Moving beyond the Status Quo in Reducing Racial and Ethnic Disparities in Children's Health

Abstract

Dennis P. Andrulis, PhD, MPHa During the 1990s, increasing attention was focused on longstanding racial and ethnic disparities in health and health care. New research and experiences from the front lines documented the extent of these differences, their costs to individuals and society, and the role the health care system plays in perpetuating them. As evidence continued to mount, policymakers, practitioners, and others intensified their interest in improving the knowledge base, skills, communication, and training around care for diverse popu lations. Since then, these and other cultural competence efforts have grown from typically small, isolated programs into more sophisticated and potentially far-reaching initiatives whose value has been strongly reaffirmed in a series of reports and recommen dations, including those from the Institute of Medicine (IOM),1 the Department of Health and Human Services Office of Minority Health,2 The Agency for Health Re search and Quality,3 the Centers for Medicare & Medicaid Services cultural compe tence/disparities health plan language that was part of the 2003 Quality Assurance/ Performance Improvement requirements,4 numerous state issuances, and specific pro grams undertaken by providers. In many ways, having acknowledged the considerable body of evidence attesting to racial and ethnic disparities, the field is moving beyond documentation to seek and implement models and strategies to reduce them. To date, however, health care professionals and research have not tended to focus specifically on how to reduce racial and ethnic disparities affecting families and children. Such inatten tion exists in spite of the growing documentation that rates for certain conditions, such as asthma, are disproportionately higher among minority children.5 The consequences of these disparities can be profound, affecting activities of daily living, schooling, and other areas. The purpose of this article is to use information from research and other work emerging from the field of cultural competence and disparities reduction to suggest directions for research, practice, and service settings to address the needs of children. It presents 1990 and 2000 data from our project that profiled the nation's 100 largest cities and their suburban areas (defined as the metropolitan statistical areas [MSAs] sur rounding these cities) for families, children, and maternal/infant health to describe a subset of racial/ethnic disparities.6 Using these indicators and other research to docu ment progress as well as significant, continuing challenges, this article identifies four dimensions that contribute to racial/ethnic disparities: biologic/genetic factors, access, quality of care, and language and communication. Recommendations for future direc tions to address these dimensions are intended to guide practitioners and their health care settings as well as research focused on reducing disparities and improving cultural competence for this patient population.