Racial inequities remain a feature of the US health care landscape 20 years after the former Institute of Medicine (now the National Academy of Medicine) published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, a landmark report that found widespread racial and ethnic inequities in the quality of health care, even after accounting for access-related factors such as health insurance coverage. This publication summarizes findings from “Unequal Treatment at 20: Accelerating Progress Toward Health Care Equity,” a daylong symposium held at Urban’s headquarters in March 2023 that explored why racial and ethnic inequities in health care have persisted over the past 20 years.

Speakers at the symposium noted that while the nation has made progress toward improving the overall quality of care, many barriers to racial equity remain. They touched on an array of themes, including the following:

• Achieving health care equity requires addressing institutional and structural forms of racism operating both within health care systems and in society at large, such as persistent health care segregation, social and economic inequality that sets the stage for racial and ethnic health inequity, and political factors, such as the growing backlash against diversity, equity, and inclusion initiatives. 
• Both long-standing and newer challenges—including the explicit and implicit biases of health care providers and the biases of artificial intelligence and machine learning as clinical decision supports—must be addressed through research and policy tools, such as improved patient demographic data collection and monitoring for heath care inequity.
• No single intervention will mitigate against health care inequity; rather, comprehensive strategies that engage affected communities as full partners in system redesign are needed. 
• Community leaders and advocates, patients who experience inequity, policymakers, health care providers, health care systems administrators and regulators, civil rights leaders and litigators, and others will need to be involved in new research and policy strategies that can accelerate equity at state and federal levels.