It’s been more than a decade since Congress first officially acknowledged that this country has a problem with race and health. In 1999 the government asked the Institute of Medicine—an independent nonprofit whose reports are the gold standard for health-care policymakers—to investigate disparities in health and health care among racial and ethnic minorities. The results were damning: the ensuing study, called Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that minorities had poorer health and were consistently getting lower-quality care even when factors such as insurance status and income weren’t involved. They were less likely to get lifesaving heart medications, bypass surgery, dialysis, or kidney transplants. They were more likely to get their feet and legs amputated as a treatment for late-stage diabetes. Clearly, something needed to be done.
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In the years since the report, the issue has gotten plenty of publicity, more reports have come out, and several agencies—including the National Center on Minority Health—have examined the problem and suggested solutions. Still, studies continue to turn up disturbing disparities. For instance, earlier this month, a paper from the Fred Hutchinson Cancer Research Center found that between 1992 and 2004, black women were up to 90 percent more likely to be diagnosed with advanced breast cancer than white women, even though rates of mammogram screening were similar for the two groups. Another recent study put the health data in financial terms and found that race-related differences in health care cost the country $229 billion between 2003 and 2006, a result that Health and Human Services Secretary Kathleen Sebelius called “just stunning and shocking.”
So why, now that everyone’s aware of the problem, do we still have one? Mostly, the reason is that health and race are both complicated issues to examine academically. Put them together, and constructing a study design that can tease apart all the issues and make sense of the data is an enormous challenge. In other words, we still don’t really know what’s causing a lot of these disparities, much less what to do about them.