Boston takes aim at racial disparities in healthcare

Research has long shown that disparities between racial and ethnic groups exist in the health system. Much of it has revealed the root causes of the inequity. Now Boston, a city long at the forefront of medicine, is making what may be the nation's strongest effort to end such gaps.

At the center of these efforts is the new Disparities Solutions Center at Massachusetts General Hospital (MGH). The facility is the first of its kind in scope, its architects say - a "living laboratory" intended to offer solutions to hospitals, health plans, and government officials across the country.

Sources of disparity reach well beyond the medical system: poverty and environmental factors cannot easily be separated from race and ethnicity when evaluating equity in healthcare. But there is growing concern that the health system can do more to address the problems within its confines.

An Institute of Medicine report in 2002 titled "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care" revealed gaps along racial lines even when socioeconomic factors - such as income and insurance status - are level. Since then, research on higher rates of illnesses from diabetes to HIV among African-Americans, Latinos, and other minorities has received greater attention.

Here, in a city becoming increasingly multicultural, momentum to bridge chasms has come from politicians and institutions alike. The announcement of the center comes on the heels of a $1 million health disparities program announced by Boston Mayor Thomas Menino last month. One aspect of the program will require that hospitals collect patients' information on income and ethnicity, data that can later be analyzed to determine if particular groups do not receive adequate treatment.

And while challenges of access and equal treatment in Boston mirror those in cities and towns across the country, state Sen. Dianne Wilkerson (D) says for a city renowned for its medical institutions, the need for the center is clear. "To have disparities in the shadow [of such institutions]" is a daily reminder of the problem, she says.

Wilkerson says she has been concerned about health disparities ever since visiting a preschool class in Roxbury, a predominantly minority neighborhood in Boston, six years ago. There, she found cubbyholes filled with asthma inhalers.

With initial funding of $3 million from MGH and the network Partners HealthCare, The Disparities Solutions Center will bring together experts to research best practices, develop and evaluate solutions, and educate students and doctors.

Health leaders across the country praised the center. "This is an opportunity to pull together and help frame a lot of the work going on around the country, and bring national attention to it," says Makani Themba-Nixon, executive director of The Praxis Project, a Washington nonprofit that focuses on health equity in communities.

Many communities have done a particularly good job of addressing cultural sensitivity in healthcare, says Will Pittz, lead investigator of a report released this month that focused on the subject. "I think what we've seen is a lot of good local and even state level models that a national level solution could learn a lot from," says Mr. Pittz, a researcher and organizer at the Northwest Federation of Community Organizations.

A national move to bridge gaps in healthcare has had some success, says Ms. Themba-Nixon, demonstrated in the creation of a reporting network to track disparities at facilities across the country. But many agree that more efforts need to focus on the nation as a whole.

That's what Joseph Betancourt, new director of the Disparities Solutions Center, hears when he travels across the country. Providers acknowledge that disparities exist but say they are powerless to remedy them. "We will help [them] do something about it."

Still, many inequities will persist, ones much larger than the medical system. Thousands of Americans lack health insurance. Language barriers can lead to miscommunication that proves deadly in some cases. Asthma is often triggered by air pollution, which hits poor urban areas particularly hard.

In Boston, mistrust of healthcare providers in minority communities flourishes, says Senator Wilkerson, due in part to the ratio of minority patients to minority caregivers.

The Sullivan Commission on Diversity in the Healthcare Workforce found that blacks, Latinos, and native Americans make up a quarter of the US population but are only 6 percent of the nation's doctors.

That gap is an issue that Wilkerson says she hopes the center can address. "It impacts their level of trust," she says.

Doctors and officials stressed at a press conference at MGH Tuesday that the initiative here could put Boston at the forefront of equitable healthcare nationwide, as it moves from a set of ideas to a plan of action.

It is an important mandate, say leaders, but one that carries significant responsibility. "For those [findings] in the framework, it legitimizes best practices," Themba-Nixon says, "but those left out of it, which may be important, could [become] marginalized."