From: Robina Suwol
Date: 08 Feb 2004
Remote Name: 126.96.36.199
From the British Medical Journal, February 7, 2004: Owen Dyer London
The United State's first national report on disparities in health care
has been watered down through the intervention of political appointees seeking
to deny the existence of a race based gap in health care in the country, say
doctors, congressmen, and ethnic minority pressure groups.
The annual report card was expected to elaborate on the findings of a study in 2002 by the Institute of Medicine, which argued that the evidence of racial and ethnic disparities in healthcare treatment was "overwhelming."
Yet the final version contains none of these conclusions-just the statement that "some socioeconomic, racial, ethnic, and geographic differences exist." A report by the special investigations division of the Congressional Committee on Government Reform found that the word "disparity," mentioned 30 times in the "key findings" of the draft, was used only twice in the key findings of the final version.
The task of preparing the report card fell to a branch of the Department of Health and Human Services-the Agency for Healthcare Research and Quality. Agency scientists produced a draft in June 2003 that agreed with the conclusions of the Institute of Medicine. The draft reported "significant inequality" in health care in the United States, called healthcare disparities "national problems," and emphasized that these disparities were "pervasive in our healthcare system."
"Changes to the scientists' draft minimized the importance and extent of racial and ethnic disparities in health care, undermining efforts to address these problems," said the congressional report.
The scientists' initial draft had concluded that "disparities come at a personal and societal price," including lost productivity, needless disability, and early death. The final version drops this conclusion and replaces it with the finding that "some `priority
populations' do as well or better than the general population in some aspects of health care."
"They say, for example, that native Americans are less likely to die of cancer," said Dr H Jack Geiger of New York University's School of Biomedical Education.
"But they neglect to mention that native Americans have a lower life expectancy and are therefore less likely to get cancer." Dr Geiger, who contributed research to the 2002 study by the Institute of Medicine, wrote an editorial in the Washington Post
last week criticizing the editing of the report (27 January, p A17).
The final version of the National Healthcare
Disparities Report can be accessed at