American Medical Student Association

Global Health Equity

Health disparities exist both on a global level - with some countries unable to afford life-saving HIV treatment or even condoms - and within our nation's health care system, where we see persistent racial, ethnic and socioeconomic disparities in medical care and overall health.

What Others are Doing to Eliminate Health Disparities

Education may be one of the most important tools as part of an overall strategy to eliminate healthcare disparities. Healthcare providers and medical students alike should be aware that racial and ethnic disparities exist in healthcare, often despite providers' best intentions.

Medical student action

• The PRIME project was an initiative of AMSA Foundation funded by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine and Dentistry to create a module called Breaking Barriers that focuses on how barriers to health care negatively impact health, and what people in the healthcare field can do to tear down these barriers.  
  • Breaking Barriers I: Introduction to Barriers to Health Care
  • Breaking Barriers II: Racial and Ethnic Minorities
  • Breaking Barriers III: Lack of Health Insurance | PowerPoint (969 KB)
  • Breaking Barriers IV: Lesbian, Gay, Bisexual, Transgender (LGBT) | PowerPoint (349 KB)
  • Breaking Barriers V: Barriers to Rural Health Care  

Healthcare providers

Given that stereotypes, bias, and clinical uncertainty may influence clinicians' diagnostic and treatment decisions, education may be one of the most important tools as part of an overall strategy to eliminate health disparities. Cross-cultural education programs have been developed to enhance health professionals' awareness of how cultural and social factors influence healthcare, while providing methods to obtain, negotiate, and manage this information clinically once it is obtained.

• The Providers Guide to Quality and Culture is an excellent resource for learning how to give culturally competent care to individuals from a variety of racial and ethnic backgrounds. Take the Quality and Culture Quiz to find out how culturally aware you are.
   
• Other case-based exercises for healthcare providers who want to learn more: Cultural Competency in Medicine and Cross Cultural Issues in Primary Care
   
• A Report of the Sullivan Commission on Diversity in the Healthcare Workforce, "Missing Persons: Minorities in the Health Professions," focuses on means of ensuring more diverse health professionals receive the education and training to better address the health needs of our nation.

Notable sponsors and advocacy organizations

• The National Center on Minority Health and Health Disparities (NCMHD) promotes minority health and strives to lead, coordinate, support, and assess the NIH effort to reduce and ultimately eliminate health disparities. They envision an America in which all populations will have an equal opportunity to live long, healthy and productive lives. In accordance with this mission, they recently provided $74.5 million to various institutions, and HHS' Office of Minority Health awarded 65 grants totaling $10.5 million - $4.6 million of which is supported by funds from the Minority AIDS initiative - to support state-based efforts to eliminate health disparities.
  
  Much of this money will go toward research on minority health disparities, while some will go to community-based projects that will work to reduce "high-risk" behaviors such as tobacco use, physical inactivity or poor eating habits, as well as to improve healthcare access. Another portion will fund minority health offices in 14 states or go toward supporting the development of "effective and durable" service delivery among community organizations and health departments involved in HIV/AIDS treatment and prevention.
   
• The Henry J. Kaiser Family Foundation is a key player in the fight against health disparities. Kaiser has a web page that serves as a clearinghouse for racial and ethnic minority issues. The Kaiser Network provides up-to-date news, references, web casts, and other information about efforts to reduce racial and ethnic disparities in healthcare access. In addition, kaiserEDU gives students and faculty access to data, literature, news and developments regarding major health issues, including the uninsured and health policy issues.  
   
• The Centers for Disease Control's Office of Minority Health supports research and professional development, reports on the health status of racial and ethnic minorities in the U.S., and initiates strategic partnerships with governmental as well as national and regional organizations. In 1984, the U.S. Department of Health and Human Services established a Task Force on Black and Minority Health to study the substantial inequities in the health of U.S. minorities and as a result published the seminal study, the 1985 Report of the Secretary's Task Force on Black and Minority Health, that led to the subsequent creation of this office.
   
• Physicians for Human Rights has made racial and ethnic healthcare disparities one of its flagship issues. The research they have done and the resources they have created are some of the best on the web. The Right To Equal Treatment: A Report by the Panel on Racial and Ethnic Disparities in Medical Care presents evidence for the existence of systemic healthcare disparities. This is apparent even after normalizing for such possibly confounding variables as health insurance status, sex, age, income, education, hospital type, stage of disease and concomitant diseases. The report explores some possible causes and future actions to address this injustice. They also provide information on career development, student organizing, multi-media presentations, health and human rights. AMSA collaborates with PHR to encourage medical students to learn about and address health disparities.

Other organizations that have made eliminating health disparities a priority:

• The American Medical Association (AMA) has established policies and programs and formed partnerships in an effort to reduce health disparities. 

Important reports and studies

• In 1999, Congress directed the Agency for Healthcare Research and Quality (AHRQ) to develop the National Healthcare Disparity Report (NHDR) and requested that AHRQ annually track "prevailing disparities in healthcare delivery as they relate to racial factors and socioeconomic factors in priority populations." The NHDR provides a national overview of racial, ethnic, and socioeconomic disparities in health care in the general U.S. population and among "priority populations" which include both specific population groups as well as geographically-defined groups. The NHDR includes data and analysis on the following: low-income groups; racial and ethnic minority groups; women; children; the elderly; individuals with special healthcare needs; the disabled; people in need of long-term care; people requiring end-of-life care; and place of residence (e.g., rural communities). AHRQ also has a compendium of minority health research and reports on their website.  

Recommended Reading

• Waking Up in America, by Pedro Greer, Simon and Schuster, 1999.  
• The Spirit Catches You and You Fall Down, by Anne Fadiman, Farrar, Straus, and Giroux, 1997.  
• Cultural Diversity in Health and Illness, by Rachel Spector, Prentice Hall, 2003.  
• Promoting Health in Multicultural Populations: A Handbook for Practitioners, edited by Robert M. Huff and Michael V. Kline, Sage Publication, 1999.  
• At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States, by Lu Ann Aday, Jossey-Bass, Inc., 2001.

Recommended Films

• Miss Evers' Boys. Emmy Award-winning exposé about the infamous Tuskegee Study, in which Nurse Evers describes a federally funded program to treat black syphilis patients

• Unnatural Causes: Is Inequality Making Us Sick? is the acclaimed documentary series broadcast by PBS and used by thousands of organizations around the country to tackle the root causes of our alarming socio-economic and racial inequities in health.The 4-hour series crisscrosses the nation uncovering startling new findings that suggest there is much more to our health than bad habits, health care, or unlucky genes. The social circumstances in which we are born, live, and work can actually get under our skin and disrupt our physiology as much as germs and viruses.

• The Deadliest Disease in America, is a documentary film that includes workshops developed to reduce barriers of access to health care. The Deadliest Disease in America is a thought-provoking film that, together with intensive workshops, highlights clearly the unequal treatment that individuals often receive based on color. This program is used to help community members and health care professionals understand how to identify racism in the health care system, and what to do about it. With both individuals and institutions ready to take responsibility for overcoming racism in our society, this is a crucial time to address racial and ethnic inequities in comprehensive health care reform.