Reframing the disparities agenda: A time to rethink, a time to focus

The release of the Institute of Medicine’s reports Unequal Treatment: Confronting Racial and Ethnic Disparities in Health and Crossing the Quality Chasm: A New Health System for the 21st Century over a decade ago led to numerous efforts in programs, practice, and research to improve health equity and health care quality. The pediatric community has been in the forefront of this effort providing “high touch” community participatory efforts to reduce health disparities among children. However, the article in this month’s Academic Pediatrics by Dougherty and colleagues describing broad trends using the 2011 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) database highlight that at the macro level, little measurable change has occurred. In his foreword to the 2013 Centers for Disease Control (CDC) Health Disparities and Inequalities Report, Thomas Frieden, director of the CDC, noted that reports such as these give an overview of national level data sets and serve to “shine a bright light on the problem to be solved.” Yet given that we have shined the light for several decades, is it now time for analyses to provide insights on potential solutions? The shortcomings of actionable data from the article by Dougherty and colleagues and that of the CDC report are a reflection of the limitations of national data sets, not the reporting of the results. Reflection on the current study creates an opportunity to reframe the health disparities conversation. (author introduction)