Research on health disparities has accelerated rapidly in the last 5 years, fueled by publication of the Institute of Medicine report Unequal Treatment and by increased availability of funding. A MEDLINE search using the keyword phrase continental population groups and text words disparity or disparities yielded more than 1800 publications. Fewer than 500 of these articles were published before 2001, and annual publications have grown steadily. . .

Few scholars are able to keep pace with this burgeoning, interdisciplinary literature, much less adequately synthesize the disparate data. Compendia like Multicultural Medicine and Health Disparities are therefore particularly helpful. This single volume, edited by David Satcher and Rubens Pamies, focuses primarily on racial and ethnic health disparities in the United States. Discussion of health care disparities is woven into many of the book's 34 chapters. . .

Texts by more than 80 authors are challenging to edit. Editors struggle to ensure uniformity in chapter organization and writing quality, synthesize common findings across disparate disciplines, and avoid redundancies. Satcher and Pamies have been largely successful. The book is organized into three main sections. The first, "Health-Care Disparities Across the Life Span," includes a series of chapters that address that subject but also touch on issues of access. The first chapter,"Health Disparities in the United States: A Continuing Challenge," by Hani Atrash and Melissa Hunter, provides a concise overview of disparities in health based on national data. Subsequent chapters address disparities in health and access related to geography, reproductive health, children, children of immigrants, and geriatrics and end of life. . .

The second section, "The Disparate Burden of Disease," is organized by disease. It concludes with a chapter on case studies that vividly highlights poor care resulting from lack of cultural competency. Most chapters begin with an overview of the epidemiology of disparities; review what is known about potential causes, including poor access and unequal treatment; and conclude with summaries and recommendations to address disparities. . .

In the chapter on HIV infection by Eric Goosby, former Director of the Office of HIV/AIDS Policy in the US Department of Health and Human Services (DHHS), readers are reminded of the horrific toll exacted by HIV on the minority community. AIDS is diagnosed 23 times more frequently among African American women than white women and is among the top three causes of death for younger and middle-aged African American men and women. Yet only two pages are devoted to factors that contribute to disparities, and the chapter ends abruptly without clear recommendations for national policy. . .

The last section, "Issues in Health-Care Policy and Delivery," takes up a range of issues related to cultural competency, diversity, participation in research, and trust in medical institutions. Topics that have received less attention in the disparities literature include medical genetics, community health centers, faith-based initiatives to address disparities, alternative and complementary medicine, and the potential impact of bioterrorism on minority health. . .

Given Dr Satcher's notable work as director of the Centers for Disease Control and Prevention (CDC), US Surgeon General, and, now, director of the National Center for Primary Care, I looked forward to the book's final chapter, which he has authored, "The Role of Government in Minority Health: A Surgeon General's Perspective." Indeed, the chapter provides an excellent review of the history and roles of the key federal agencies within the DHHS relevant to health disparities. However, I found myself wanting more discussion of federal policies outside the purview of the Surgeon General or CDC that have disparate impact on minority health. Public education campaigns and targeted initiatives alone will not eliminate disparities. Federal policies related to education, housing, health care, the environment, job training, criminal justice, and taxation, among others, must be clearly aligned with the Healthy People 2010 goal of eliminating disparities in health for us to succeed. . .

As with any edited text, particularly one that cuts across diseases and disciplines, some redundancy is unavoidable. However, I would have preferred key terms such as "race" and "ethnicity" to have been defined once in an introductory chapter rather than the definitions being repeated. Similarly, a chapter devoted to common strategies and policies to address disparities would have been helpful. . .

In the past two years, other books on health disparities have been published. The two-volume Praeger Handbook of Black American Health, edited by Livingston(2004), provides a more sociological perspective on disparities, addressing African American health. Its concluding recommendations are more sweeping than those in Multicultural Medicine. A second text, Minority Populations and Health: An Introduction to Health Disparities in the United States, by LaVeist (2005), offers the advantages of a single-author book, including better integration of content, but provides fewer details on disparities in particular areas. Thus, it complements Multicultural Medicine. I am confident that Multicultural Medicine will serve as a valuable reference source for researchers and policy makers and as a textbook for graduate and undergraduate students for the remainder of the decade.. .

Kevin Fiscella, MD, MPH, Reviewer . University of Rochester School of Medicine and Dentistry . Rochester Center to Improve Communication in Health Care . Rochester, NY . kevin_fiscella@urmc.rochester.edu.

