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In June 2002, the Institute of Medicine issued Unequal Treatment [full text from National Academies Press], a landmark report about the impact of race on health outcomes. Its major finding is that even in settings where providers and programs are clearly dedicated to providing the best care for everyone, race seems to predict who will have less access and poorer outcomes.

In April 2003, Contra Costa Health Services formally adopted Reducing Health Disparities: Diversity and Cultural and Linguistic Competence at Contra Costa Health Services (see below), a plan developed after lengthy planning process and extensive discussion.