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1	How Can We Intervene to Eliminate Racial and Ethnic Disparities in Health Care? From the IOM Report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare Brian D. Smedley, Ph.D. Institute of Medicine
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3	Age-Adjusted Death Rates by Sex, Race, and Hispanic Origin
4	Age-Adjusted Death Rates per 100,000 for Selected Causes of Death by Race and Ethnicity
5	Probability of being uninsured for population under age 65, by race and ethnicity
6	Percentage of Adults Age 18 and Older Without a Regular Doctor
7	Access to Specialty Care by Adults, By Race and Hispanic Origin, 1994
8	Percentage of Adults Who Believe They Would Receive Better Health Care if They Were of a Different Race and/or Ethnicity
9	STUDY CHARGE – IOM Unequal Treatment Report
10	Evidence of Racial and Ethnic Disparities in Healthcare Disparities consistently found across a wide range of disease areas and clinical services Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account Disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc. Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995)
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13	What are Potential Sources of Racial/Ethnic Health Care Disparities? Health systems-level factors – financing, structure of care; cultural and linguistic barriers Patient-level factors – including patient preferences, refusal of treatment, poor adherence, biological differences Disparities arising from the clinical encounter
14	Potential Sources of Racial and Ethnic Healthcare Disparities – Healthcare Systems-Level Factors
15	Potential Sources of Disparities: The Clinical Encounter Patients’ attitudes toward health care and preferences for treatment Physicians’ conscious and unconscious stereotypes and biases Characteristics of health care settings that may encourage stereotypes and biases – time pressure, resource constraints, complex problems
16	Effects of Stereotyping: What the Research Shows Stereotypes: Can exert powerful effects on thinking and actions at an implicit, unconscious level, even among well-meaning, well-educated persons who are not overtly biased. Can influence how information is processed and recalled. Can exert “self-fulfilling” effects, as patients’ behavior may be affected by providers’ overt or subtle attitudes and behaviors.
17	“Patients” experiencing symptoms of heart disease, from Schulman et al. (1999)
18	“Patients” experiencing symptoms of heart disease, from Schulman et al. (1999)
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20	Federal and State Regulatory and Policy Strategies
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22	The Role of Accrediting Organizations Encourage data collection and monitoring for disparities in access to and quality of care Encourage the development, implementation and evaluation of system-wide “cultural competency” interventions Encourage diversity efforts in health professions schools and, among hospitals and health systems, recruitment of underrepresented minority health professionals
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