Efforts of colleges and universities to increase the enrollment of minority students also have increasingly become the focus of sharp criticism (Bowen, 1998). While empirical evidence of the impact of diversity in colleges and universities has become a core part of the debate about college admission policies, little attention has been given to rigorously assessing the scientific evidence about the likely impact of increasing the numbers of underrepresented minority physicians, especially as an intervention to improve health care for minority populations and, ultimately, to reduce health disparities in the United States.

The goals of this paper are to present a brief overview of racial and ethnic disparities in health and the potential causes of these differences, primarily related to health care, and then to review the conceptual underlying bases and the evidence about the likely pathways by which increasing the diversity of physicians might decrease disparities. We focus on three hypothesized pathways. The first pathway is through the practice choices of minority physicians, which may lead to increased access to care in underserved communities. The second pathway is through improvements in quality of health care due to better physician-patient communication and greater cultural competency. The third hypothesized pathway is through improvements in the quality of medical education that may accrue to medical students as a result of increasing diversity in medical education.

BACKGROUND

Disparities in Health Status Across Racial and Ethnic Groups in the United States

Differences in health status across racial and ethnic groups in the United States have been described for a wide array of diseases, conditions, and outcomes (NCHS, 2000). Despite overall improvements in life expectancy in the past century, African Americans still experience a lower average life expectancy at birth and higher average age-adjusted all-cause death rates than Whites. African Americans also experience higher death rates for many conditions, including coronary disease, stroke, and cancer, and infant morality rates are higher among both African-American and American Indian/Alaska Native populations than among Whites and most Hispanic subpopulations. Mexican Americans experience a higher rate of uncontrolled hypertension than white Americans. Asian and Pacific Islander Americans, African Americans, and Hispanic Americans all have an elevated incidence of tuberculosis compared with the white population. African Americans, Hispanics, and Native Americans have surpassed Whites in the incidence of HIV infection, and die at higher rates than Whites from diabetes mellitus, homicide, and unintentional injuries (NCHS, 2000). With respect to health-related quality of life, higher percentages on African Americans and Hispanics report that they are in fair or poor health as compared to Whites (NCHS, 1994).



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