Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare

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When the Institute of Medicine (IOM) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care issued its report in March 2002 [1], it created a stir not unlike the one that greeted the announcement of two other influential, and somewhat controversial reports, the report on patient safety and that on the quality chasm. The press, by and large, reported the bottom line on the racial and ethnic disparity study: that the quality of care received by racial and ethnic minorities in this country is generally lower than that provided to the majority population. Does this mean that the IOM report says that doctors and nurses in America are racist? The answer is “no,” and the press generally reported this accurately. The study explicitly says that there is no evidence that any significant proportion of healthcare professionals in the United States harbors overtly prejudicial attitudes. However, the study does say that our society still reflects attitudes and behaviors that can fairly be called discriminatory, which should come as no surprise to anyone. It also says that doctors and other clinicians are human and are influenced by the environment in which they live and practice, and that among the multiple complex factors that influence their decisions, bias and stereotypical behavior may play a role. But its most important contribution, in my view, is its attempt to understand and lay out how racial and ethnic disparities come about and what we, as professionals, should be doing about it. This is what I would like to focus on today. The committee gave considerable thought to a name for the study and selected Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The implications of the title were carefully weighed. “Unequal Treatment” stands in contrast to “equal treatment under the law,” as defined in the 14th amendment to the Constitution of the United States. The word “confronting” clearly points to a portion of its charge that the committee took equally seriously: to recommend interventions that can be undertaken to try eliminate such racial and ethnic disparities. The study on racial and ethnic disparities was commissioned by the Congress, and had as its specific charge: