New Fight for Racial Equality in Health Care

Thirty private and state medical groups announced an initiative Monday aimed at stemming widespread shortfalls in medical care received by racial minorities.

The groups say they will soon begin a nationwide educational campaign to increase cultural sensitivity in the nation’s doctors’ offices, hospitals, and medical schools. Studies show that ethnic minorities frequently receive lower-quality care than whites for the same medical problems.

“The fact is that care has been unequal. That’s wrong. It’s bad medicine, it’s expensive, it’s just not the way we should be doing things in the United States of America,” says John C. Nelson, president of the American Medical Association.

Studies have consistently found racial inequality in care for a wide range of medical disorders. For example, studies of medical records show that doctors -- the vast majority of whom are white -- are more likely to recommend surgical procedures for whites than they are for blacks with the same form of heart disease.

Black women are also less likely to receive Pap smears (search) for cervical cancer or mammogram tests for breast cancer than are white women, even when their insurance status and ability to pay is the same.

A study cited in a 2002 Institute of Medicine report on racial disparities in health care also found that Hispanic patients were less likely than whites to receive pain medication after a bone fracture in Los Angeles emergency rooms.

Biases in the System

The report stopped short of blaming the differences on conscious racism, but it did conclude that ingrained biases in the minds of physicians may play a critical role in causing disparate care. Inequalities were less common in the Veterans Affairs and military health systems but were common in treatment of the general population, Alan R. Nelson, MD, who chaired the IOM panel that published the report, says in an interview.

“We were struck by the fact that studies not showing racial disparities were hard to find," says Alan Nelson, who is a member of the AMA but has no family relationship to the AMA president of the same name.

The groups say they have launched a national survey of doctors in an effort to learn more about causes of potential bias among physicians. The survey will also ask doctors about their “cultural competence” -- a buzzword that refers to an understanding of customs, social experiences, and language that can affect health care.

“We’ve got to help them adjust for the sake of their patients,” says Randall W. Maxey, a former president of the National Medical Association, an organization for black doctors. The group is leading an education effort with the AMA and the National Hispanic Medical Association.

The federal government has also launched several efforts, including the opening of a center for health disparities research at the National Institutes of Health.

John Nelson, the AMA president, cites “a generalized distrust” of doctors by many minority patients that he says could undermine their willingness to follow treatment. Such feelings are often evoked as part of the fallout from the Tuskegee experiments of the 1920s, in which white doctors observed the progression of syphilis in a group of black men instead of offering available treatments.

Doctors can begin to restore that trust by taking concrete steps the groups say they hope to impart. “Then they will comply with your treatment plan, if they can afford it,” Maxey says.

By Todd Zwillich, reviewed by Brunilda Nazario, MD

SOURCES: John C. Nelson, MD, president, American Medical Association. Alan R. Nelson, MD, chairman, Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Randall Maxey, past president, National Medical Association.