EquiCare Toolkit

Overview: The EveryONE project toolkit empowers healthcare providers to define and promote health equity in their practices. It offers practical guidance on a range of topics including implicit bias training for staff and assessing patients’ social needs.

American Academy of Family Physicians. (n.d.). The Everyone Project. https://www.aafp.org/family-physician/patient-care/the-everyone-project.html

Overview: A recent report from the Commonwealth Fund, Advancing Racial Equity in U.S. Health Care: The 2024 State Health Disparities Report, highlights persistent racial and ethnic disparities in health care access, quality, and outcomes across the U.S. The analysis reveals stark divides in premature deaths, with Black Americans and American Indians disproportionately affected by preventable and treatable conditions, even in states with high-performing health systems. Using 25 measures, the report evaluates state performance across health care access, service quality, and outcomes for Black, white, Hispanic, American Indian and Alaska Native (AIAN), and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. It provides a comprehensive state-by-state overview of how health care systems serve diverse communities. The tool is designed to help policymakers, health system leaders, and community stakeholders assess the impact of current and past health policies on different racial and ethnic groups and guide efforts toward creating a more equitable health care system for the future.

Commonwealth Fund. (2024). Advancing racial equity in U.S. health care. https://www.commonwealthfund.org/publications/fund-reports/2024/apr/advancing-racial-equity-us-health-care

Overview: The second edition of APA’s Inclusive Language Guide builds on its 2021 version, reaffirming the American Psychological Association’s commitment to equity, diversity, and inclusion. This guide highlights the power of language, explains why certain terms are harmful to marginalized communities, and offers culturally sensitive alternatives. It also provides the origins of problematic phrases and encourages respect by using terms individuals identify with. The guide emphasizes continual learning and adaptation as language evolves, supporting effective communication in a diverse and inclusive society.

American Psychological Association. (2023). Inclusive language guide (2^nd ed.). https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines.pdf

Abstract: Child health disparities in terms of access to high-quality physical and behavioral health services and social needs supports are rampant and pernicious in the United States. These disparities reflect larger societal health inequities (social injustice in health) and lead to preventable population-specific differences in wellness outcomes with marginalized children facing substantial and systematically disproportionate health burdens. Primary care, and specifically the pediatric patient-centered medical home (P-PCMH) model, is a theoretically well-positioned platform to address whole-child health and wellness needs, yet often does so in a way that is inequitable for marginalized populations. This article delineates how the integration of psychologists within the P-PCMH can advance child health equity. This discussion emphasizes roles (i.e., clinician, consultant, trainer, administrator, researcher, and advocate) that psychologists can undertake with explicit intentionality toward promoting equity. These roles consider structural and ecological drivers of inequities and emphasize interprofessional collaboration within and across child-serving systems of care using community-partnered shared decision-making approaches. Owing to the multiple intersecting drivers implicated in health inequities—ecological (e.g., environmental and social determinants of health), biological (e.g., chronic illness, intergenerational morbidity), and developmental (e.g., developmental screening, support, and early intervention)—the ecobiodevelopmental model is used as an organizing framework for psychologists’ roles in promoting health equity. This article aims to advance the platform of the P-PCMH to address and promote policy, practice, prevention, and research in child health equity and the important role of psychologists within this model.

Shahidullah, J. D., Hostutler, C. A., Coker, T. R., Allmon Dixson, A., Okoroji, C., & Mautone, J. A. (2023). Child health equity and primary care. American Psychologist, 78(2), 93–106. https://doi.org/10.1037/amp0001064

Abstract: The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report on Implementing High-Quality Primary Care identifies 5 high-level objectives regarding payment, access, workforce development, information technology, and implementation. Nine junior primary care leaders (3 internal medicine, 3 family medicine, 3 pediatrics) invited from broad geographies, practice settings, and academic backgrounds used appreciative inquiry to identify priorities for the future of primary care. Highlighting the voices of these early career clinicians, we propose a response to the report from the perspective of early career primary care physicians. Health equity must be the foundation of the future of primary care. Because Barbara Starfield’s original 4 Cs (first contact, coordination, comprehensiveness, and continuity) may not be inclusive of the needs of under-resourced communities, we promote an extension to include 5 additional Cs: convenience, cultural humility, structural competency, community engagement, and collaboration. We support the NASEM report’s priorities and its focus on achieving health equity. We recommend investing in local communities and preparatory programs to stimulate diverse individuals to serve in health care. Finally, we support a blended value-based care model with risk adjustment for the social complexity of our patients.

