—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

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This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Bobbie Berkowitz. Appointed by the National Research Council, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Since early 2007, the Roundtable has met with the objectives of increasing the visibility of racial and ethnic health disparities as a national problem, furthering the development of programs and strategies to reduce disparities, fostering the emergence of leadership on this issue, and tracking promising activities and developments in minority care that could lead to the reduction or elimination of disparities. The Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities includes representatives from the health professions, federal, state, and local government, foundations, academia, managed care organizations, advocacy groups, and community-based organizations. Its mission is to facilitate communication across sectors and—above all—to generate action.

Through its convening capacity and by holding public workshops across the nation, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities aspires to advance understanding of health disparities and explore solutions for ending them. In doing so, it endeavors to make a lasting contribution to the quality of life for some of this country’s most vulnerable groups.

With this goal in mind, on July 28, 2008, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities convened a workshop in Los Angeles, California, America in Transition, a View from California: Implications for Addressing Health Disparities. By focusing on the complexities of immigration in the country’s most populous state, California, the Roundtable looked at how the discussion of “framing” health disparities can influence the actions that are taken in response.

The Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities thanks all workshop participants for their individual contributions to this workshop. Their willingness to share their time and expertise led to frank discussions about immigration, demographic changes, and the role of “framing” in highlighting health disparities for the public.

We especially want to give thanks to Alicia Dixon, our project officer for The California Endowment. The workshop took place at The California Endowment’s Center for Healthy Communities. Thanks to Alicia and the other California Endowment staff, especially George Kim and Jessica Lieder, for ensuring that the workshop ran smoothly.

Thanks also to all of our speakers and panelists. Biosketches for all presenters can be found in Appendix B.

The Roundtable members also thank the Institute of Medicine staff for their ongoing efforts to support the work of the Roundtable. Sincere gratitude is extended to Dr. Rose Marie Martinez, Director, Board on Population Health and Public Health Practice; Karen Anderson, for planning, organizing, and implementing this workshop; and Thelma Cox, for managing all of the administrative components of the meeting. We also want to thank Patrick Burke and Hope Hare for their ongoing assistance and support.

Thanks to the planning committee that worked so diligently on arranging the workshop: Rajni Banthia, America Bracho, Will Crimi, Jamila Davison, Cara James, Jim Krieger, Rose Marie Martinez, Sam So, Mildred Thompson, Bill Vega, and Winston Wong.

Several Robert Wood Johnson Clinical Scholars volunteered as scribes during the breakout sessions in the afternoon (Rhondee Benjamin-Johnson, Nazleen Bharmal, Anisha Patel, Rashmi Shetgiri, and Kara Odom Walker). Thanks to all for your assistance during the workshop.

Finally, special thanks go to all of the sponsors who make the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities a reality. Financial support for the Roundtable and its activities was provided by the Agency for Healthcare Research and Quality in the Department of Health and Human Services; The California Endowment; the California Health Care Foundation; the Centers for Disease Control and Prevention in the Department of Health and Human Services; The Commonwealth Fund; the Connecticut Health Foundation; the Healthcare

Georgia Foundation; the Henry J. Kaiser Family Foundation; Kaiser Permanente; Merck & Co., Inc.; the Missouri Foundation for Health; the Robert Wood Johnson Foundation; and the W.K. Kellogg Foundation.

Nicole Lurie, Chair

Roundtable on the Promotion of Health Equity

and the Elimination of Health Disparities

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