Harvard Public Health Review

If we as a nation are truly committed to putting our legacy of racial segregation behind us, one place to begin is our health care system. While the reasons for lower health status for racial and ethnic minorities are many, the health care system should be part of the solution, not part of the problem. Yet, in study after study, we see that African Americans, Hispanics, and Native Americans who have insurance and access to health care fail to receive lifesaving therapies at alarming rates.

Why, in 2008, do such disparities still exist? Part of the story is that health care is still very segregated: Just 22 percent of primary care physicians provide outpatient care to nearly all elderly blacks. A majority of blacks and Hispanics receive care in just 5 percent of U.S. hospitals. These hospitals often have large numbers of poor patients and greater difficulties providing high-quality care.

While the legal barriers upholding segregation are gone, insidious factors have led to a health system that is both separate and unequal. Chief among these is de facto segregation in housing, jobs, and schools. While it isn't feasible for you, our next President, to single-handedly integrate our society, you can take concrete steps to ensure all Americans receive high-quality care by appointing health leaders who'll make the following goals a top priority.

First, make sure hospitals that care for the poor are not penalized for doing so. This will require more generous and smarter reimbursement programs. Second, help minority-serving caregivers improve the quality of care they provide. This will mean providing stronger incentives for using nurse managers, not just physicians, to manage chronic diseases. By using electronic health records (which can reduce medical errors and improve effective care) and partnering with community-based organizations, they can encourage patients to pursue preventive care and healthier lifestyles.

Finally, your administration must make eliminating racial and ethnic health inequalities a high-profile initiative. Doctors and nurses want to provide equal care to all their patients. Raising awareness of the fact that our health care system still treats patients differently will spur providers to come up with more creative and ingenious solutions. We cannot easily fix the legacies of segregation. But ensuring that all Americans receive high- quality care-especially when they are sick and vulnerable-is a good place to start.

Advice to the Next President: 7 Ways to Fight Health Inequities