Fighting Unequal Treatment

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Ensuring that all Americans have access to quality health care is one of the major goals of The Robert Wood Johnson Foundation (RWJF), as is improving the quality of health care for people with chronic conditions. Working toward this goal means that we must eliminate the embarrassing and unacceptable gaps in health care experienced by racial and ethnic minorities. Research indicates that Americans do not receive half of the care that experts recommend,1 but the evidence also indicates that these quality gaps are even worse for racial and ethnic minorities.2 Disparities in treatment exist across a wide range of chronic conditions, and the evidence of differential treatment is particularly strong with regard to treatment for cardiovascular conditions such as myocardial infarction and congestive heart failure.3 Even though disparities in care have not been conclusively linked to disparities in health outcomes, many experts believe that persistent patterns of lower-quality care for minority Americans do contribute to worse health outcomes, which could explain in part the disproportionate impact of heart disease on minority Americans. Mortality rates from cardiovascular disease are higher among blacks than whites,4 and one study found that heart disease accounted for nearly one third of the overall mortality difference between black and white patients.5 For all of these reasons, efforts to reduce disparities in cardiovascular care are likely to be particularly important in closing gaps in care and will be a high priority for RWJF in the next half decade. This editorial describes the foundation’s approach to reducing racial and ethnic disparities in health care and the underlying rationale for the strategy. For RWJF, developing a new targeted strategy for funding work to reduce racial and ethnic disparities in care required an immediate emphasis on discovering or helping to develop replicable solutions. We believe …