RWJF Perspective

Foundation Launches Diverse Programs to Address Disparities in Health Care

Numerous studies have documented that the quality of health care in America falls far short of the recommended standards, and that this problem is even worse for Americans from certain racial and ethnic backgrounds. While the evidence of these racial and ethnic gaps is strongest for African-American and Hispanic patients, it is highly likely that other racial and ethnic groups also experience lower-quality health care, although the problems are less well documented for others. More and more Americans are becoming aware of the existence of racial and ethnic disparities in health care, but most still do not understand the extent and consequences of the problem, and no one quite knows what to do to reduce the level of disparities that occur. While the quality of care any patient receives in any health care facility in America often varies depending on social and economic factors, numerous research studies show that African Americans and Hispanics routinely receive lower-quality treatment than whites – even when income level and insurance status are equal. While lower-quality health care is often associated with lower socioeconomic status, racial and ethnic disparities persist even when income level and insurance status are equal.

In September 2005, an opinion poll conducted by The Harvard School of Public Health, the Robert Wood Johnson Foundation (RWJF), and ICR/International Communications Research examined the extent to which the American public was aware of racial and ethnic disparities in health care. The results demonstrated that while the majority of Americans agree that many people have difficulty attaining quality health care due to their race or ethnicity, most still do not realize that the problem of getting quality care is worse for minorities than it is for whites. In fact, only 32 percent felt that the problem of attaining quality care is worse for African Americans and Hispanics than it is for whites.

The Robert Wood Johnson Foundation has long aimed to improve the quality of health care for the most vulnerable patients among us. Although the Foundation recognizes that the quality of one's health and health care results from myriad factors, we have chosen to focus on finding solutions that health care systems can rapidly adopt to reduce racial and ethnic gaps in care. The Foundation's goals are to make demonstrable progress in the following areas:

• Improving knowledge of the complicated set of factors that affect the magnitude and type of racial and ethnic disparities in care;
• Ensuring that health plans and providers have the data they need to develop fact-based strategies to reduce these gaps in care;
• Helping health plans, providers, and others test and implement real-world interventions that help reduce racial disparities in clinical settings; and
• Spreading the word on successful strategies nationwide, and ultimately moving health care systems to center quality health care around the needs of patients.

"The problem of racial and ethnic disparities in health care is one of the most sensitive and important issues facing the medical community today," said Risa Lavizzo-Mourey, MD, MBA, RWJF president and CEO. "While the research that has been conducted to date has been vitally important in understanding that this problem is real, we must move beyond documenting the existence of disparities and shift our focus to developing and testing solutions."

Dr. Lavizzo-Mourey served as co-vice chair of the Institute of Medicine committee that produced the 2003 report, "Unequal Treatment," which documented health care disparities in racial and ethnic groups. She played a significant role in the development of the Foundation's strategy, and since the 2003 report, RWJF has taken decisive actions to ensure that racial disparities in health care are addressed in this country.

"As the nation's largest Foundation devoted exclusively to health care, RWJF has a unique responsibility to help find answers to this seemingly insolvable problem," said Lavizzo-Mourey.

"We have worked with national experts on disparities, health care providers working in typical clinical settings, leaders of large and small hospitals, insurers and groups representing patients to develop our strategy. We are now on a course to identify specific quality improvements that can be evaluated, quantified and replicated in diverse clinical settings in order to reduce racial and ethnic disparities for patients from all backgrounds."

RWJF Initiatives

Over the next three years, the Foundation aims to significantly reduce racial disparities through three important new initiatives, in addition to numerous other disparities-related projects the Foundation funds.

RWJF's major initiative to combat racial and ethnic disparities is Expecting Success: Excellence in Cardiac Care, directed by Bruce Siegel, M.D., M.P.H., research professor at The George Washington University School of Public Health and Health Services. This program is working with 10 hospitals to improve the quality of cardiac care provided to patients of color. Part of the program will focus on care provided within the hospital setting; part of the program focuses on supporting demonstration projects to extend the continuum of care into the communities where patients live.

Two other programs recently unveiled are Finding Answers: Disparities Research for Change, an initiative led by Marshall H. Chin, M.D., M.P.H., associate professor of Medicine at the University of Chicago, and Leading Change: Disparities Solutions Initiative, led by Joseph R. Betancourt, M.D., M.P.H., assistant professor of Medicine at Harvard Medical School, and senior scientist at the Institute for Health Policy at Massachusetts General Hospital. Finding Answers will focus on evaluating interventions and strategies aimed at reducing disparities, and Leading Change will integrate and disseminate the results of Finding Answers and other disparities projects funded by RWJF and use these results to inform leadership and technical assistance activities aimed at helping health care systems develop and implement successful disparities interventions. Both programs will work together to advance the pursuit and implementation of practical solutions for eliminating racial and ethnic disparities in health care.

"We are committed to identifying solutions that can have a national impact and directly affect the lives of African-American and Hispanic patients," said Lavizzo-Mourey. "Our initiatives will help raise public awareness of the problem, but more important, they will highlight the best and most promising approaches that hospitals and health care plans can utilize. The results will be crucial to improving the quality of health care for all Americans."

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The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.

 

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