Henry, T. L., Britz, J. B., Louis, J. S., Bruno, R., Oronce, C. I. A., Georgeson, A., Ragunanthan, B., Green, M. M., Doshi, N., & Huffstetler, A. N. (2022). Health equity: The only path forward for primary care. Annals of Family Medicine, 20(2), 175–178. https://doi.org/10.1370/afm.2789

Abstract – Background: Healthy People provides science-based, 10-year targets for public health objectives for the U.S. population. As in the preceding two decades, Healthy People 2020(HP2020) included an overarching goal related to health disparities. Objective: This report examines changes in health disparities overtime by race and ethnicity for HP2020 objectives using three measures of disparity. Methods: Data were analyzed for 506 objectives from 68 data sources from 2001 to 2018. Analyses were restricted to HP2020 objectives with data by race and ethnicity at the baseline and final timepoints for a minimum set of population groups. Health disparities by race and ethnicity were evaluated using three measures that were used in HP2020: the maximal rate difference, maximal rate ratio, and summary rate ratio. Changes in disparities over time were evaluated by comparing the baseline and final timepoints for each of the respective measures. Based on the statistical significance of the change (n= 469) or, when statistical significance could not be assessed, the magnitude of the change(n= 37), each of the disparities measures was categorized as having narrowed, shown little or no detectable change, or widened. Analyses were conducted to compare findings and evaluate agreement in the change categories. Results: Little or no change was detected in disparities for most of the objectives, regardless of the measure used (76.9%for the maximal rate difference, 83.3% for the maximal rate ratio, and 92.1% for the summary rate ratio). Foreach measure, a slightly higher percentage of objectives were categorized as having narrowed rather than widened in disparities. Agreement in the disparities change categories across objectives was 75.6% for the three measures. Conclusion: These findings show that health disparities persist and that multiple measures provide different approaches for assessing progress toward their elimination.

Huang, D. T., Bassig, B. A., Hubbard, K., Klein, R. J., & Talih, M. (2022). Examining progress toward elimination of racial and ethnic health disparities for Healthy People 2020 objectives using three measures of overall disparity. Vital Health Statistics, 2(195). https://doi.org/10.15620/cdc:121266

Overview: This report summarizes evidence demonstrating how decades of systemic health inequities have yielded significantly worse outcomes for racial and ethnic minoritized, marginalized, and under resourced populations.  The study discussed aims to address a critical gap in behavioral health and health equity research related to mental health inequities. Building on three landmark reports published over 20 years ago, this study seeks to illuminate the economic impact of the nation’s failure to invest in behavioral health interventions, services, treatments, supports, and programs.

Satcher Health Leadership Institute, Morehouse School of Medicine. (2022). The economic burden of mental health inequities in the United States: Report. https://satcherinstitute.org

Abstract: The COVID-19 pandemic has illuminated and amplified the harsh reality of health inequities experienced by racial and ethnic minority groups in the United States. Members of these groups have disproportionately been infected and died from COVID-19, yet they still lack equitable access to treatment and vaccines. Lack of equitable access to high-quality health care is in large part a result of structural racism in US health care policy, which structures the health care system to advantage the White population and disadvantage racial and ethnic minority populations. This article provides historical context and a detailed account of modern structural racism in health care policy, highlighting its role in health care  coverage, financing, and quality.

Yearby, R., Clark, B., & Figueroa, J. F. (2022). Structural racism in historical and modern U.S. health care policy. Health Affairs (Millwood), 41(2), 187–194. https://doi.org/10.1377/hlthaff.2021.01466

Abstract: This article reassesses and recontextualizes findings of an independent writing group commissioned in 2005 by what was then known as the Institute for Ethics of the American Medical Association (AMA). The authors were members of this group, which uncovered a paradigm case of structural racism that has perpetuated health inequity since the issue of admitting African Americans was first raised at the AMA’s national meetings immediately after the Civil War ended, in 1868. Upon publication of the writing group’s findings, the AMA publicly apologized for its social, cultural, and political roles in the racist history of organized medicine. Now, in 2021, the authors of this article seek to situate this aspect of the AMA’s history as it prepares itself for antiracist leadership in the health care sector.

Baker, R., & Wynia, M. K. (2021). Living histories of structural racism and organized medicine. AMA Journal of Ethics, 23(12), E995–E1003. https://doi.org/10.1001/amajethics.2021.995

Abstract: Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.

