So this is technically improvement, and it will be reported as improvement, but it's the kind of improvement that distances itself from the designation. It is a reduction in injustice, not cause for celebration. These numeric gains look big, but these metrics—what is done for an imminently sick person when they are in the hospital—are a poor proxy for the deepest, insidious health disparities across races in the United States. The healthcare system is one that, as recently as World War II, would not mix donations in blood banks from white and black people, despite the empiric fact that the blood is biochemically identical. And the race problem in American healthcare is a problem for every American.

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The New England Journal today simultaneously published a study that is much less heartening. It showed that racial disparities in preventive care—measures taken to keep people healthy and out of the hospital—persist, largely unchanged between 2006 and 2011. John Ayanian, a professor and director of the Institute for Healthcare Policy and Innovation at the University of Michigan, and colleagues found that elderly black Medicare enrollees were substantially less likely than their white counterparts to have adequate control of their blood pressure, cholesterol, and blood sugar.

The researchers noted that as of 2008, life expectancy was 5.4 years shorter for black men than white men in the United States, and 3.7 years shorter for black women than for white women. Among men, 38 percent of that racial gap is accounted for by cardiovascular disease and diabetes. Among women, the number is even larger, 54 percent. Poorly controlled blood pressure, cholesterol, and blood sugar are understood to underlie much of that mortality, and much other morbidity.

The studies together show that we have been able to improve general quality of care for a limited number of conditions in hospital settings, but the more important metric, health outcomes, remains largely unchanged. According to Marshall Chin, an internal medicine physician and professor in healthcare ethics at the University of Chicago, we still have a long way to go before we actually improve outcomes and reduce disparities.

What Trivedi's study examined were limited measures that are easier to improve than long-term health outcomes. In the case of Trivedi's study, Medicare required hospitals to monitor and publicly share their performance statistics on the metrics that the researchers examined. Medicare linked hospital reimbursement to how well hospitals did on those metrics. So they had clear incentives to do better. But right now, according to Chin, there aren't many incentives to reduce disparities.

Specialties like preventive care and primary care, where these disparities are best addressed, are poorly reimbursed. Doctors in those fields earn much, much less than their specialist peers. And on a larger scale, there is very little incentive for healthcare organizations to work on addressing social determinants of health: the social and economic drivers of disparities, starting with creating healthy communities.