WASHINGTONWell-documented racial and ethnic disparities exist in health
care even among individuals with the same income and health insurance, and a
significant part of the problem lies with the health care system and its
professionals, according to a report by the Institute of Medicine (IOM).
"Disparities in the health care delivered to racial and ethnic
minorities are real and are associated with worse outcomes in many cases,"
said Alan R. Nelson, MD, who chaired the committee that wrote the report.
"And because death rates from cancer, heart disease, and diabetes are
significantly higher in racial and ethnic minorities than in whites, these
disparities are unacceptable."
Surprise and Shock
He described some of the committee’s 15 members as surprised, even
shocked, at the amount of evidence documenting the disparity problem. "We
were not unaware of the extent of the disparity. We were surprised at the
breadth and depth of the evidence," said Dr. Nelson, who is special
advisor to the chief executive officer of the American College of Physicians-American
Society of Internal Medicine and a former president of the American Medical
Determining the extent of excess mortality among minorities resulting from
differences in care was impossible, but the preponderance of evidence
demonstrates disparities across a number of diagnostic and treatment
procedures, said Joseph R. Betancourt, MD, a senior scientist at Harvard
Medical School’s Institute for Health Policy.
He cited, as one example, a 1999 study by epidemiologist Peter B. Bach, MD,
of Memorial Sloan-Kettering Cancer Center, and his collaborators, which looked
at racial differences in the treatment of 10,984 patients with resectable stage
I/ II non-small-cell lung cancer.
"African-Americans underwent surgery for resectable lung cancer
considerably less often," Dr. Betancourt said. "The African-American
patients who did undergo surgery had the same mortality rate as the whites who