Appendix A

Statement of Task

An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine (the National Academies) will examine the current state of racial and ethnic health care disparities in the United States. This work will include support for the infrastructure and activities required to update the 2003 Unequal Treatment report. The update will highlight the major drivers of health care disparities, provide insight into successful and unsuccessful interventions to reduce disparities, identify gaps in the evidence base, and propose strategies to close those gaps. The committee will consider ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care and make recommendations to advance health equity.

The National Academies will conduct a scoping review of the literature on racial and ethnic health care disparities in the years since the Unequal Treatment report (2003-2022). This task will also provide a comprehensive status update on the implementation of the Institute of Medicine report recommendations, as well as whether specific health care disparities have improved, remained the same, or worsened. The topics will include but are not limited to

• Societal factors such as bias, racism, discrimination, intersectionality, stereotyping and intersectionality at the individual (clinical and nonclinical staff), interpersonal, institutional, and health system levels.
• Technology factors, such as bias in diagnostic tools and algorithms used in clinical practice and decision making, and variability in access to broadband Internet and other telecommunication technologies, as well as digital inequality.

• Geographic factors, such as variability in the social determinants of health, language and English proficiency, and access to both social services, (including those not directly related to health care), language, and health care services for acute and chronic conditions in different communities.
• Policy factors, such as federal and state laws and regulations and public health programs.
• Health care factors, such as the coverage and design of health plans, institutional or clinic-based access, and the demographic and specialty profile of the clinical workforce.
• The impact of clinical training and education in perpetuating disparities, and ways to improve training, enhance cultural competency, and diversify the health care workforce.
• The committee will also consider ways to scale and spread effective interventions to reduce racial and ethnic disparities in health care.

The review and summary of findings will focus on the Office of Management and Budget (OMB) defined racial and ethnic groups, report disaggregated findings where possible (e.g., by country of origin or national heritage). The literature review should also:

• Incorporate evidence on racial and ethnic disparities in health care measured by access, utilization and quality of care given that major advancements related to health care policy (e.g., the Affordable Care Act), demographic shifts, and public health emergencies (e.g., COVID-19) have differentially impacted people from racial and ethnic groups and may have exacerbated disparities.
• Examine health care disparities across the spectrum of health care settings with an emphasis on primary care in the continuity outpatient setting but also including specialty outpatient care, emergency or urgent care, and hospital care.
• Examine racial and ethnic health care disparities across the life-span (e.g., between racial and ethnic minority children and older adults compared with their White counterparts and the relationship between adverse childhood experiences [ACEs] and how these pathways develop into health disparities in later life).
• Determine the interventions that have been most effective at the local, state, and federal levels for reducing racial and ethnic disparities in health care using the intervention strategies outlined in the previous report as a guide.
• Identify the institutional, community-based, or community-engaged approaches that have addressed racial and ethnic disparities in health care access, utilization and quality of care and quantify those with the most positive impact.

• Determine the community-engaged research approaches that are most replicable and scalable.

Drawing on this detailed literature review, and supplemented by public input, the committee will apply its expert judgment in order to develop recommendations with a focus on advancing health equity.

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