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While health disparities are “obviously a life or death issue among people of color,” the IOM’s Smedley says, the issue should be of grave concern to everyone. If subjective considerations affect the quality of care an individual receives, he points out, “this presents a serious problem for all Americans.” Who’s to say where such subjectivity could strike next?
If ingrained prejudice and racism do indeed exist, what can be done about it? The IOM report called for “comprehensive solutions at the federal level,” including close monitoring of present disparities, such as rates of infant mortality, life expectancy, and cancer survival, says Smedley. The public, health care providers, insurance companies, and policymakers should be made aware of the problem, the panel concluded. And health institutions should introduce policies—such as evidence-based guidelines—to ensure consistency in treatment and referrals. In addition, says Smedley, “steps need to be taken to increase the diversity of health care providers.”
Although the report found that the quality of care doesn’t seem to be better when the doctor and patient are of the same ethnicity, concordance of race can make a difference in a patient’s perception of care. According to a 2002 study by LaVeist and Johns Hopkins doctoral candidate Amani Nuru-Jeter published in the Journal of Health and Social Behavior, patients “who were race-concordant” with their physicians “reported greater satisfaction” with their treatment. The findings led the authors to recommend “support for the continuation of efforts to increase the number of minority physicians, while placing greater emphasis on improving the ability of physicians to interact with patients who are not of their own race.”
Says LaVeist, “Patient satisfaction is an important component of quality care. We know from previous studies that a patient’s comfort level will determine compliance.” Of course, a patient following the prescribed treatment regime will be more likely to achieve the best results.
The Urban Medical Institute (UMI) in the Park Heights section of West Baltimore occupies the campus of what was once Liberty Hospital, the city’s first black hospital. Purchased by Bon Secours in 1996, the facility’s new mission is to provide clinical services and community outreach for the Park Heights community. Most of the doctors here look like the patients they treat. Pat Schmoke, wife of former Baltimore Mayor Kurt Schmoke, runs a busy ophthalmology practice on the second floor, not far from the offices of Athol Morgan, a Johns Hopkins–trained cardiologist renowned for achieving high rates of patient compliance and survival. Both are African-American.
When the Institute was established, LaVeist took a six-month leave of absence to work at UMI in an effort to “create a research infrastructure.” In other words, he helped to establish protocols for taking patient data and tracking maladies—information that continues to prove invaluable in his research. Institute director Phil Christian takes great pride in UMI’s contributions to LaVeist’s work. “He is intimately knowledgeable of this population, and his perspective is extremely important to where we are,” Christian says of LaVeist. “Whenever he publishes something, those of us at ground zero believe it.”
In his work at the Institute, Christian has identified a related disparity: differences in pay scales and the costs associated with medical services between public and private facilities.