Health disparities is not a new topic. Addressing health disparities was formalized as one of the Healthy People 2010 goals. That priority of addressing health disparities has been carried through the federal funding of research. We now have a considerable body of health services research that has expanded and deepened our understanding of the parameters of health disparities that exist in the United States and of which provider behaviors might be contributing to the disparities. Knowing that individual provider behaviors and certain health care system characteristics are associated with disparities, although important, seems insufficient. Missing is an understanding of the actual organizational processes that allow, support, or ignore individual and system behaviors contributing to health disparities.
Research rarely looks at the roles health care executives, boards of trustee, or management teams play in reducing (or increasing) racial and ethnic disparities in health status that exist in the market of their organization. We do not know, for example, whether strategic planning leads to internally focused improvement processes or externally focused community efforts that might have consequences for reducing local health disparities. Internally focused process improvement efforts could easily include variables that would capture and describe the differences in process by race/ethnicity or payment status. There is no shame in acknowledging that a problem exists, only in refusing to look for such problems. The more challenging aspect of finding a problematic internal process is then having the leadership and managerial skills and knowledge to lead the organization on a corrective path. Here, we need translational research that can provide insights on how to tailor the breadth of knowledge into the most effective action.
Externally focused efforts by health care organizations and activities in the local market or state politics are occurring. However, executive teams in search of evidence that can be used to support such efforts will not find much. For example, there is sparse research on whether community involvement or community advocacy by a health care organization might benefit the organization's bottom line, and if so, by what mechanisms. Intuitively, a link exists, but where is the evidence? Health care organizations have mission statements and value statements that frequently include some reference to addressing health needs of the community, providing care to those in need, or having compassion for the needy. Such references are indirectly about individuals who are experiencing the disparities. Other than measures of uncompensated or charity care, we have few data on whether or how those missions contribute to reducing health disparities. Measures of uncompensated care are viewed in relationship to changes in fiscal parameters but are virtually never in relationship to changes in local health status statistics.
Attention to health disparities is not just a matter of being idealistic. Health disparities is directly contributing to overall health care costs and the low ranking of the United States on key health status indicators relative to other industrialized nations. Nonetheless, I am confident that small or large organizational steps to internally and externally address health disparities can be accomplished to the benefit of all.
L. Michele Issel, PhD, RN
Editor-in-Chief