Beyond equal care: how health systems can impact racial and ethnic health disparities.

Much has been written on the existence of racial and ethnic differences in health status and health care access and quality in the US. Researchers, think tanks, government entities, and advocacy organizations have worked to summarize many of the root causes, environmental and behavioral influences, and health system factors that play a role. Yet sustained and significant change has been elusive. Many of the initiatives and efforts aimed at reducing health disparities have focused on the role of the health care system. In this context, potential solutions usually include approaches such as cultural competency training, access to linguistically appropriate care, expansion of insurance coverage, and support for consistent delivery of known best care practices to all patients. However, factors outside traditional health care delivery—including community-based social determinants of health such as environmental pollution, job opportunities, education, income, and support for healthy lifestyles—play an equally if not more important role in disparities. Whereas at first blush it may seem that these factors are beyond the purview of health care organizations, there are in fact many ways in which they can influence—for better or for worse—these factors. Although equal care is a critical goal, if health care organizations’ efforts to reduce disparities focus only on this goal, they will have limited impact on reducing overall differences in health status and outcomes.