Prejudice and the medical profession: a five-year update.

Over the past decades the mortality rate in the United States has decreased, and life expectancy has increased. Yet a number of recent studies have drawn Americans' attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system, which is the envy of the world, is not only flawed by basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities. Progress has been made in several areas since the original Institute of Medicine 2002 report. However, five years later, the 2007 National Healthcare Disparities Report (NHDR) reported that overall, disparities in quality and access for minority groups and poor populations have not been reduced since the original report. The three key themes that have emerged from this report are the following: (1) overall, disparities in health care quality and access are not getting smaller; (2) progress is being made, but many of the biggest gaps in quality and access have not been reduced; and (3) the problem of persistent uninsurance is a major barrier to reducing disparities. Unless measures are taken to address this racism, unless a new sense of trust is established between the medical establishment and racial and ethnic minorities, these injustices will continue to deepen and expand, and more lives will be placed in jeopardy. What is needed is a comprehensive, multi-level, culturally relevant strategy that contains interventions that target individuals, communities, and the nation as a whole. This will entail understanding the causes of racism in the medical profession, identifying practical interventions that address racism in individuals, communities, and the nation as a whole, and forming partnerships that will work to develop a new sense of trust between the medical establishment and the minority communities.