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Example research essay topic: Racial Educational Disparities In Healthcare - 2,912 words

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Racial Educational Disparities in Healthcare Abstract: Racism is nothing new in American society, so its hardly a surprise that it exists on some level in the U. S. healthcare system, black and Hispanic healthcare officials say. The question is: How pervasive is racism against minority doctors in U. S. hospitals?

A resent study suggests that such discrimination is significant, affecting scores of minority physicians across the country who have a much tougher time than their white colleagues securing hospital admissions. In fact, nearly one in three minority doctors reported that they could not obtain hospital admissions for their patients higher than the estimated 25 % rate among white physicians, according to the study by the Center for Studying Health System Change in Washington. (Finley, 2003) Introduction: The study suggests pattern of ethnic and racial disparities in Americas healthcare system, said J. Lee Hargraves, one of three researchers who conducted the national survey for the center, a nonpartisan research organization funded by the Robert Wood Johnson Foundation. African-American and Hispanic physicians compared with their white colleagues have more difficulty getting needed services to their patients, Hargraves said. The inability of minority physicians to obtain needed specialty and hospital care for patients likely contributes to the well-documented health disparities among African-Americans, Hispanics and whites. Asked whether the disparity appears to be based on discrimination, Hargraves said, When one looks at the large body of evidence about ethnic disparities in healthcare, you cant walk away without thinking that discrimination is one of the possible barriers to healthcare. (Romano, 2001) Based on a 1998 - 1999 survey of more than 12, 000 physicians, the study is described by its authors as the first national report to examine the success of minority physicians in getting care for their patients.

It was published in Medscape General Medicine, a peer-reviewed, online general medical journal. The data confirms what weve heard involving anecdotal information about the unfairness with which African-American and Hispanic physicians are treated, said B. Want Kong, chief executive officer of the Association of Black Cardiologists, an Atlanta-based organization with about 800 members. In fact, were surprised that (the disparity) was that conservative. We thought it would be a lot worse. Kong said one of the keys to reducing such discrimination is increasing the number of minority physicians.

Only about 5 % of U. S. physicians are Hispanic, and less than 5 % are black. (Romano, 2001) Discussion: In an editorial accompanying the results, two Chicago physicians said the results support anecdotal experiences of minority physicians across the country. As African-American physicians who have lived and practiced in underserved communities for many years, we do not find the results from this surprising, wrote Cheryl Whitaker, M. D. , and Eric Whitaker, M. D. , of Northwestern University's Institute for Health Services and Policy Research, Chicago.

In an interview, Cheryl Whitaker, who is married to Eric Whitaker, said, I think there is racism within the system. That may be hard to put your finger on, but these are some of the (statistics) that are measurable and do reflect some racism. About 32 % of black physicians in the study reported having trouble obtaining inpatient admissions, compared with 29 % of Hispanics and 24 % of whites. This adds to the story that minority patients are having worse access and more problems with outcomes, Hargraves said. (Romano, 2001) Minority physicians also were far more likely than whites to encounter roadblocks when seeking specialty referrals for their patients, the study found.

About 12 % of African-American and nearly 15 % of Hispanic doctors reported such problems, compared with less than 8 % of whites. These findings suggest there are real barriers in the healthcare system that keep minority physicians from being able to access needed care for their patients, Hargraves said. The study suggests that disparities in health problems for minorities groups are exacerbated by these trends. For instance, deaths from heart disease are greater for blacks in the U. S. than for whites; and blacks and Hispanics are diagnosed with cancer at more advanced stages than whites.

The Joint Center for Political and Economic Studies has partnered with former secretary of the U. S. Department of Health and Human Services, Dr. Louis W. Sullivan, to increase racial and ethnic diversity within the nations health care work force. This alliance will spearhead the implementation of the recommendations of the Sullivan Commission on Diversity in the Healthcare Workforce and those of the Institute of Medicines (IOM) Panel 2004 Report, which showed clear links between a diverse and culturally-sensitive health care system and health outcomes for communities of color. (Romano, 2001) The Sullivan report, Missing Persons: Minorities in the Health Professions, and the IOM report, In the Nations Compelling Interest: Ensuring Diversity in the Health Care Workforce, both emphasized the critical role of health care work force diversity in improving the quality of service delivery and overcoming barriers to access to care among racial and ethnic minorities.

We are pleased that the Joint Center is partnering with Dr. Sullivan on this important issue, said Joint Center president Togo West Jr. Access to quality health care is the most important issue facing every American today. It is an even greater imperative for communities of color.

Through this project, we expect to finally have concrete steps aimed at ensuring that communities of color are served by people who understand and can meet their needs. (Finley, 2003) In its initial phase, the project will focus on building alliances with federal and other government agencies, as well as corporations and nonprofit and community-based organizations. It will also work to implement the Sullivan Commissions recommendation that the president develop an advisory panel to demonstrate the seriousness of this issue to the nation. Past studies have clearly shown that racial and ethnic minority health providers are more likely to serve communities of color, said Sullivan, who chaired the commission. Yet, although African Americans, Hispanic Americans and American Indians together account for nearly a quarter of the nations population, they constitute less than nine percent of nurses, six percent of physicians, and five percent of dentists.

