In 2002, the Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, a landmark monograph documenting health disparities in the U.S. health care system. Since the publication of Unequal Treatment, the field of pediatric health disparities research has advanced significantly with a proliferation of studies examining a wide array of topics concerning inequities in child health. Advances in health care policy and legislation have also added to a heightened discourse on pediatric health disparities. While there has been substantial activity in efforts to address pediatric health disparities, questions remain regarding whether these efforts have changed the trajectory of health equity among children. The aim of this paper is to examine the practical challenges of addressing pediatric health disparities in the dynamic context of global changes in health care research, policy, and legislation relevant to children. Using the Adaptive Leadership framework, this paper outlines a conceptual model for assessing the scope of progress made in addressing pediatric health disparities, diagnoses the continued adaptive challenges of pediatric health disparities, and provides an agenda for further work and future investment.

Key Take Away Points

  • Publication of Unequal Treatment provided an impetus to address pediatric health disparities
  • Health disparities among children persist despite significant investments in research, policy, and legislation
  • The Adaptive Leadership framework provides a conceptual model for assessing current challenges and opportunities to address pediatric health disparities

Author Biography

Jean L. Raphael MD, MPH is an Assistant Professor of Pediatrics at Baylor College of Medicine and a faculty investigator at the Center for Clinical Effectiveness at Texas Children’s Hospital. He is a pediatrician and health services researcher with expertise in minority health policy. Dr. Raphael’s work combines health services research and behavioral interventions to enhance care delivery for minority children with chronic conditions. He is currently principal investigator on NIH and Aetna Foundation funded studies.


This work was supported by a grant to Dr. Raphael, NIH Grant Number 1K23 HL105568.



Responses to this Article:

Yolande M. Pengetnze and Glenn Flores, Journeying Beyond the Balcony to the Block Party and Up to 50,000 Feet: Disparities in Children’s Health and Healthcare (March 2013)