Research on health disparities has accelerated rapidly in the last 5 years, fueled by publication of the Institute of Medicine report Unequal Treatment and by increased availability of funding. A MEDLINE search using the keyword phrase continental population groups and text words disparity or disparities yielded more than 1800 publications. Fewer than 500 of these articles were published before 2001, and annual publications have grown steadily.

Few scholars are able to keep pace with this burgeoning, interdisciplinary literature, much less adequately synthesize the disparate data. Compendia like Multicultural Medicine and Health Disparities are therefore particularly helpful. This single volume, edited by David Satcher and Rubens Pamies, focuses primarily on racial and ethnic health disparities in the United States. Discussion of health care disparities is woven into many of the book's 34 chapters.

Texts by more than 80 authors are challenging to edit. Editors struggle to ensure uniformity in chapter organization and writing quality, synthesize common findings across disparate disciplines, and avoid redundancies. Satcher and Pamies have been largely successful. The book is organized into three main sections. The first, "Health-Care Disparities Across the Life Span," includes a series of chapters that address that subject but also touch on issues of access. The first chapter, "Health Disparities inthe United States: A Continuing Challenge," by Hani Atrash and Melissa Hunter, provides a concise overview of disparities in health based on national data. Subsequent chapters address disparities in health and access related to geography, reproductive health, children, children of immigrants, and geriatrics and end of life.

The second section, "The Disparate Burden of Disease," is organized by disease. It concludes with a chapter on case studies that vividly highlights poor care resulting from lack of cultural competency. Most chapters begin with an overview of the epidemiology of disparities; review what is known about potential causes, including poor access and unequal treatment; and conclude with summaries and recommendations to address disparities.

In the chapter on HIV infection by Eric Goosby, former Director of the Office of HIV/AIDS Policy in the US Department of Health and Human Services (DHHS), readers are reminded of the horrific toll exacted by HIV on the minority community. AIDS is diagnosed 23 times more frequently among African American women than white women and is among the top three causes of death for younger and middle-aged African American men and women. Yet only two pages are devoted to factors that contribute to disparities, and the chapter ends abruptly without clear recommendations for national policy.

The last section, "Issues in Health-Care Policy and Delivery," takes up a range of issues related to cultural competency, diversity, participation in research, and trust in medical institutions. Topics that have received less attention in the disparities literature include medical genetics, community health centers, faith-based initiatives to addressdisparities, alternative and complementary medicine, and the potential impact of bioterrorism on minority health.

Given Dr Satcher's notable work as director of the Centers for Disease Control and Prevention (CDC), US Surgeon General, and, now, director of the National Center for Primary Care, I looked forward to the book's final chapter, which he has authored, "The Role of Government in Minority Health: A Surgeon General's Perspective." Indeed, the chapter provides an excellent review of the history and roles of the key federal agencies within the DHHS relevant to health disparities. However, I found myself wanting more discussion of federal policies outside the purview of the Surgeon General or CDC that have disparate impact on minority health. Public education campaigns and targeted initiatives alone will not eliminate disparities. Federal policies related to education, housing, health care, the environment, job training, criminal justice, and taxation, among others, must be clearly aligned with the Healthy People 2010 goal of eliminating disparities in health for us to succeed.

As with any edited text, particularly one that cuts across diseases and disciplines, some redundancy is unavoidable. However, I would have preferred key terms such as "race" and "ethnicity" to have been defined once in an introductory chapter rather than the definitions being repeated. Similarly, a chapter devoted to common strategies and policies to address disparities would have been helpful.

In the past two years, other books on health disparities have been published. The two-volume Praeger Handbook of Black American Health, edited by Livingston (2004), provides a more sociological perspective ondisparities, addressing African American health. Its concluding recommendations are more sweeping than those in Multicultural Medicine. A second text, Minority Populations and Health: An Introduction to Health Disparities in the United States, by LaVeist (2005), offers the advantages of a single-author book, including better integration of content, but provides fewer details on disparities in particular areas. Thus, it complements Multicultural Medicine. I am confident that Multicultural Medicine will serve as a valuable reference source for researchers and policy makers and as a textbook for graduate and undergraduate students for the remainder of the decade.

Kevin Fiscella, MD, MPH, Reviewer University of Rochester School of Medicine and Dentistry Rochester Center to Improve Communication in Health Care Rochester, NY kevin_fiscella@urmc.rochester.edu

"This single volume, edited by David Satcher and Rubens Pamies, focuses primarily on racial and ethnic health disparities in the United States. Discussion of health care disparities is woven into many of the book's 34 chapters....I am confident that [this book] will serve as a valuable reference source for researchers and policy makers and as a textbook for graduate and undergraduate students for the remainder of the decade."--"Journal of the American Medical Association," .