Gopal, D. P., Chetty, U., O’Donnell, P., Gajria, C., & Blackadder-Weinstein, J. (2021). Implicit bias in healthcare: Clinical practice, research, and decision-making. Future Healthcare Journal, 8(1), 40–48. https://doi.org/10.7861/fhj.2020-0233

Abstract — Background: The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation’s underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations. Methods and findings: In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA’s pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk. Conclusion: HHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.

Streeter, R. A., Snyder, J. E., Kepley, H., Stahl, A. L., Li, T., & Washko, M. M. (2020). The geographic alignment of primary care health professional shortage areas with markers for social determinants of health. PLOS ONE, 15(4), e0231443. https://doi.org/10.1371/journal.pone.0231443

Abstract: The American Academy of Pediatrics is committed to addressing the
factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families.

American Academy of Pediatrics, Section on Adolescent Health, Council on Community Pediatrics, & Committee on Adolescence. (2019). The impact of racism on child and adolescent health [Policy Statement]. Pediatrics, 144(2), Article e20191765. https://doi.org/10.1542/peds.2019-1765

Overview: APA’s 2019 guidelines emphasize the core values of psychology and provide insights on addressing race and ethnicity in practice, research, and education.

American Psychological Association, APA Task Force on Race and Ethnicity Guidelines in Psychology. (2019). Race and ethnicity guidelines in psychology: Promoting responsiveness and equity. APA Task Force on Race and Ethnicity Guidelines in Psychology. https://www.apa.org/about/policy/approved-guidelines

Overview: This issue brief highlights the importance of addressing social, economic, and environmental factors to improve health and achieve health equity. It provides an overview of social determinants of health and identifies emerging initiatives to tackle them.

Artiga, S., & Hinton, E. (2018). Beyond health care: The role of social determinants in promoting health and health equity (Issue Brief). Kaiser Family Foundation.   https://resource.nlm.nih.gov/101740257

Overview: The report The Road to Achieving Equity, commissioned by Robert Wood Johnson Foundation (RWJF), concluded  that while the term health equity is widely used, its meaning often lacks a shared understanding.  This report aims to foster discussion and promote consensus on the definition of health equity and its actionable  implications within RWJF’s Culture of Health Action Framework. The goal is not to standardize the definition of health equity but to identify key elements that drive effective action. This report is the first in a series addressing critical challenges in advancing health equity. In this context, ‘health’ refers to health status itself, distinct from health care, which is just one of many factors influencing health. The concepts discussed are grounded in widely accepted ethical and human rights principles and informed by evidence from the health sciences.

Braveman, P., Arkin, E., Orleans, T., Proctor, D., & Plough, A. (2017). What is health equity? And what difference does a definition make? Princeton, NJ: Robert Wood Johnson Foundation.  https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf437393

Abstract: Policymakers and others concerned about public health often speak of the need to achieve health equity. Yet the term can mean different things to different people. For  government, other organizations, and communities, lack of shared understanding can be a serious obstacle to effective action. This lack of understanding makes it difficult to agree on concrete goals and criteria for success and can lead to wasted efforts, with policies and practices that work at cross-purposes. This article provides a carefully constructed definition of health equity and discusses the definition’s implications both for action and for assessing progress toward health equity.

Braveman, P., Arkin, E., Orleans, T., Proctor, D., Acker, J., & Plough, A. (2018). What is health equity? Behavioral Science & Policy, 4(1), 1–14. https://doi.org/10.1177/237946151800400102

Abstract – Introduction: This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC). Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization. Results: Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning. Discussion: We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model.

Bridges, A. J., Villalobos, B. T., Anastasia, E. A., Dueweke, A. R., Gregus, S. J., & Cavell, T. A. (2017). Need, access, and the reach of integrated care: A typology of patients. Families, Systems, & Health, 35(2), 193–206. https://doi.org/10.1037/fsh0000268

Abstract: Healthcare disparities, which represent differential treatment by patient race and the experience of bias within the medical system in ways that cannot be accounted for by medical factors, systematically contribute to the relatively poor health of members of stigmatized groups internationally. We focus on bias in healthcare experienced by Blacks relative to Whites in the USA because, practically, these disparities are significant and socially consequential, and, empirically, these disparities are the most comprehensively documented and studied. Specifically, we describe the nature and extent of racial bias among healthcare providers; examine the effects of these biases on treatment, behavior toward Black patients, and the responses and perceptions of Black patients; and suggest ways of reducing the negative effects of racial bias in healthcare. Although physicians generally inhibit the direct effects of conscious (explicit) bias in the healthcare they provide, implicit bias, both independently and in combination with explicit attitudes, plays an influential role in the dynamics of physicians’ healthcare interactions with Black patients, producing lower quality care. We further identify several theory-based interventions to limit, and potentially eliminate, the negative consequences of provider biases within the medical context, recognizing the active roles that both providers and patients have in these exchanges.

