Call it not separate, but certainly unequal. Such is the state of health outcomes in America. The Robert Wood Johnson Foundation (RWJF), the nation’s largest health philanthropy, is spending $300 million of its endowment to address this longstanding problem.

The Health Resources and Services Administration defines health disparities as “population-specific differences in the presence of disease, health outcomes, or access to health care.” In plain English: health disparities are gaps in the quality of care that occur across racial, ethnic, and socioeconomic groups.

RWJF commissioned the brilliant folks at the Dartmouth Atlas Project to provide details into disparities across several health measures:

– Leg amputation (leg amputations per 1,000 Medicare enrollees)

– Breast cancer screening (average % of female Medicare enrollees age 65-69 having at least one mammogram over a 2-year period)

– Diabetes: annual HgbA1c testing (average annual percent of diabetic Medicare enrollees age 65-74 having HgbA1c test

Predominant provider a generalist (% of Medicare beneficiaries whose predominant ambulatory provider was a primary care physician)

ACS discharges (discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees)

– Diabetes: annual eye exam (average annual % of diabetic Medicare enrollees age 65-74 having eye exam)

– Diabetes: annual lipid testing (average annual % of diabetic Medicare enrollees age 65-74 having blood lipids test)

– Primary care provider (% of Medicare beneficiaries who had a primary care physician).

A few of the most dramatic findings are that:

– African-Americans lost legs to amputations at a rate 5x that of whites five times that of whites

– One in three women insured by Medicare are not getting recommended mammograms

– One in seven patients with diabetes is not getting the blood tests that help track and manage their condition.

This map illustrates the areas where RWJF’s Aligning Forces for Quality (AF4Q) project will focus efforts and resources. AF4Q was launched in 1996. In this year’s program, the Foundation will commit $300-million to 14 communities in this project — representing 11% of the total U.S. population. This is the largest project of its kind ever taken by an American philanthropic organization.

A note about the Dartmouth Atlas, which I personally highly value, respect, appreciate and utilize. Since its inception in 1996, the Dartmouth Atlas Project has used Medicare data to describe the wide variations and gaps in care in the U.S. They have shown that, in so many instances, more care leads to poorer outcomes. The Project’s data has demonstrated that the U.S. could lower health care costs if the highest intensity hospitals (that is, those who ‘do more care’) adopted the practices of the nation’s best performing hospitals.

Health Populi’s Hot Points: Health care is locally delivered and consumed, and the AF4Q is going to the roots of health care delivery to help develop models of care that will address the persistent gaps in health quality across race, ethnic and socioeconomic groups.

The 14 communities that RWJF selected in this project competed to participate in this effort. Each community will deploy a team that includes physicians, hospitals, nurses, and other key touchpoints to help improve the quality of care for citizens.

and these communities will learn much from this hard work. They will share the lessons learned on the Foundation’s website portal on Quality/Equality in health.

This week as we ponder another Robert — not Johnson, but Kennedy — whose life was cut too short 40 y

ears ago this week — the issue of inequality continues to permeate so much of American life. The issue of health disparities hits the bullseye of what Robert Kennedy worked so hard to redress.

Yet, there are many reasons to be hopeful about the future, even with the many challenges that face us (and that Health Populi readers often tire of me covering!). The Robert Wood Johnson Foundation’s efforts to address health disparities give me much hope….