Although the poorer health status of racial and ethnic minorities and new immigrant populations is primarily attributable to poverty and related environmental factors — social, physical, biological, economic and political — as well as lack of access to health care, a significant contribution may be made by racial and ethnic disparities in the quality of medical care, specifically, by differences in the diagnostic work-up and treatment of minority patients already in the health care system.

Recent reviews of the relevant peer-reviewed literature in the United States have provided overwhelming evidence that African-Americans, people of Hispanic origin and American Indians are strikingly less likely to receive coronary artery angioplasty or bypass surgery, advanced cancer treatment, renal transplantation or surgery for lung cancer compared with white patients matched for insurance status, income or education, severity of disease, comorbidity, age, hospital type and other possible confounders.

Even more disturbingly, these differentials were also found in basic elements of clinical care such as the adequacy of physical examinations, history-taking and laboratory tests — even the adequacy of medication for pain — and across the whole spectrum of disease. There is evidence in some studies that the patients who were denied appropriate or necessary care included some who were at greatest risk, and who suffered accelerated mortality in consequence.

What is most heartening is an explosion of interest in undergraduate and graduate training for cultural competence and the continuing development of resources to assist physicians and other health care workers in that process.