Clinical Solutions to Eliminate Racial and Ethnic Health Disparities

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Clinical Solutions to Eliminate Racial and
Ethnic Health Disparities

• Jim Webster, MD, MS
• July 2008

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The Problem

• Multiple data sets recurrently and repeatedly
  show that racial and ethnic health disparities
  routinely overly disadvantage minority
  populations in multiple ways
• What Should be done?
• They should be Eliminated
• Easier said than done. Sending out a memo
  probably wont cut it

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Current Programs

• There are many well done, well supported (govt
  and Pvt.) projects that are working to reduce and
  eventually eliminate racial and ethnic health
  disparities
• Most are focused on specific diseases and/or
  problems
• The IOMC has a program focused on communities and
  providers using the metabolic syndrome as the
  vehicle

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IOMC Disparities Project

• Community outreach educational interventions to
  multiple constituencies at non traditional sites
• Cultural Competency (CC) presentations to
  audiences in all health care disciplines at
  various career levels and ages
• New initiatives e.g. ? completing required CC
  modules for clinical privileges, CME
• Measuring /- outcomes is the quandary

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The 100,000 Foot View

• What are the larger barriers to eliminating these
  Disparities?
• We know because we see them every day, everywhere
  we look in the community, not just in our
  clinical work

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McGinnes, et. al., Health Affairs, Vol. 21(2)
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The Inverse Care Law is also a Major Contributor

• The availability of good medical care varies
  inversely with the need for it in the population
  being served.
• Hart, JT Lancet 19711405-12

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My Cure (Editorial here)

• As well as universal access we all should
  constantly push for
• Improving non-medical arbiters of health
  reminding everyone all the time about the health
  benefits of social programs
• Repeal the Inverse care law by recruiting allies
  to completely reengineer and restructure the
  financial and organizational basis of health care
  delivery, nothing less