Incorporating civil rights principles into public health regulations at the state level to reduce health care disparities by strengthening the health care system at the community level

Health care disparities invite questions about civil rights principles that have been operationalized in case law. This presentation will compare nondiscrimination standards in healthcare for racial and ethnic minorities under Title VI of the Civil Rights Act of 1964 with nondiscrimination standards for persons with disabilities under Section 504 of the Rehabilitation Act of 1973 that extended Title VI to persons with disabilities, which then morphed into the Americans with Disabilities Act (ADA) in 1990. Comparing the way these different minorities have been differentially protected by comparable civil rights laws in the healthcare marketplace, provides a basis for considering how nondiscrimination standards could be more effectively enforced by incorporating nondiscrimination standards into public health laws and regulations that monitor health disparities, identify the barriers to equal access and quality, and spread the costs of “reasonable accommodations” throughout the healthcare delivery system at the state and community levels. If nondiscrimination standards were incorporated into licensing, quality assurance, accreditation, and conditions of participation, it should be possible address the problems of fragmentation in the health care delivery system, and to reduce health care disparities in the most efficient, effective, and equitable way. By focusing on public accountability for nondiscrimination standards at the community level, it may be possible to increase the efficiency, effectiveness, and equity of the health care delivery system in serving the total population, and to generate savings that can then be captured and invested in both clinical and non-clinical interventions that address the social determinants of poor health.