Proceedings of a Workshop

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Unequal treatment revisited: The current state of racial and ethnic disparities in health care: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27448.

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WORKSHOP PLANNING COMMITTEE ON UNEQUAL TREATMENT REVISITED: THE CURRENT STATE OF RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE¹

GEORGES C. BENJAMIN (Cochair), Executive Director American Public Health Association

JENNIFER (JEN) E. DEVOE (Cochair), John and Sherrie Saultz Professor and Chair, Department of Family Medicine, Oregon Health & Science University

MARGARITA ALEGRIA, Chief of the Disparities Research Unit at Massachusetts General Hospital; Harry G. Lehnert, Jr. and Lucille F. Cyr Lehnert Endowed Chair, Mass General Research Institute; Professor, Departments of Medicine and Psychiatry, Harvard Medical School

JOHN ZAVEN AYANIAN, Alice Hamilton Distinguished University Professor of Medicine and Healthcare Policy; Inaugural Director, Institute for Healthcare Policy and Innovation, University of Michigan

ELAINE E. BATCHLOR, Chief Executive Officer, MLK Community Healthcare

DARRELL J. GASKIN, William C. and Nancy F. Richardson Professor in Health Policy; Director, Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health

VALARIE BLUE BIRD JERNIGAN, Professor of Rural Health and Medicine; Director, Center for Indigenous Health Research and Policy; Oklahoma State University Center for Health Sciences

THOMAS A. LAVEIST, Dean and Weatherhead Presidential Chair in Health Equity, School of Public Health and Tropical Medicine, Tulane University

MONICA E. PEEK, Ellen H. Block Professor of Health Justice, Section of General Internal Medicine; Associate Director, Chicago Center for Diabetes Translation Research, the University of Chicago Pritzker School of Medicine

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¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

VINCENT GUILAMO-RAMOS, Dean and Bessie Baker Distinguished Professor of the Duke University School of Nursing; Vice Chancellor for Nursing Affairs, Duke University; Director, Center for Latino Adolescent and Family Health, Duke University

BRIAN RIVERS, Director, Cancer Health Equity Institute; Professor, Community Health and Preventive Medicine, Morehouse School of Medicine

SARA ROSENBAUM, Professor Emerita of Health Law and Policy, Milken Institute School of Public Health, George Washington University

RUTH SHIM, Luke & Grace Kim Professor in Cultural Psychiatry, Department of Psychiatry & Behavioral Sciences; Associate Dean of Diverse and Inclusive Education, University of California, Davis School of Medicine

KOSALI I. SIMON, Distinguished Professor and Herman B. Wells Professor; O’Neill Chair and Associate Vice Provost of Health Sciences, O’Neill School of Public and Environmental Affairs, Indiana University Bloomington

PAUL C. TANG, Adjunct Professor, Clinical Excellence Research Center, Stanford University

REGINALD TUCKER-SEELEY, Vice President of Health Equity, ZERO—The End of Prostate Cancer

CONSUELO HOPKINS WILKINS, Senior Vice President and Senior Associate Dean for Health Equity and Inclusive Excellence, Professor of Medicine, Vanderbilt University Medical Center

Study Staff

FRANCIS AMANKWAH, Senior Program Officer

CHIDINMA CHUKWURAH, Senior Program Assistant

AMIRA DAOUD, Research Associate

ROSE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice

SHARYL NASS, Senior Director, Board on Health Care Services

National Academy of Medicine Fellows

ALICIA COHEN, James C. Puffer, M.D./American Board of Family Medicine NAM Fellow; Investigator, VA Providence Healthcare System; Assistant Professor of Family Medicine Alpert Medical School, Brown University; Assistant Professor of Health Services, Policy, and Practice, Brown University School of Public Health

TRACY MADSEN, American Board of Emergency Medicine NAM Fellow; Associate Professor, Department of Emergency Medicine; Associate Professor Department of Epidemiology, Alpert Medical School, Brown University; Director of Clinical Research, Brown Emergency Medicine

