Anne Beal

"One of the things that strikes me is that we do not have an uproar–in terms of our communities that are most affected by disparities in care–that is saying, ‘How are we going to address these disparities?’" said Anne Beal, senior program officer of The Commonwealth Fund. With MADD, mothers who lost children fought against future preventable deaths. "Why do we not have ‘Mothers Against Infant Mortality’?" asked Beal. "Why do we not have mothers whose infants have died unnecessarily come together and say, ‘This is no longer acceptable’?"

The symposium, sponsored by the Harvard Interfaculty Program on Health Systems Improvement and the U.S. Department of Health and Humans Services Offices of the Regional Health Administrator and Minority Health (Region 1), was aimed at identifying new frontiers in racial and ethnic health disparities, bringing together faculty, students, professionals, and doctoral fellows from research communities across the country to form collaborations.

Health disparities is a political issue that requires a political response, said Beal.

Unfortunately, the political climate for translating disparities research into effective public policy looks bleak. While researchers have been diligently building the case to document and eliminate disparities, politicians have cut taxes, reallocated money away from social and health programs, starved the federal budget with a trillion-dollar deficit, and played politics with scientific research, asserted Barbara Krimgold, director of the W.K. Kellogg Foundation’s Scholars in Health Disparities program.

Still, there is hope. Established in 2000, the National Center on Minority Health and Health Disparities at the National Institutes of Health aims to encourage research on health disparities with an educational loan repayment program for qualified people with a doctoral degree or its equivalent, noted Mireille Kanda, deputy director of the center.

One avenue through which disparities may be eliminated is improving the overall quality of care available in the country, said Beale. Framing equity as an issue of quality brings the issue into the mainstream and makes it more politically palatable, she said.

Quality improvement methods are a key strategy, particularly when applied to improving clinical care at the front lines. To successfully address disparities, quality improvement efforts must target the right topics for intervention and be applied in a way to address these disparities, said Charles Homer, president and CEO of the National Initiative for Children’s Healthcare Quality, a non-profit education and research organization. He is also an associate professor in the Department of Society, Human Development, and Health at HSPH.

"We all know that African Americans are more likely to have low birthweight babies," he said. "We all know that maternal smoking contributes to low birthweight." Yet, a general campaign to reduce maternal smoking may not lower disparities because African-American women are somewhat less likely to smoke than are white women. "Not that you shouldn’t do [an anti-smoking campaign]," Homer said, "but you shouldn’t do it under the illusion that addressing maternal smoking will reduce disparities in infant mortality."

The time for action is now, urged many of the speakers. "We need to do more research, but we know enough [now] to do a better job," said Kaytura Felix Aaron, senior advisor on minority health at the Agency for Healthcare Research and Quality at the Department of Health and Human Services. "It’s our mandate to use the research to improve the practice."

A webcast is available at http://www.healthpolicy.harvard.edu/2004symposium.php.

--CCM