The major finding of the IOM study is:

Racial/Ethnic disparities consistently are found across a wide range of health care settings (managed care, public/private hospitals, teaching/community, etc.), disease areas (CVD, Ca, HIV, DM, etc.) and clinical services, even when various confounders are controlled for (i.e. SES, stage of presentation, comorbidities).

Specific findings include:

• Racial and ethnic disparities in health care exist and, because they are associated with worse outcomes in many cases, are unacceptable.
• They occur in the context of broader historic and contemporary social and economic inequality, and evidence of persistent racial and ethnic discrimination in many sectors of American life.
  
• Many sources - health systems, health care providers, patients, and utilization managers - contribute to racial and ethnic disparities in health care.
• Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare.
• Racial and ethnic minority patients are more likely than white patients to refuse treatment, but differences in refusal rates are generally small, and do not fully explain healthcare disparities.
  

Dr. Reyes identified multiple implications of the report. In order to address disparities in healthcare delivery, improvements must be made in a number of areas:

• Physician training to increase understanding of the nature of disparities and the need for improved physician - patient relationships and communication.
  
• Increased patient protections and enforcement of civil rights laws.
  
• Increased diversity of the health care workforce.
  
• Expanded use of evidence based guidelines.
  
• Increased availability of interpreter services.
  
• Reduced fragmentation of health care financing.
  
• Adoption of financial incentives to promote healthier patients.
  
• Increased research and data collection related to disparities.

Dr. Reyes congratulated and then charged the summit participants to join in efforts to eliminate health care disparities, to build coalitions to generate sustained advocacy for policy change, and to remain tenacious, realistic, hopeful and focused on the possible.

Connerly Initiative
Carmen Nevarez, MD, MPH, Vice President of External Affairs, Public Health Institute

Ward Connerly, author of Proposition 209, has drafted a new initiative he has named the Racial Privacy Initiative. The initiative states that:

"The State shall not classify any individual by race, ethnicity, color, or national origin in the operation of public education, public contracting, public employment,…(or) in the operation of any other state operation.

"Exemptions are provided for law enforcement, medical research subjects and patients. The state is defined in the initiative as any public entity."

Analyses of the impact of the initiative by public health organizations indicate that it will preclude collection or use of race and ethnicity data in databases for vital records, behavioral health factors surveys, hospital discharges, and Medi-Cal eligibility. It would also impact the California Health Interview Survey, public health disease reports, and our ability to calculate disease rates and disparities in health status and health care among different populations.