Skip to main content
Consensus Study Report


Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received.

In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed.

How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Suggested Citation

Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press.

Import this citation to:

Publication Info

780 pages |  6 x 9 |  DOI:
Chapters skim
Front Matter i-xvi
Summary 1-28
1 Introduction and Literature Review 29-79
2 The Healthcare Environment and Its Relation to Disparities 80-124
3 Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient- and System-Level Factors 125-159
4 Assessing Potential Sources of Racial and Ethnic Disparities in Care: The Clinical Encounter 160-179
5 Interventions: Systemic Strategies 180-198
6 Interventions: Cross-Cultural Education in the Health Professions 199-214
7 Data Collection and Monitoring 215-234
8 Needed Research 235-243
References 244-268
Appendixes 269-270
A Data Sources and Methods 271-284
B Literature Review 285-383
C Federal-Level and Other Initiatives to Address Racial and Ethnic Disparities in Healthcare 384-391
D Racial Disparities in Healthcare: Highlights from Focus Group Findings 392-405
E Committee and Staff Biographies 406-414
Paper Contributions 415-416
Racial and Ethnic Disparities in Diagnosis and Treatment: A Review of the Evidence and a Consideration of Causes - H. Jack Geiger 417-454
Racial and Ethnic Disparities in Healthcare: A Background and History - W. Michael Byrd and Linda A. Clayton 455-527
The Rationing of Healthcare and Health Disparity for the American Indians/Alaska Natives - Jennie R. Joe 528-551
Patient-Provider Communication: The Effect of Race and Ethnicity on Process and Outcomes of Healthcare - Lisa A. Cooper and Debra L. Roter 552-593
The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare - Mary-Jo DelVecchio Good, Cara James, Byron J. Good, and Anne E. Becker 594-625
The Civil Rights Dimension of Racial and Ethnic Disparities in Health Status - Thomas E. Perez 626-663
Racial and Ethnic Disparities in Healthcare: Issues in the Design, Structure, and Administration of Federal Healthcare Financing Programs Supported Through Direct Public Funding - Sara Rosenbaum 664-698
The Impact of Cost Containment Efforts on Racial and Ethnic Disparities in Healthcare: A Conceptualization - Thomas Rice 699-721
Racial and Ethnic Disparities in Healthcare: An Ethical Analysis of When and How They Matter - Madison Powers and Ruth Faden 722-738
Index 739-764

What is skim?

The Chapter Skim search tool presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter. You may select key terms to highlight them within pages of each chapter.


Copyright Information

The National Academies Press (NAP) has partnered with Copyright Clearance Center's Marketplace service to offer you a variety of options for reusing NAP content. Through Marketplace, you may request permission to reprint NAP content in another publication, course pack, secure website, or other media. Marketplace allows you to instantly obtain permission, pay related fees, and print a license directly from the NAP website. The complete terms and conditions of your reuse license can be found in the license agreement that will be made available to you during the online order process. To request permission through Marketplace you are required to create an account by filling out a simple online form. The following list describes license reuses offered by the NAP through Marketplace:

  • Republish text, tables, figures, or images in print
  • Post on a secure Intranet/Extranet website
  • Use in a PowerPoint Presentation
  • Distribute via CD-ROM
  • Photocopy

Click here to obtain permission for the above reuses. If you have questions or comments concerning the Marketplace service, please contact:

Marketplace Support
International +1.978.646.2600
US Toll Free +1.855.239.3415

To request permission to distribute a PDF, please contact our Customer Service Department at

loading iconLoading stats for Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care...