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Ten ways to help end health care disparities.

We hear a great deal about "closing the gap" in health disparities in this country. To address these disparities, we must apply a multifaceted approach with leadership from the federal, educational, professional, financial, and business communities. Long-term and short-term strategies are needed.

Although it's important to keep in mind that health care disparities can relate to age, gender, disability status, sexual orientation, or other factors, I'd like to focus on health care disparities among racial and ethnic minorities. For patients, their race and ethnicity play a role in the quality of care available to them, according to the 2002 Institute of Medicine (IOM) report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care."

I ask all of you to learn about these issues. Fewer than half of U.S. medical schools offer courses in health disparities, and that's a problem.

Here are 10 steps we can take to get us closer to solutions:

1. Maintain the focus of federal, state, and professional groups on the increasing disparities in health care and research related to minority populations. There needs to be a national, broad-scale initiative to bring these concerns to the forefront. Repeated discussion of these issues will provide the many different constituents who will need to work together to address this national tragedy.

2. Support the 2003 IOM report, "Health Professions Education: A Bridge to Quality," which lists five core competencies: delivering patient-centered care, working as part of interdisciplinary teams, practicing evidence-based medicine, focusing on quality improvement, and using information technology. Patient-centered care includes identifying, respecting, and caring about patients' differences, values, preferences, and expressed needs.

We must also continue to support and acknowledge the assistance of international medical graduates, who bring a terrific sense of culture and a sense of duty to our medical profession. That they fill a void in our medical care should be seen as a small part of the overall solution to this underlying problem of disparities.

3. Be aware that just because health care providers speak the same language as most of the patients they're taking care of does not assure us that they are culturally competent in the care that they're providing. Adding a Spanish speaker to one's staff does not ensure culturally competent care for all Spanish-speaking patients.

4. Promote the statements that relate to diversity in the 2004 IOM report, "In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce." These statements should be discussed aggressively during accreditation visits. We must clearly define the diversity goals that need to be achieved and a mechanism to achieve them. We should hold institutions accountable if they don't achieve these goals. Penalties should be swift and stern.

5. Measure the success of programs that focus on identifying and mentoring minority students in high schools and colleges. If they are not producing the desired results, we must modify them or direct resources toward other avenues of recruitment.

6. Be direct and uncompromising when it comes to improving the education of our children, from preschool through college preparatory classes in high school. We must provide our students with counselors to help them understand all the possible career paths, provide them with mentoring, and teach the socialization skills required for success in the health care field.

7. Encourage the formation of partnerships between medical schools and historical black colleges and universities throughout the country to increase the number of underrepresented minority students admitted into the health professions. At the University of Nebraska, our relationship with Dillard University in New Orleans is only a couple of years old, and already we're seeing tremendous results. The relationship provides interaction and mentoring opportunities that aren't available otherwise. Both institutions benefit.

8. Initiate a national recruitment campaign similar to the Association of American Medical Colleges' "Project 3,000 by 2000" campaign, which aimed to increase the number of first-year medical students who were African American, Latino, or Native American to 3,000 by the year 2000. Campaign publicity brings awareness to our efforts and results in large increases in the number of qualifying minority students.

9. Recruit minority professionals to give their time to our cause, including professional organizations like the National Medical Association and health care institutions throughout the country. We must be committed to mentoring young people through shadowing and other types of activities to help them achieve careers in the health care professions.

10. Encourage dentists to participate in the broader mandate to achieve universal and continuous health coverage of all Americans. Oral health disparities comprise a silent epidemic among African Americans.

Prosperity can breed prosperity. We must reach back as we step forward. If it took a village to help you get to where you are today, then you must be part of a village that assists others to make and reach professional goals.

BY RUBENS J. PAMIES, M.D.

DR. RUBENS J. PAMIES is vice chancellor for academic affairs, dean for graduate studies, and professor of internal medicine at the University of Nebraska, Omaha.
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Title Annotation:Guest Editorial
Author:Pamies, Rubens J.
Publication:Internal Medicine News
Article Type:Editorial
Geographic Code:1USA
Date:Sep 15, 2004
Words:831
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