Proceedings of a Workshop
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality through a contract between the National Academy of Sciences and the National Institutes of Health (Contract Number: HHSN263201800029I, Task Order Number: 75N98022F00012). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-71474-7
International Standard Book Number-10: 0-309-71474-5
Digital Object Identifier: https://doi.org/10.17226/27448
This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
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.
The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.
The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.
The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.
Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.
Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.
Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.
Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release.
For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.
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
___________________
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
This page intentionally left blank.
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.
This page intentionally left blank.
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.
This page intentionally left blank.
Contents
LEARNINGS FROM THE PAST 2 DECADES
Child and Adolescent Health Perspective
Maternal Health Care Perspective
Mental Health and Substance Use Disorders Perspective
Sexual and Gender Minorities (SGM) Perspective
RACIAL AND ETHNIC INEQUITIES IN HEALTH CARE: CLINICIAN AND HEALTH ORGANIZATION PERSPECTIVES
Accrediting Organization Perspective
Language Access: A Case Study in Health Care Inequities
COMMUNITY EXPERIENCES OF RACIAL AND ETHNIC INEQUITIES IN HEALTH CARE
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
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 Administrative Data
Leveraging Clinical and Biomedical Data with Artificial Intelligence
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)
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)
This page intentionally left blank.
This page intentionally left blank.
Acronyms and Abbreviations
ACA | Affordable Care Act |
AI | artificial intelligence |
AIAN | American Indian Alaska Native |
AMA | American Medical Association |
CDC | Centers for Disease Control and Prevention |
CHW | community health worker |
CMS | Centers for Medicare & Medicaid Services |
EHR | electronic health record |
FQHC | federally qualified health center |
GAO | Government Accountability Office |
HHS | Department of Health and Human Services |
HRSA | Health Resources and Services Administration |
I/DD | intellectual and developmental disabilities |
IHS | Indian Health Service |
KP | Kaiser Permanente |
LGBTQ+ | lesbian, gay, bisexual, transgender, questioning, other |
MSM | Morehouse School of Medicine |
NIA | National Institute of Aging |
NIH | National Institutes of Health |
NIMHD | National Institute of Minority Health and Health Disparities |
NYU | New York University |
OCR | Office for Civil Rights |
OMB | Office of Management and Budget |
OMH | Office of Minority Health |
ONC | Office of the National Coordinator for Health Information Technology |
SDOH | social determinants of health |
SGM | sexual and gender minority |
SPD-15 | Statistical Policy Directive 15 |
USCDI | United States Core Data for Interoperability |
VA | Department of Veterans Affairs |
VHA | Veterans Health Administration |