The National Medical Association (NMA) is the oldest and largest national organization representing African-American physicians and health professionals in the United States. Established in 1895, the NMA is the collective voice of more than 25,000 African-American physicians and the patients they serve. Since its inception, the NMA has been committed to improving the quality of health and outcomes of minority and disadvantaged people. While throughout its history the NMA has focused primarily on health issues related to African-Americans and medically underserved populations, its goals, initiatives, and philosophy encompass all sectors of the population. More than 100 years since its founding, the NMA has become firmly established in a leadership role in medicine and serves as a catalyst for the elimination of disparities in health and the leading force for parity in medicine.

In October 2000, the NMA established the Commission for Healthy Parity for African-Americans, composed of distinguished health scientists and activists who are committed to this agenda. This Commission has created the foundation for the Health Policy and Research Institute, which will develop, study, and recommend corrective actions to eradicate these health disparities. Key recommendations include the following:

• Creation of the Health Policy and Research Institute would focus on documenting racial bias as a major contributor to the delivery of unequal healthcare for people of African descent. The Institute would serve as a think tank, focusing on (1) racism and its impact on healthcare disparities; (2) developing policies focused on eliminating racism in the healthcare delivery system; (3) developing a community-focused action center to mobilize the community; and (4) becoming a repository for research and studies on the issue of racial and health disparities.
• Racial bias and racism in medicine in the United States must be accepted as contributing causes and risk factors for the current disparate health status and poor outcomes of African-Americans.
• The goals of Healthy People 2010 must address the impact of racial bias and racism in medicine in order to achieve health parity for African-Americans.
• Legislation must be created that supports tax incentives for small businesses to provide insurance for low-wage workers.
• Medicaid/Medicare programs must be reformed to restructure eligibility requirements, especially for the elderly and disabled, so that their benefit allocations are more closely related to their medical necessity rather than their socioeconomic status.
• Medicaid/Medicare programs must be reformed so that provider compensation is tied to severity of illness and co-morbidity.
• Congressional hearings must be held on racial bias and the impact of racism on healthcare in America.
• A national presidential and/or congressional advisory committee on racial bias and ethnic health disparities must be established. It should report annually on the status of healthcare parity to the president and/or Congress through consolidated reports to the Department of Health and Human Services from the Council of Graduate Medical Education, the National Institutes of Health (NIH), and the Office of Minority Health.
• The American Association of Health Plans, the Joint Commission on Accreditation of Health Care Organizations, the National Committee on Quality Assurance, and other accrediting agencies-including those on a state level-must adopt uniform standards to collect healthcare outcome data based on race and ethnicity. These standards should include data on healthcare participants and providers and should take into account severity of illness, patient confidentiality, methods of collection, and nondiscriminatory use of the data.
• The NIH for Minority Health Disparities must receive increased funding to coincide with its expanded mission and the growing population it serves.

Successful implementation of these recommendations will be difficult. But the goal is no less than the creation of a new period of health reform to correct race-based health disparities-one that will last.

Rodney G. Hood

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