A Word From the President: Eliminating Health Disparities to Improve the Health of All
AAMC Reporter: October 2011
We all have seen the headlines calling attention to the troubling state of health disparities in our nation. According to the Centers for Disease Control and Prevention, African American, Hispanic, Asian American, American Indian, and Alaska Native populations have higher mortality rates than other populations, while other research has shown differences of up to 33 years of life expectancy between various racial and geographic groups in the United States. Health disparities directly reflect social determinants of health and are higher in communities where there is greater poverty, more stress, less access to fresh foods, and less recreational space. Disparities are also connected to increased medical errors, prolonged hospital stays, avoidable hospitalizations and readmissions, overand under-utilization of procedures, and failures in timely referral to specialist care. Given these factors, reducing health disparities is more than just the right thing to do—it is a critical component of improving health care quality.
Academic medical centers are active partners in improving the health of their local communities. While our members represent only 6 percent of all hospitals in the United States, they and their faculty physicians provide 40 percent of all hospital-based charity care. Teaching hospitals also are more likely to offer community programs like AIDS services and nutrition counseling. In short, AAMC-member institutions treat a disproportionate share of the sickest patients with the most complex illnesses, serving as the sites for approximately 29 percent of all Medicaid and 19 percent of all Medicare hospitalizations.
Three years from now, in 2014, the U.S. health system will begin accommodating the first of the 32 million Americans newly insured through the Affordable Care Act, including individuals who may not have had regular health care before. This incredible influx will demand that academic medicine accelerates its efforts to address health disparities. How can we intensify our efforts?
First, we must educate and train a more diverse health professions workforce. Under the leadership of Marc Nivet, Ed.D., AAMC chief diversity officer, we are now working with a broader definition of diversity that builds upon its historical origins in gender, racial, and ethnic equity, and also includes factors like socioeconomic status, geography, language, nationality, gender identity, sexual orientation, religion, disability, and age. A more diverse health workforce will enhance the educational experience for all health professions students by allowing them to interact in teams that are more representative of the U.S. population.
The second way in which academic medicine can contribute to fighting disparities is by educating a culturally competent health workforce. To borrow from Terry Cross and colleagues, culturally competent care enables “effective work in cross-cultural situations.” A diverse and culturally competent workforce is essential given recent Census estimates that minorities are on track to become the majority by 2042.
Finally, academic medicine can leverage the emerging fields of comparative effectiveness research (CER) and implementation science. CER compares different medicines, devices, or ways of delivering care to find which ones work best for different population subgroups. Academic medical centers are building their capacities to conduct CER, and the knowledge they gain will help many currently disadvantaged communities. Implementation science studies how best to move what we learn from CER into everyday practice. Through implementation science, researchers, clinicians, and community leaders are taking the results of exemplary pilot studies and bringing them to scale.
Researchers in academic medical centers have developed many interventions for communities with seemingly intractable disparities, and these interventions are now ready for broader dissemination. Successful programs include community-based approaches to reducing emergencies among children with asthma, reductions in hypertension, and better self-care of diabetes and other chronic conditions, to name just a few. Many of these interventions were successful because researchers engaged directly with community members, who expressed concerns and preferences and helped design interventions responsive to their needs.
In recognition of our need to accelerate efforts to reduce and eventually eliminate health disparities, the AAMC is partnering with leading health and academic organizations on two new efforts.
The first is the Equity of Care campaign, a national call to action to eliminate health disparities. The effort has three primary objectives. First, it seeks to increase the collection of race, ethnicity, and language data of all hospital patients upon admission to better track and compare outcomes. Second, it calls for all clinicians and hospital support staff to receive cultural competence training so that they appropriately and sensitively approach different patient populations. And third, the Equity of Care efforts seek to increase diversity among health system boards and leadership teams, making them more reflective of the patient populations they serve to ensure a greater awareness and capacity to address health equity challenges. For more information on this important effort, please visit www.equityofcare.org.
The second new initiative to address health disparities is called U-HEALTH (Universities for Health Equity through Alignment, Leadership, and Transformation of the Healthcare Workforce). A partnership among the AAMC, the Coalition of Urban Serving Universities/Association of Public and Land-grant Universities (USU/APLU), and the National Institute on Minority Health and Health Disparities (NIMHD) of the National Institutes of Health, U-HEALTH is the first-ever partnership of a coalition of university presidents and a major medical association to focus on improving health equity by transforming the health workforce.Together, our organizations have committed to create a learning and data collaborative that will inform national policy and practice, and apply lessons learned to a broader constituency of higher education institutions. U-HEALTH is led by Dr. Nivet, whose “Viewpoint” on the next page can give you more information about this important new partnership.
Our health system faces many challenges. But if we are to achieve our mission “to improve the health of all,” we must reinvigorate and accelerate our efforts to reduce health disparities.
Darrell G. Kirch, M.D.
AAMC President and CEO