If we are to adequately serve our increasingly diverse population, we must ensure that we have providers who can relate to their patients. (Finley, 2003) The project, which is funded by a seed grant from the W. K. Kellogg Foundation, complements the Health Policy Institutes ongoing work in helping communities to establish short-and long-term goals to eliminate health disparities. This focus on building a more diverse cadre of health providers is, therefore, very important, particularly for urban and low-income communities. The models that will be developed for implementing the policy recommendations of both reports will also be very important for building the capacity of local communities to address health disparities, said Dr. Gail C.

Christopher, director of the Health Policy Institute. (Finley, 2003) While African Americans, Hispanics or Latinos, and American Indians represent more than 25 percent of the U. S. population, they represent less than 14 percent of physicians, 9 percent of nurses, and only 5 percent of practicing dentists. The Sullivan Commission on Diversity in the Healthcare Workforce held its first hearing on the matter this summer in Atlanta, collecting testimonies from educators, local legislators, business leaders, students and community advocates. Just last month, the 15 -member commission held hearings in Denver and is planning to hold hearings in other major cities before the end of the year (see Black Issues, May 22). Although the problem of under representation of minorities in the health professions is well documented, both state and federal tax dollars continue to support medical schools and residency training programs whose production of physicians falls far short of the goal, Dr.

George Rust told the commission at the Atlanta hearing. In 1997 the Medical College of Georgia had only one African American student matriculate in its freshman class, said Rust, professor of family medicine and deputy director, National Center for Primary Care at Morehouse School of Medicine. The real questions should no longer focus on does it matter but rather how to address the long-standing need for greater depth and diversity in our health care work force. The how must consider a wide range of multi-faceted interventions that bring together parents, young people, educators and educational institutions, providers and professional associations, federal, state and local agencies, and society in general, said Valerie Hepburn, director of the division of health planning for the Georgia department of community health, also testifying before the commission at its Atlanta hearing. (Guzman, 2005) Recent action by the U. S. Supreme Court in support of affirmative action in college admissions does not offer a solution for the lack of minorities in health-related fields, according to Sullivan.

We know this ruling will not automatically lead to changes in how schools, especially health professional schools recruit, admit and retain underrepresented minority students, Sullivan says. It will take innovative approaches by schools to fulfill the dream of putting a health professions career within reach for more of our nations qualified minority students. (Guzman, 2005) Findings from the hearings will inform the commissions final report, scheduled for release in Spring 2004, on bringing about systemic change at U. S. health professionals schools, and ultimately, to eliminate disparities in health status and unequal access to health services. The commission is administered by the Duke University School of Medicine and funded by the Kellogg Foundation. Unless current U.

S. trends in medical and health education are reversed, the lack of minorities in the nations health work force will continue to be an ongoing contributor to the nations racial and ethnic health disparities, a prestigious health commission has predicted. According to the Sullivan Commission on Diversity in the Healthcare Workforce, the lagging rate of minorities in the health profession is placing the health of the nation - and particularly the health of people of color - at risk. Also lagging are the percentages of minority students enrolled in medical, nursing and dental school programs as well as the percentage of minority faculty at such schools, which means the problem is not likely to resolve itself in the near future without intervention, according to Missing Persons: Minorities in the Health Professions, a September report from the commission. Despite the fact that minority health care providers are more likely to work in under-served areas and to serve minority patients, the recognized shortage of such providers persists, noted Louis Sullivan, MD, chair of the commission and president emeritus at Morehouse School of Medicine. Without much more diversity in the health work force, minorities will continue to suffer, said Sullivan, a former U.

S. secretary for health and human services and the commissions namesake. Access to health professions remains largely separate but equal. (Guzman, 2005) According to the report, blacks, Hispanics and American Indians make up almost a quarter of the U. S. population, yet as a group account for only 6 percent of physicians, 9 percent of nurses and 5 percent of dentists. The outlook isnt much better in the nations health professional schools: The report found that only about 2, 200 of the 16, 000 students scheduled to graduate from U.

S. medical schools in 2007 are blacks, Hispanics or American Indians, and similar statistics are present in nursing and dentistry programs. Disparities were also noted among school faculty, with minorities accounting for fewer than 4. 2 percent of medical school faculty members, 10 percent of baccalaureate nursing faculty members and 8. 6 percent of dental school faculty members. This lack of leadership and sparse representation among faculties sends a chilling message to current and potential minority students, the report stated. (Guzman, 2005) Because of the severity of their under-representation in the health work force, the report focused primarily on blacks, Hispanics and American Indians.

