A call for papers: disparities in health.

Abstract

Over the last 3 decades, a growing volume of research documents disparities in health care access, treatment, and health status for people from racial and ethnic minority groups in the United States. Former Surgeon General Dr. David Satcher noted the persistence of health disparities and called for their elimination by the year 2010. Understanding the extent of racial and ethnic disparities is the first step toward their elimination, but understanding why disparities exist and how to eliminate disparities requires further research. The factors that contribute to racial and ethnic disparities in health status are diverse and span social, economic, educational, ecological, environmental, and behavioral issues as well as problems in health care and other systems, and interpersonal interactions between providers and patients. In addition, genetic and biologic factors interact with these social and environmental factors across the life span. There are many factors in the health care system, ranging from the lack of universal health insurance to the under-representation of African Americans, Mexican Americans, Puerto Ricans, and American Indians and Alaska Natives among health care professionals, that present tremendous barriers to care for people from racial and ethnic minority populations. Research documents disparities in treatment and the use of procedures in people from racial and ethnic minority groups.1 In general, minorities receive less-intensive hospital care,2 fewer cardiovascular procedures,3 fewer antiretrovirals for HIV infections,4 less-aggressive treatment of prostate cancer,5 fewer orthopedic procedures,6 less analgesia for cancer pain,7 and lower quality prenatal care.8 In 1999, the Henry J. Kaiser Family Foundation reported the results of a national survey that found that 16% of whites, 35% of blacks, and 30% of Latinos believe that racism in health care is a major problem. A significant proportion of blacks and Latinos reported that they had experienced bias or discrimination in the health care system due to their race/ethnicity or English language ability.9 The recent Commonwealth Fund report indicated that 18% of Hispanics, 16% of blacks, 13% of Asians, and 9% of whites had experienced disrespect in the health care system.10 Communication with their providers is a major problem for members of racial and ethnic minority groups. The Commonwealth Fund survey reported that blacks, Hispanics, and Asians have more difficulty communicating with their providers and understanding provider instructions and other health information, and are less involved in their care than they would like to be.10 Researchers have investigated communication in patient and provider pairs in which race is discordant and found that providers are less likely to encourage participatory interactions when the physician is white and the patient black.11 Other studies have documented difference in quality of care for Medicare recipients in managed care settings.12 It is time to move beyond simply describing disparities to better understanding why disparities exist and developing strategies for eliminating them. Eliminating disparities requires thoughtful approaches in the way we deliver clinical care, the way we conduct research, and the way we educate current and future physicians. The Journal of General Internal Medicine therefore issues this call for papers that focus on disparities in health for a Special Issue. The goals of the Special Issue are to increase readers’ understanding of the complexity of factors that contribute to health disparities, to reinforce the need for interventions at multiple levels to eliminate health disparities, and to highlight research methodologies that are appropriate for investigating racial, ethnic, and other disparities in health status and health care quality. The Special Issue will contain review articles and original empirical studies that focus on policies, social determinants, interpersonal factors, and other factors that contribute to disparities. We seek articles that describe approaches to eliminating disparities at multiple levels, including communities, health care systems, and interpersonal interactions. We also seek to describe innovative curricula related to educating physicians about disparities and cultural competence as well as programs that promote the recruitment, retention, and advancement of under-represented minorities in medicine. The Special Issue will include approximately 10 to 12 articles including 5 to 6 original studies, brief reports, review articles, perspectives, or original studies under Innovations in Education and Clinical Practice, Health Policy or Populations at Risk. The submission deadline is February 1, 2003.