Health Affairs, 24, no. 4 (2005): 1182-1183 doi: 10.1377/hlthaff.24.4.1182 © 2005 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Letters

Ending Health Care Disparities

Medical schools and teaching hospitals are engaged in their communities, whether working with community partners in Harlem to analyze diesel-exhaust exposure among young people or building community-based care systems in urban hospitals for hundreds of thousands of patients.¹ And although this work is affected by the magnitude of need and the scarcity of resources, these efforts persist.

We agree with the Bronx Health REACH project that diversifying the health care work-force is crucial to addressing health care disparities, and community/health professions school partnerships are the key to success. In our ten-year experience with the Health Professions Partnerships Initiative, we learned that academic preparation programs must persist across all grade levels, create systemic improvements, involve a range of community groups, require sizable resources and commitments from participants, and demand acceptance of contributions by all participants. And they can transform all involved.²

Collaboration between professional organizations is also needed. One example is the Summer Medical and Dental Education Program, funded by the Robert Wood Johnson Foundation and jointly administered by the AAMC and the American Dental Education Association (see www.smdepgrant.org). Further, the AAMC is deeply engaged with the Health Professionals for Diversity Coalition, which will provide collective leadership in advocating for diversity in the health professions (see www.hpd-coalition.org).

The Bronx community’s efforts are heroic, and we have much to learn from their work. Although the AAMC’s efforts to increase the number of minority medical students to 3,000 by 2000 fell short, our commitment to diversifying the physician workforce has not faltered. It is hard to ask communities like the Bronx for patience while we do our part—we share the belief in Dr. King’s observation, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."³ And we state boldly that we are in this fight to the finish.

Charles Terrell

NOTES

1. M.E. Northridge et al., "Diesel Exhaust Exposure among Adolescents in Harlem: A Community-Driven Study," American Journal of Public Health 89, no. 7 (1999): 998–1002[Abstract/Free Full Text]; and S. Foreman, "Montefiore Medical Center in the Bronx, New York: Improving Health in an Urban Community," Academic Medicine 79, no. 12 (2004): 1154–1161.[CrossRef][Web of Science][Medline]
2. Health Professions Partnership Initiative, Learning from Others: A Literature Review and How-To Guide from the Health Professions Partnership Initiative, 2004, www.aamc.org/diversity/reading.htm (11 May 2005).
3. From a presentation at the Second National Convention of the Medical Committee for Human Rights, Chicago, Illinois, 25 March 1966.

Disparities: Author Responds

I contend that if medical schools were truly a part of their communities—owning their health problems, researching the problems that are most prevalent in those communities, engaging students and community and faith-based organizations in these efforts—a natural pipeline would evolve of minority student applicants who had worked with and in those institutions and in whom the institutions would have an investment in nurturing.

Pipelines are of limited value if the admissions committees remain the filters that screen out those who aren’t stamped out of the traditional educational mold and who don’t score highest on standardized tests. Other filters screen out those of limited financial means. In our efforts to diversify the physician work-force, the pipeline programs and educational enrichment programs Terrell refers to are necessary but have proved insufficient to solve the problem. The goal of diversifying the medical student population must be elevated to the highest level in U.S. medical schools. Nothing short of a dramatic restructuring of the schools’ priorities will achieve the results this country needs.

Neil Calman

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