Open Letter to President Barack Obama Regarding the Impact of Health-System Reform on Emerging Populations

13 January 2010

America is in the midst of a historic demographic shift that is reshaping the country. Populations that were once considered “minorities” are now part of an emerging majority. This new majority needs a health-care system that has the capacity to provide quality care to a diverse America.

The following letter has been sent to President Barack Obama, asking him to use this moment to build a 21st-century health-care system to provide quality care to all Americans.

Dear President Obama:

The National Minority Quality Forum and the undersigned are genuinely excited by your promise to reform health care, and we look forward to supporting your efforts through education and research-based innovation, information sharing, and coordination with other organizations, coalitions, and advocacy groups. However, we must not build the new system on a flawed foundation.
The United States Census Bureau projects that no later than the year 2020, approximately 40% of the US population will be composed, collectively, of racial/ethnic population groups that are currently classified as “minorities”; by 2050, these groups will constitute an estimated 54% of the population.
More frequently than we care to admit, when national health policy has been deliberated, the implications for America’s emerging majority have been largely ignored. The legacy of this inattention is a health-care system that is unable to meet the needs of the diverse American population. The evidence of this inattention is rife in scientific research that is skewed toward a diminishing majority, in quality metrics that ignore patient variability, in health-care policies that promote inequalities, in differences in reimbursement that systemically undercompensate providers who treat emerging populations, in a lack of cultural and linguistic competency, and in poor health outcomes and medical errors for an increasing number Americans.
A fragmented mixture of programs, including initiatives by previous administrations, have been undertaken from time to time to address health-care inequities and the resulting health status disparities. A review of current health-care reform frameworks reveals a disturbing tendency toward perpetuating an anachronistic system rather than redressing the fundamental misalignment between our past and our future.
As documented in the Agency for Healthcare Research and Quality’s National Healthcare Disparities Report, 2008, for Blacks, Asians, American Indians/Alaska Natives, Hispanics, and poor people, at least 60% of the quality-of-care measures have not improved in the past six years. We concur with report’s statement that, “All population groups should receive equally high quality of care.”
The research and consensus building of an impressive cohort of clinicians, academics, political and social scientists, historians, and epidemiologists inform the recommendations outlined in this letter. This comprehensive body of work includes, but is not limited to, reports issued by the Institute of Medicine (Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care), the Sullivan Commission (Missing Persons: Minorities in the Health Professions), the National Medical Association and the National Pharmaceutical Council (Racial and Ethnic Differences in Response to Medicines: Towards Individualized Treatment), the United Kingdom National Health Service’s R&D Health Technology Assessment Programme (The Causes and Effects of Socio-Demographic Exclusion from Clinical Trials), and the Intercultural Cancer Council and Baylor College of Medicine (Major Deficiencies in the Design and Funding of Clinical Trials).
The treatment of emerging populations by the US health-care system can no longer be ignored or delayed. Given the length of time required to create new evidence and to incorporate that new evidence into new and innovative treatment protocols, pharmaceuticals, and medical technologies/devices, an immediate paradigm shift is imperative.
We believe that implementation of the following recommendations will ensure that your health-care reform efforts will address the problems that promote inequalities in our health-care system, that compromise the health of children and families today, and that could well undermine the competitiveness of our workforce in the future.


We recommend the establishment of a White House Advisory Panel on Emerging Populations to enhance the federal government’s effectiveness in preparing the nation’s system of research-based innovation, delivery, and financing to ensure that high quality, effective care is available for and provided to all American populations. Specifically, the panel would provide advice regarding the following:

  • Evaluating all economic incentives (e.g., pay for performance, step therapy) in the Medicare, Medicaid, and State Children’s Health Insurance Program reimbursement systems to ensure that they do not perpetuate or increase disparities in health-care and that providers who disproportionately serve emerging populations receive adequate compensation.

  • Promulgating policies and procedures for the mandatory collection and reporting of de-identified data by race and ethnicity, at a minimum, for population groups according to Office of Management and Budget Directive 15 guidelines, including data on the spoken- and written-language preferences of enrollees.

  • Developing continuing education programs on best practices, clinical guidelines, health literacy, cultural proficiency, and health-care inequities and health status disparities that target physicians and other health-care professionals who serve emerging populations.

  • Establishing health empowerment zone programs to improve the health and environment of emerging populations, including those in US territories and possessions.

  • Promulgating policies and procedures for formulary-review criteria and processes that provide emerging populations access to prescription drugs, biologics, and/or medical technologies that are efficacious for them, and considering conditions and diseases (e.g., diabetes, hypertension, and cardiovascular disease) that disproportionately affect emerging populations.

