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Excerpted From: M. C. Gibbons, Common Ground: Exploring Policy Approaches to Addressing Racial Disparities from the Left and the Right, 9 Journal of Health Care Law and Policy 48 (2006) (209 Footnotes) (Full Document)


Although the existence of racial and ethnic disparities is increasingly recognized, a complete understanding of the causes and MichaelGibbonssolutions to these problems remains elusive. Part One of this paper provides a historical overview of the origins of these disparities. Part Two outlines fundamental challenges to achieving a clear understanding of the problem and briefly discusses current policy strategies espoused by conservative and liberal proponents. Finally, Part Three provides an in-depth discussion of one promising approach with significant bipartisan support.>

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While a significant amount of evidence convincingly documents the existence of racial and ethnic disparities, broad consensus does not yet exist regarding the fundamental causes of these disparities or the best strategies to address the problem. Progress on this issue has been hampered by poorly defined terminology and imprecise dialogue. In addition, presuppositional differences regarding the relationship between the socio-environment, health behaviors, health care, and health status serve to confuse and influence the scientific questions being asked and the interpretation of findings. In the face of these challenges, the existence of racial and ethnic disparities, and in some cases the increasing magnitude of these disparities, is forcing debate and action on possible strategies and policy solutions.

One approach that continues to receive significant bipartisan support involves the identification, training, and utilization of individuals indigenous to minority populations as culturally appropriate bridges between minority communities and a fragmented health care system. Community Health Workers, as they are generically called, are also known by over thirty terms, including Patient Navigators, Lay Health Aids, Community Health Advisors, Dumas, and Promatoras. While the idea of the Community Health Worker is not new and its roots can be traced to several health care infrastructure building efforts of the developing world, its domestic origins have their roots in the War on Poverty. As health care costs continue to rise in the face of an increasingly diverse U.S. population, a resurgence of interest in the model has emerged. Scientific evidence suggests that the model can help improve access to health care, enhance communication between providers and patients, and improve health outcomes. In addition, preliminary evidence suggests significant potential cost savings for wider implementation of the model. Ongoing research is elucidating the best approaches for systematic training and integration of CHWs into the current health care system.

Associate Director, Johns Hopkins Urban Health Institute; Director, Center for Community HEALTH; Assistant Professor of Medicine and Public Health, Johns Hopkins Medical Institutions.

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