On March 25, 1966, at a press conference before the second convention of the Medical Committee for Human Rights, Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.”
Nearly four decades later, a panel of health experts published the landmark report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The 2003 report documented disparities in health care for numerous racial and ethnic groups and across virtually all medical specialties, including cardiology, obstetrics, oncology, and emergency medicine. The committee found that racial and ethnic gaps in the quality of care were “remarkably consistent,” even after accounting for access-related factors, such as income and insurance status.
Echoing King’s observation of inequities in mortality, the Unequal Treatment study also found that racial and ethnic disparities in health care are associated with higher death rates for patients of color. Yet, despite the national attention garnered by the report’s disturbing findings, little progress has been made toward ending these systemic injustices.
On March 21, in observance of the 20th anniversary of the Unequal Treatment report, the Urban Institute will host a day-long symposium to explore how far the nation has come—and how far it has yet to go—to end the injustice of health care inequality. The symposium is the first major stop for a cohort of health equity experts, whose mission is to launch a new program of action to elevate health care inequities as a national priority and build momentum for key remedies and structural reforms.
The project’s multidisciplinary team has pinpointed, from the start, three core areas that must be addressed if the nation is to write a new chapter on health and health care delivery for people of color.
Establish mechanisms of public- and private-sector accountability
For two decades, the federal Agency for Healthcare Research and Quality has tracked racial and ethnic disparities, but no federal accountability mechanism exists for health care institutions. Accountability mechanisms offer an indispensable tool for exposing racial discrimination and pointing toward solutions in other federal institutions and sectors. The federal Home Mortgage Disclosure Act, for example, requires financial institutions to provide mortgage data to the public, including the race and ethnicity of applicants, the disposition of their application, and the types of loan products sold.
Despite this data disclosure, racial disparities in homeownership persist, suggesting accountability mechanisms for racial equity need to be continually assessed to ensure fairness and identify other changes needed. President Biden’s second executive order on equity, which requires the review and strengthening of federal agency equity plans each year, is a promising pathway to ensuring ongoing federal accountability.
Data collection can also be the linchpin of equity accountability in health care. But Urban Institute researchers found that key barriers to race and ethnicity data collection persist, including legal concerns, organizational capacity, and patient mistrust when self-reporting personal data. But the health system can reduce these barriers through a combination of “carrots” (e.g., financial incentives and administrative staff training) and “sticks” (e.g., improved federal and state guidance and enforcement of existing laws).
Center community engagement in research and policy development
When the Unequal Treatment report was published, many advocates and clinicians fighting for health care equity were hopeful that action would be imminent, given the weight of the evidence and the moral urgency. Today, even with the many important equity-related provisions of the 2010 Affordable Care Act, the prospects for concerted public- and private-sector action appear uncertain.
To press the system toward greater accountability and solutions, advocates and clinicians can elevate the voices of the patients affected by inequity in care. Their experiences can give rise to a new generation of community-engaged equity research, informing questions and shaping more effective policies and practices. Their ideas about system redesign can help close the gulf between consumers’ needs and how health care is financed and delivered. And their voices and stories could help build political will for action.
Galvanize political will across sectors
Although strong research and policy analysis alone aren’t enough, they’re important information drivers for racial justice movements that can spur political will. Racial justice movements are taking root in communities around the world, sparked in many instances by the continuing outrage of seeing Black, Latinx, and Indigenous people abused at the hands of police. Advocates, researchers, and policymakers should actively look to expose how racism remains endemic in educational, carceral, criminal justice, and health care systems, and how these systems often intertwine, which compounds their effects. Such an intersectoral analysis can help build broader alliances and a deeper understanding of the structural underpinnings of racial inequality.
Urban’s symposium on March 21, Unequal Treatment at 20: Accelerating Progress toward Health Care Equity, will gather researchers, policymakers, advocates, and individuals with lived experiences of inequity to discuss challenges to and opportunities for greater progress. We hope to build the new connections, strategies, and commitments necessary to advance the moral imperative of equity in health care. Our commitment is to curate what we learn from this day of engagement to support health care equity campaigns in the years to come, so that 20 years from now, we can say unequal treatment is a thing of the past.