Transactions from the Annual Meeting of the American Gynecological and Obstetrical Society
Of disparities and diversity: Where are we?

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There has been remarkable improvement in the health of women over the past century; however, disparities among minority populations persist. While the reasons for the disparities, usually poorer health, are many and complex, such disparities are unacceptable. Because the reasons for disparities are multiple and complex, eliminating health disparities will require a multifaceted approach. Increasing research into health disparities, biologic, sociologic, and health services research, transforming the health care system into a culturally sensitive system, eliminating unequal treatment provided to minority populations, increasing diversity in the health care workforce, and assuring that health care providers provide culturally competent health care are needed.

Section snippets

Reviewing evidence for disparities

When reviewing evidence for disparities in health outcomes among minority populations and making comparisons over time, several caveats have to be considered.

First, to accurately explore health status and health outcomes among minority populations requires that data collection be impeccable and analyses consistent. Herein lies a problem.

While the race of the population has been collected in every decennial beginning with the first US census in 1790, racial categories, as well as the wording of

Examples of disparities in health

Of the nearly 140 million women living in the US, women of racial and ethnic minorities comprise almost 40 million, or about 28% of the population.13, 14

One need look at any one of several collections of health data, such as the Women of Color Data Book,15 the National Center for Health Statistics,16 the Kaiser Family Foundation,17 Commonwealth Foundation,18 and, most recently, the National Healthcare Disparities Report,19 to know that disparities in health status and health outcomes exist.

Sources for disparities in health status and health outcomes

An immediate response to why disparities in health status exist is to invoke genetic predisposition and biologic factors as the cause, even though these same factors exist among all populations. Therefore, while there may be genetic and biologic factors that contribute to diseases associated with health disparities, such as HLA genotype with human papillomavirus and cervical cancer, and p53 mutations with more aggressive breast cancer,25, 26 one cannot dismiss the fact that the onset or

Interventions

Increasing diversity in the health care workforce, increasing research into health disparities, and emphasizing the incorporation of culturally competent curriculum in medical education have been proposed as a strategies to reduce disparities in health and decrease inequalities in health care.

Research

Continued biologic and genetic research is needed to decrease disparities in health. Encouragingly, the NIH funding classified as supporting health disparities, approached $3 billion dollars in 2003. While biomedical and genetic research is needed, how we approach research to reduce disparities will require a new framework. To this end, I refer to the NIH Roadmap: “Biomedical research traditionally has been organized much like a series of cottage industries—lumping researchers into broad areas

Increase diversity

Several groups of studies provide a strong rationale for increasing diversity among health professionals to influence care. Racial and ethnic minority health care professionals are more likely than their white peers to practice in minority and medically underserved communities, care for poor patients and patients with Medicaid insurance or no health insurance.39, 40, 41 Underrepresented minority physicians are more likely to treat patients of color.39, 42, 43 Minority patients are more likely

Culturally competent curricula

In order to address disparities in health care and eventual health outcomes, the need to provide “culturally competent” health care has evolved as one of the strategies. A MEDLINE search for “culturally competent health care” results in a multitude of references describing cultural competence and its effect on health outcomes. But, it is not entirely clear what is meant by culturally competent health care and why it is important. The Center for Linguistic and Cultural Competence in Health Care50

Summary

Disparities in health status and health outcomes exist. While we are able to measure the existence of racial and ethnic disparities in health, why disparities exist and how to reduce them in many cases is still unknown. The reasons for disparities in health are complex and, thus, a single solution to eliminating disparities in health is not readily apparent. Data on race and ethnicity and uniform data analyses are essential to identify health disparities, to aid in selecting special initiatives

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    Presidential Address, presented at the 23rd Annual Meeting of the American Gynecological and Obstetrical Society, September 9-11, 2004, Bolton Landing, NY.

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