Frontiers of Health Services Management - Spring 2014 - (Page 38)

Expanding the Evidence Base for Health Equity t hoMaS l a V eiSt C O M M E N T A R Y I n 2 0 02 , t h e Institute of Medicine (IOM) published Unequal Treatment, a compilation of studies documenting inequities in healthcare quality among racial and ethnic minority patients. Unequal Treatment made a powerful presentation of the evidence that was impossible to ignore. The report was compelling mainly because all of the patients in the studies summarized in the report were insured and had access to healthcare. The disparities outlined in Unequal Treatment were not caused by a lack of access to healthcare; they essentially resulted from "unequal treatment." Since 2002, advocates for efforts to address health inequities have relied on a social justice narrative to urge healthcare leaders and government to deploy resources to solve this long-standing problem. They argue that addressing disparities is the "right thing to do," that disparities are inconsistent with the values of the society. The social justice frame proved convincing to some. However, initiatives to eliminate disparities in care have more often focused on cultural competence training for clinicians or diversity awareness programs. Both approaches seem necessary, but they are likely insufficient to address the massive systemic problems outlined in the IOM report. The healthcare industry's tepid response to health inequities is perhaps the result of an inability to measure cultural competence or an inadequate evidence base from which to take definitive action. If we cannot determine what specific factors within the healthcare system are causing the disparities, how are we to determine where to take action? And if we can determine where action is needed, how do we know what action to take? Having grown convinced of the limitations of the social justice frame, I coauthored a study of the economic costs of health inequities to the US economy (LaVeist, Gaskin, and Richard 2009). We estimated those costs to Thomas LaVeist, PhD, is the William C. and Nancy F. Richardson Professor in Health Policy and director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. 38 * f ro ntier s o f h ea lt h s e r vic e s ma na g e m e nt 30 :3

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014

Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead

Frontiers of Health Services Management - Spring 2014