issues. The study was based on a 2001 survey of more than 6,700 Hispanic, African-American, Asian American and Caucasian adults age 18 and older nationwide.

The findings reveal that minority Americans do not fare as well as whites in a wide range of health care quality measures, including effective patient-physician communication, overcoming cultural and linguistic barriers to health care, access to health services and medical insurance, and feeling that they are being treated with respect by health care providers. For example:

• Thirty-three percent of Hispanics, 27% of Asian Americans and 23% of African Americans reported experiencing difficulty communicating with their physicians, compared to only 16% of white respondents.

• Nearly one out of six African Americans (15%), one of seven Hispanics (13%), and one of 10 Asian Americans (11%) said they felt they would receive better health care if they were of a different race or ethnicity. Only1% of Caucasians surveyed agreed with that statement.

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• Sixty-five percent of whites and 61% of African Americans reported being very satisfied with their health care, compared to 56% of Hispanics and less than half of Asian Americans (45%).

• Only 57% of Hispanics said they have a regular doctor, in contrast with 80% of whites, 70% of African Americans and 68% of Asian Americans.

• Nearly one-half of Hispanics and one-third of African Americans lacked health insurance for all or part of the year prior to the survey.

“As our population grows more diverse, these findings send a clear warning that the health care quality divide is in danger of turning into a gulf,” concludes Karen Davis, president of The Commonwealth Fund. “To ensure a healthy future for all, we must work to improve every quality of care measure. We should pay particular attention to those areas where minority Americans are at greatest risk, such as eliminating barriers linked to language, literacy and lack of health insurance.”

A Call to Action

These concerns and recommendations are echoed in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, a newly published report from the Institute of Medicine (IOM), one of the four National Academies. This exhaustive, nearly 600-page study was sponsored by the Department of Health and Human Services, with additional support from The Commonwealth Fund and the Henry J. Kaiser Family Foundation.


The congressionally mandated report shows that racial and ethnic minorities in this country tend to receive lower-quality health care than whites do, even when their insurance status, income, age and severity of conditions are comparable. The authors also emphasize that disparities in treating such deadly conditions as heart disease, cancer and HIV infection are partly responsible for higher death rates for Americans of color.

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The study presents numerous examples to support these conclusions, such as:

• Compared to whites, minorities are less likely to be given appropriate cardiac medications, undergo bypass surgery, receive kidney dialysis and transplants, get appropriate cancer diagnostics tests and treatment or have access to the most sophisticated treatments for HIV.

• On the other hand, minority patients are more likely to receive certain less-desirable medical procedures, such as lower limb amputations for diabetes.

• A disproportionate number of minorities are enrolled in more affordable but “lower-end” health insurance plans, which provide fewer resources per patient and place stricter limits on covered services.

• Even when they are insured at the same levels as whites, minorities are less likely to enjoy a consistent relationship with a primary care physician, in part because of the lack of doctors in many minority communities.

The Unequal Treatment study is intended to be not just a wake-up call for the nation’s health care decision-makers but also a formal call to action, according to Alan Nelson, MD, chair of the IOM’s Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. “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,” he says.

Some of the study’s many recommended strategies include:

• Promoting consistency and equity of care through the use of “evidence-based” guidelines for health care providers and insurers.

• Eliminating the fragmentation of health care plans along socioeconomic lines.

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• Increasing the number of minority health care providers–especially in minority and medically underserved communities–and making more interpreters available in hospitals and clinics that serve limited-English-speaking populations.

• Providing the Department of Health and Human Services with greater resources for enforcing laws that prohibit discrimination in health care and for investigating complaints.

• Conducting research on the prevalence and influence of bias, prejudice and stereotyping on the part of health care providers.

Both of these landmark reports are available for use by health professionals and educators. To order a free copy of the Commonwealth Fund study, call (888) 777-2744 and request publication number 523, or visit The 80-page report can also be downloaded from the Web site.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care can be purchased from the National Academy Press at (800) 624-6242 or The complete text of the 598-page study, organized into six sections, can also be viewed online.

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