  • Promulgating policies and procedures for the development of culturally and linguistically appropriate communications for enrolled populations regarding the scope of benefits and the appropriate use of preventive and treatment services.

  • Promulgating policies and procedures for the review of comparative effectiveness research to ensure that it examines the effects of health-care interventions on diverse populations and that it clearly defines the population cohorts for whom the research findings are valid and applicable.

  • Developing and implementing a more effective national response to the under-representation of emerging populations in the health professions.

Gary A. Puckrein, PhD
President and Chief Executive Officer
National Minority Quality Forum

cc: House Speaker Nancy Pelosi


Rev. John T. Abercombie, Truth and Deliverance Christian Church
Mohammad Akhter, MD, MPH, National Medical Association
Salim Al Nurridin, Healthcare Consortium of Illinois
Barbara Barron, VITAS Healthcare Corporation
Carolyn Barley Britton, MD, National Medical Association
Denise Brooks-Williams, National Association of Health Services Executives
Carl Burrell, MSW, Olympic Fields Family Counseling Center
Colorado Council of Black Nurses
Rev. Tyrone Crider, Sr., Mount Calvary Baptist Church
Brenda Fowler, National Medical Association
Dr. Bambi Gaddist, South Carolina HIV/AIDS Council
Kirk Geter, DPM, President-Elect American College of Foot & Ankle Orthopedics & Medicine
Edward Gometz, University of Chicago Medical Center
Robert Graham, MD, Lenox Hill Hospital
Antoinette Green, Trinity Health
Kevin Heffernan, PhD, Tufts Medical Center
Freddie Hill, Jr., Dixmoor Apostolic House of Prayer
Chandra Jackson, Johns Hopkins University
William Jenkins,Jr., Word Made Flesh Worship Center
Atul Kumar, MD, Department of Veterans Affairs
Maria Lemus, Vision y Compromiso
Mercedes Mallette, Healthcare Consortium of Illinois
William McCoy, Am I My Brothers Keeper

Patricia Medley, RN, MS, Maryland Healthcare Resources, Inc
Charles Mickens, Light of Zion Ministries
Robert Miller, Episcopal Church
Claire Morin, MD, Tusha International
Pastor Jeffery Mullins, Victory Christian Int Ministries

Del. Shirley Nathan-Pulliam, Maryland General Assembly
National Association of Hispanic Nurses/Colorado Chapter
Christine Ngaruiya, University of Nebraska Medical Center
Marilyn Curtain Phillips, Self
Othelia Pryor, PhD, Michigan Minority Health Coalition

Jorge Quel, MD, Hispanic American Allergy Asthma and Immunology Association
Edgar J. Ridley, Edgar J. Ridley & Associates, Inc.
Linda L. Ridley, Edgar J. Ridley & Associates, Inc.
Mark Robinson, S/R Communications Alliance
Rene Rodriguez, MD, Interamerican College of Physician & Surgeons, Inc
Duncan Ross, AtCor Medical Holdings, Ltd.
Gerard Rushton, PhD, University of Iowa
Terry Schlede, Community Health Consulting Services
Vicki Shepard, Healthways
James Simms, Outreach Church of God in Christ
Janice Smith, New Faith Baptist Church
Sharon Gary-Smith, Cascadia Behavioral Healthcare Inc.
Thelma King Thiel, Hepatitis Foundation International
Dwight Tillery, Center for Closing the Health Gap in Greater Cincinnati
Edward Treadwell, MD, Brody School of Medicine-East Carolina University School of Medicine
Reverend Walter P. Turner, Illinois Faith Based Association
Apostle Carl L. White, Jr., Southland Minsterial Health Network
Dr. E. Faye Williams, Esq., National Congress of Black Women, Inc.
Richard Allen Williams, MD, The Minority Health Institute, Inc.
Terrie Williams, Stay Strong Foundation
Sunil Wimalawansa, PD, PhD, FACE, FRCP, FRCPAth, FACP, DSc, UMDNJ-RWJMS
Eunita Winkey, ATWINDS Foundation

About The Forum

The National Minority Quality Forum (NMQF) is a 501(c)(3) not-for-profit, non-partisan, independent research and education organization. The vision of NMQF is a health services research, delivery and financing system that provides quality and effective health services to the biodiverse American general population of the 21st century. NMQF helps assure that national and local quality improvement initiatives are informed by scientific evidence, and place a priority on the quality of care and patient outcomes in all populations.

LettersAllison Davis