Board on Population Health and Public Health Practice Liaison

JOSHUA A. SALOMON, Professor of Health Policy, Department of Health Policy, School of Medicine, Center for Health Policy, Freeman Spogli Institute for International Studies; Director, Prevention Policy Modeling Lab, Stanford University

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by LUCILE L. ADAMS-CAMPBELL, Georgetown University Medical Center. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

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Acknowledgments

The workshop planning committee thanks the speakers, who generously shared their expertise and time to make the workshop a success. The workshop planning committee is grateful for the support of the National Institutes of Health (National Institute on Minority Health and Health Disparities, National Institute of Nursing Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Institute of Neurological Disorders and Stroke, National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, and National Institute on Aging) and the Agency for Healthcare Research and Quality.

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Contents

ACRONYMS AND ABBREVIATIONS

PROCEEDINGS OF A WORKSHOP

WORKSHOP OVERVIEW

LEARNINGS FROM THE PAST 2 DECADES

Child and Adolescent Health Perspective

Maternal Health Care Perspective

Mental Health and Substance Use Disorders Perspective

Aging Perspective

Disability Perspective

Sexual and Gender Minorities (SGM) Perspective

CONFRONTING RACISM

RACIAL AND ETHNIC INEQUITIES IN HEALTH CARE: CLINICIAN AND HEALTH ORGANIZATION PERSPECTIVES

Nursing Perspective

Physicians’ Perspective

Federally Qualified Health Center Perspective

Integrated Health Care System Perspective

Accrediting Organization Perspective

Language Access: A Case Study in Health Care Inequities

COMMUNITY EXPERIENCES OF RACIAL AND ETHNIC INEQUITIES IN HEALTH CARE

Building Community Power

Community-Based Participatory Research

Indigenous Health Equity Perspective

Immigrant Health Equity Perspective

Asian American Health Equity Perspective

Mental Health Equity for Black Communities

WHAT COULD BE DONE DIFFERENTLY

Clinical Perspective

Community Health Perspective

Primary Care Systems and Innovation

Technology Development and Health Care Equity

Health Insurance Industry and Health Care Equity

SOCIOPOLITICAL AND LEGAL OPPORTUNITIES AND CHALLENGES

Indigenous Health Care Perspective

Asian American, Native Hawaiian, and Pacific Islander Health Care Perspectives

Immigrant Health Care Perspective

How Health Law Affects Population Health

Overview of Section 1557 of ACA

DATA, MEASURES, AND RESEARCH TO ADVANCE HEALTH CARE EQUITY

Leveraging Upstream Data

Leveraging Administrative Data

Leveraging Clinical and Biomedical Data with Artificial Intelligence

Race and Algorithms

Measuring Structural Racism in Health Equity Research

Opportunities for New Research: Implementation Science Perspective

Opportunities for New Research: Community Engagement Perspective

Opportunities for New Research: Translational Research Perspective

FEDERAL AGENCY INITIATIVES TO REDUCE RACIAL AND ETHNIC HEALTH CARE INEQUITIES

National Institute on Minority Health and Health Disparities (NIMHD)

Centers for Medicare & Medicaid Services Office of Minority Health (OMH)

Health Resources and Services Administration (HRSA)

Department of Health and Human Services Office of Minority Health (HHS OMH)

Indian Health Service (IHS)

Veterans Health Administration (VHA)

Office of the National Coordinator for Health Information Technology (ONC)

Department of Health and Human Services Office for Civil Rights (HHS OCR)

Office of Management and Budget (OMB)

REFERENCES

APPENDIXES

A Consensus Study Statement of Task

B Public Workshop Agendas

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Box and Figure

BOX

1 Observations from Individual Workshop Participants on Advancing Racial and Ethnic Health Care Equity

FIGURE

1 Estimated life expectancy at birth by year and racial/ethnic group, 2000–2019

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Acronyms and Abbreviations