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Medical Ethics |

Addressing Disparities and Achieving EquityAddressing Disparities and Achieving Equity: Cultural Competence, Ethics, and Health-care Transformation

Joseph R. Betancourt, MD, MPH; James Corbett, MDiv, JD; Matthew R. Bondaryk, BA
Author and Funding Information

From the Disparities Solutions Center (Dr Betancourt and Mr Bondaryk), Mongan Institute for Health Policy, Massachusetts General Hospital; The Department of Medicine at Harvard Medical School (Dr Betancourt); and Community Health and Ethics Steward Health Care (Mr Corbett), Boston, MA.

Correspondence to: Joseph Betancourt, MD, MPH, 50 Staniford St, Ste 901, Boston, MA 02114; e-mail: jbetancourt@partners.org


Editor’s Note: To view articles included in the core curriculum of the ongoing Medical Ethics series, visit http://journal.publications.chestnet.org/collection.aspx?categoryid=9185.

—Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(1):143-148. doi:10.1378/chest.13-0634
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The passage of health-care reform and current efforts in payment reform signal the beginning of a significant transformation of the US health-care system. An entire new set of structures is being developed to facilitate increased access to care that is cost-effective and of high quality. As described in The Institute of Medicine report “Crossing the Quality Chasm,” our nation is charting a path toward quality health care that aims to be safe, efficient, effective, timely, patient-centered, and equitable. As our health-care system rapidly undergoes dramatic transformation, several truths—and challenges—remain. First, racial and ethnic disparities in health care persist and are a clear sign of inequality in quality. Second, although the root causes for these disparities are complex, there exists a well-developed set of evidence-based approaches to address them; among these is improving the cultural competence of health-care providers and the health-care system. Third, as part of our care redesign, we must assure that we are prepared to meet the ethical challenges ahead and reassert the importance of equity, fairness, and caring as key building blocks of a new care delivery system. As we move ahead, it is critical to assure that our health-care system is culturally competent and has the capacity to deliver high-quality care for all, while eliminating disparities and assuring equity. Disparities are unjust, unethical, costly, and unacceptable—and integrating strategies to achieve equity as part of our health-care system’s transformation will give us an incredible opportunity to comprehensively address them.


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