Eliminating Disparities in Treatment and the Struggle to End Segregation

Segregation was the central issue facing the civil rights challenges and achievements of the 1950s and 1960s—specifically, the Brown vs. Board of Education decision, the Civil Rights Act of 1964, and the implementation of the Medicare program. However, current efforts to eliminate racial and ethnic disparities in health care treatment fail to address the effect of segregation on disparities. By reviewing the history of the civil rights era efforts to integrate health care in the United States and assessing its accomplishments, this report offers lessons of this experience for current efforts to eliminate disparities in health care treatment. Progress can best be achieved by making the reduction of health care segregation a measurable goal, reinvigorating regional planning, taking a more critical view of the impact of “consumerdriven” choice in the organization of care and health plans, and transforming health care reform into a civil rights issue. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the author and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. Additional copies of this and other Commonwealth Fund publications are available online at www.cmwf.org. To learn about new Fund publications when they appear, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 775.