Dovidio, J. F., Eggly, S., Albrecht, T. L., Hagiwara, N., & Penner, L. (2016). Racial biases in medicine and healthcare disparities. Testing, Psychometrics, Methodology in Applied Psychology, 23(4), 489–510. https://doi.org/10.4473/TPM23.4.5

Abstract – Importance: Black, Hispanic, and Native American physicians remain underrepresented in medicine despite national efforts to increase diversity in the health care workforce. Understanding the unique workplace experiences of minority physicians is essential to inform strategies to create a diverse and inclusive workforce. While prior research has explored the influence of race/ethnicity on the experiences of minority faculty and medical students, there is a paucity of literature investigating how race/ethnicity affects the training experiences of resident physicians in graduate medical education. Objective: To characterize how black, Hispanic, and Native American resident physicians experience race/ethnicity in the workplace. Design, setting, and participants: Semistructured, in-depth qualitative interviews of black, Hispanic, and Native American residents were performed in this qualitative study. Interviews took place at the 2017 Annual Medical Education Conference (April 12-17, 2017, in Atlanta, Georgia), sponsored by the Student National Medical Association. Interviews were conducted with 27 residents from 21 residency programs representing a diverse range of medical specialties and geographic locations. Main outcomes and measures: The workplace experiences of black, Hispanic, and Native American resident physicians in graduate medical education. Results: Among 27 participants, races/ethnicities were 19 (70%) black, 3 (11%) Hispanic, 1 (4%) Native American, and 4 (15%) mixed race/ethnicity; 15 (56%) were female. Participants described the following 3 major themes in their training experiences in the workplace: a daily barrage of microaggressions and bias, minority residents tasked as race/ethnicity ambassadors, and challenges negotiating professional and personal identity while seen as “other.” Conclusions and relevance: Graduate medical education is an emotionally and physically demanding period for all physicians. Black, Hispanic, and Native American residents experience additional burdens secondary to race/ethnicity. Addressing these unique challenges related to race/ethnicity is crucial to creating a diverse and inclusive work environment

Osseo-Asare, A., Balasuriya, L., Huot, S. J., Keene, D., Berg, D., Nunez-Smith, M., Genao, I., Latimore, D., & Boatright, D. (2018). Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Network Open, 1(5), e182723. https://doi.org/10.1001/jamanetworkopen.2018.2723

Abstract: Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary’s Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee’s work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.

Braveman, P. A., Kumanyika, S., Fielding, J., Laveist, T., Borrell, L. N., Manderscheid, R., & Troutman, A. (2011). Health disparities and health equity: The issue is justice. American Journal of Public Health, 101(Suppl 1), S149–S155. https://doi.org/10.2105/AJPH.2010.300062

Abstract: There is little consensus about the meaning of the terms “health disparities,” “health inequalities,” or “health equity.” The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. (“Social advantage” refers to one’s relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.

Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167–194. https://doi.org/10.1146/annurev.publhealth.27.021405.102103

Abstract – Context: Studies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions. Objective: To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes. Design, setting, and participants: An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient. Main outcome measures: IAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire. Results: Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009). Conclusions: This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.

Green, A. R., Carney, D. R., Pallin, D. J., Ngo, L. H., Raymond, K. L., Lezzoni, L. I., & Banaji, M. R. (2007). Implicit bias among physicians and its prediction of thrombolysis decisions for Black and White patients. Journal of General Internal Medicine, 22(9), 1231–1238. https://doi.org/10.1007/s11606-007-0258-5

Overview: Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients’ and providers’ attitudes, expectations, and behavior are analyzed. Unequal Treatment also offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care (B. D. Smedley, A. Y. Stith, & A. R. Nelson, Eds.). Washington, DC: National Academies Press. https://doi.org/10.17226/12875