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In 2002, the Institute of Medicine (IOM) released a report showing that even if patients have the same level of income and insurance, minorities often receive a lower quality of care than their white counterparts. It showed, for example, that if two patients have kidney failure, one is more likely to be referred for renal catheterization; if two patients have chest pain, one is more likely to be referred for cardiac catheterization; if two patients arrive at an emergency room with broken bones, one is more likely to get pain medication than the other.

In every instance, the minority patient is the one less likely to get optimal care. Countless studies have documented these disparities, several published as recently as 2006. In the wake of this evidence, eliminating healthcare disparity has become a top priority for the medical community and policymakers statewide.

Fortunately, Boston has been a national leader in addressing both health and healthcare disparities almost since they came to light. In response to the IOM data, Mayor Thomas Menino began a major initiative which over time has developed into the Boston Public Health Commission's "Disparities Project," involving the city's teaching hospitals and 33 community groups. Through that project and others, local hospitals and healthcare organizations, insurers, and policymakers have begun not only to acknowledge that disparities exist, but also to take major steps toward eliminating them.

Here are a few examples:

In July 2005, the Massachusetts General Hospital formed an organization called the MGH Disparities Solution Center, dedicated to putting forth strategies that advance policy and practice to eliminate racial and ethnic disparities in healthcare. Its charge, says Director Dr. Joseph Betancourt, "is to be a local, regional, and national leader in helping people move toward solutions."

In addition to restructuring how the hospital collects and reports patient data, the center has developed two interventional programs, one for diabetes and one for colon cancer, says Betancourt, who served on IOM committees that produced the 2002 report. The interventional programs aim to address healthcare disparities, in part, by providing bilingual coaches and culturally competent "navigators" who help patients navigate the system.

Minority patients are often the ones less likely to get optimal care.

In addition, in May the center will launch a Disparities Leadership Program, a year-long executive education curriculum for leaders from hospitals, health plans, and other healthcare organizations. MGH is hardly alone in its efforts. The president of Brigham and Women's Hospital, Dr. Gary Gottlieb, was co-chair of the Mayor's Task Force to Eliminate Health Disparities. And the hospital's Center for Surgery and Public Health will offer its first Symposium on Healthcare Inequality on May 18. In addition, its Mary Horrigan Connors Center for Women's Health and Gender Biology has been a leader in working to improve the health of minority women.

Not surprisingly, Boston Medical Center is also in the vanguard. With more than 70 percent minority patients, many of them recent immigrants, the medical center has a history of responding to a diversity of needs, providing services that range from translation to food banks to legal assistance. Among the medical center's programs are person-to-person interpreters available in more than 30 languages 24 hours a day. The interpreters do more than provide translation, they serve as cultural brokers to patients and staff.

Meanwhile, the Department of Community Affairs at Cambridge Health Alliance helps to address healthcare disparities through outreach efforts and 12 community health programs that target cultural or linguistic minorities, at-risk populations, and the community as a whole. Programs are dedicated to family planning, healthcare for the homeless, interpreting, and improving health among men of color, among other things. A Zero Disparities Committee, meantime, is working towards reducing disparities in the use of services and health outcomes among all the populations the alliance serves.

In October 2005, the Blue Cross Blue Shield of Massachusetts Foundation joined the hospitals other healthcare leaders in their efforts by establishing a grant program to address healthcare disparities statewide. The program has funded 10 programs in different parts of the state over a three-year period for a total of $300,000 per program, says Celeste Reid Lee, director of community health programs. "We felt that while the Boston Public Health Commission is doing extraordinary work in Boston, as a statewide health insurer we should not only support their initiatives but offer funds to organizations across the state," she says.

To be sure, a lot remains to be done. But there is much cause for optimism, says Betancourt. "Boston has taken this issue very seriously," he says. "With the Mayor and hospital leaders aligned on this issue, there are plenty of reasons to think we can make a difference."