However, the commission recognized that Asians and Pacific Islanders are also underrepresented when compared to whites, especially when classified by ethnic affiliation. For example, while Asians and Pacific Islanders make up 8. 6 percent of the total physician work force, shortages persist in subgroups such as Malaysians, Laotians, Hmong and Cambodians. To address the findings raised in the report, the commission made 37 recommendations aimed at health professional schools, the government and the private sector. The recommendations include calls for increased funding for research on racial and ethnic disparities in health care, implementation of public awareness campaigns to attract minority students to health care and increased numbers of multilingual students in health professional schools. The commission also called for additional leadership training for minority health care professionals, increased funding for diversity programs and creation of a national advisory council or task force on health work force diversity. The commission believes its vision for American health care can be achieved within the next two decades, the report stated.

In that time, new generation of physicians, dentists, nurses and other health professionals will have been trained to care for a population where the terms majority and minority have become obsolete. (Guzman, 2005) The commission reports findings build on conclusions reached in a 2002 report from the Institute of Medicine, which recommended that the number of minority professionals be increased as a way to eliminate racial and ethnic health disparities. Such disparities are prevalent among minorities, who lag behind whites on health indicators such as cancer, heart disease and HIV/AIDS. The dearth of minority health professionals directly contributes to the nations crisis of lower quality of health care and higher rates of illness and disability among a growing number of residents, said APHA Executive Director Georges Benjamin, MD, FACP, in an APHA news release supporting the report. We see the Sullivan commissions report as a concrete blueprint to removing obstacles to minorities receiving quality health care from professionals who reflect and understand their needs. (Evans, 2004) Conclusions: The Sullivan Commissions report urged regulators, the White House, lawmakers, schools and the healthcare industry to embrace its 37 recommendations.

Among them are improving early education; boosting minority scholarships for medical and health education; and standardizing, measuring and enforcing diversity and cultural competency goals. Estimated 7. 4 % of the nations registered nurses are American Indian, Hispanic or black, according to a 2004 IOM report. Yet the three minority groups represent almost 1 -in- 4 Americans. Slightly fewer of the nations dentists, 6. 8 %, and physicians, 6. 1 %, belong to the minority groups, according to the IOM. Too few minorities apply to and graduate from U.

S. medical, nursing and dental schools to overcome the disparity, a problem the report labeled as severe and persistent. The lack of institutional, legal and financial support can significantly affect minorities access to healthcare careers, the report said. Minority medical school applications fell 21 % from 1996 to 2001, as challenges to affirmative action played out in courts and colleges.

The healthcare industry must reach out to schools, provide aid for faculty and bring minority students into hospitals, clinics or healthcare settings to give students an early introduction to medicine, said Everard Rutledge, vice president of community health for Bon Secours Health System, Marriottsville, Md. (Evans, 2004) Minorities also are missing from the ranks of healthcare executives and faculty, where they can serve as mentors for early-career professionals and students, the report said. The American Hospital Association, along with the American College of Healthcare Executives, the National Center for Healthcare Leadership and the Institute for Diversity in Health Management (See related story, p. 7), this summer launched a tool for executives trying to eliminate cultural barriers to care (March 29, p. 4). Its too early to tell how many hospitals will use the resource, said AHA spokeswoman Jennifer Armstrong Gay, though the Chicago-based trade association plans to track its use. Sullivan said no one recommendation takes priority and all are needed to transform healthcare. We see this as a problem that isnt going to be solved by a rifle-shot approach, he said. Shifting funding for higher education from loans to scholarships and better incorporating community colleges into the mainstream pipeline to health careers could boost minority access to the medical profession, he said.

In the long term, the nations schools must better prepare students for careers in science. Jordan Cohen, president of the Association of American Medical Colleges, echoed Sullivan's call to improve elementary and high school education. Inadequate early education is the single greatest barrier to medical school admission for U. S. minority students, Cohen said, calling it a fundamental, long-term problem. (Evans, 2004) References: Michael Romano. In the Physicians Practice.

Modern Healthcare, 8 / 27 / 2001, Vol. 31 Issue 35, p. 12. Tony Fong. Damage Control. Modern Healthcare, 2 / 16 / 2004, Vol. 34 Issue 7, p. 8.

Thomas A. Latest. Racial Disparities in Healthcare. FDCH Congressional Testimony, May 21, 2002. Will Finley.

Medical, Dental Schools Are Seeing Fewer Minority Students in Their Ranks. Black Issues in Higher Education, 10 / 9 / 2003, Vol. 20 Issue 17, p. 19. Melanie Evans. Controversies over Racial Disparities in Healthcare. Modern Healthcare, 9 / 27 / 2004, Vol. 34 Issue 39, p. 6. Michele Late.

Actions urged to increase numbers of U. S. minority health workers. Nations Health, Nov 2004, Vol. 34 Issue 9, p. 1. Yan Guzman. New Joint Center Partnership Focuses On Diversifying Health Care Work Force.

Black Issues in Higher Education, 2 / 24 / 2005, Vol. 22 Issue 1, p. 16. The Robert Wood Johnson Foundation. Official Web site: web Center for Studying Health System Change (HSC). Official Web site: web


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