"Despite concerted efforts, differences in health status and treatment have persisted for decades. Health care leaders must make solutions to these problems a top priority in our efforts to improve the quality of health care for all Americans."

The report highlights the stark fact that efforts to narrow gaps in racial and ethnic disparities in healthcare have not had much of an impact in the three years since the Institute of Medicine issued its landmark report.

Blueprint for Healthcare Equality

Dr. Satcher examined U.S. mortality rates for African Americans and whites between 1960 and 2000. While the infant mortality rate for African Americans improved overall, the black-white gap during those years actually worsened for infants and for African American men age 35 and older. Blacks suffered 40.5 percent more deaths -- 83,570 deaths -- than would have been expected if they were white, according to the study.

Satcher's study is one of several included in the March/April 2005 issue of Health Affairs that assesses progress made since the IOM issued its landmark report, "Unequal Treatment."

Released today at the National Press Club, papers in the journal identify gaps in health and health care that still exist, and they offer a blueprint for eliminating disparities. In addition to the Satcher study, the issue includes articles by Senate Majority Leader Bill Frist (R-TN), Sen. Edward Kennedy (D-MA), Robert Wood Johnson Foundation (RWJF) President Risa Lavizzo-Mourey, and other leading health researchers.

Comprehensive Approach Needed

Although the African American infant mortality rate dropped by two-thirds over four decades, from 44.3 per 1,000 in 1960 to 14.1 per 1,000 in 2000, the mortality gap between black and white infants worsened in those years, according to Satcher.

He identified four reasons that contributed to the gap between black and white males: Health care access expansions have consistently excluded nonelderly, nondisabled adult men; black men have not experienced the same improvements in income inequality; there was a spike in gun-related deaths between 1983 and 1995; and the death rate related to HIV infection disproportionately affected communities of color.

"Despite concerted efforts, differences in health status and treatment have persisted for decades. Health care leaders must make solutions to these problems a top priority in our efforts to improve the quality of health care for all Americans," said Risa Lavizzo-Mourey, M.D., M.B.A., president and chief executive officer of the RWJF, which was one of four funders of this thematic issue of Health Affairs.

"All efforts must be comprehensive in nature, and will need to happen on all fronts: at the federal and state levels, at teaching hospitals, in clinics and at private-sector health plans," she continued. Other organizations that provided financial support for the issue included the Aetna Foundation, California Endowment, and W.K. Kellogg Foundation.

Five Tactics for Eliminating Disparities

Five points must be considered in order to move toward eliminating disparities, according to Lavizzo-Mourey; William Richardson, president and CEO of the Kellogg Foundation; Robert Ross, president and CEO of the California Endowment; and John Rowe, chairman and CEO of Aetna:

1. Development and implementation of long-range, coherent, and coordinated strategies
2. Collection and reporting of data by race and ethnicity
3. Improving health care providers' awareness of the problem, strengthening culturally competent health care approaches, and improving the diversity of the health workforce
4. Research into community-based approaches to advance health promotion and disease prevention in communities wracked by poverty and racism
5. Leadership on the issue from a wide variety of stakeholders, including government, funders, and organizations that represent health care constituents

Articles in the March/April issue of Health Affairs address the role government and policy should play in helping to close gaps in care; the importance of collection and reporting of data by ethnicity and race; the merits of expanding public programs, such as Medicaid and the State Children's Health Insurance Program (SCHIP); and whether states are equipped to create and implement minority health policy report cards.