A challenge to public health professionals, health care providers, and consumers is to come together to improve the quality of health care and to eliminate disparities. Improving health literacy skills along with a transdisciplinary approach to care contributes to effective patient-provider communication. This article addresses a team approach to health care, a community health center experience, self-management skills, patient education, and cultural competency training. In addition, the authors provide concepts that can be incorporated in health care settings to eliminate health disparities and improve health literacy.

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The Bureau of Primary Health Care (BPHC) was developed to increase access to comprehensive primary and preventive health care and to improve the health status of medically underserved populations. Approximately 43 million Americans fall into this category, and the majority are poor, female, young, and uninsured. Under the Public Health Services Act, BPHC does not provide direct services, but rather assist local communities in identifying populations at risk of poor health outcomes and helps these communities through various programs. One of the newest initiatives of BPHC is the Office of Minority and Women's Health, developed with a mission to help reduce the disparities in the health status of women of racial and ethnic minority populations. This article outlines these disparities and discusses proposals for reducing them.

In this study 3,056 members (10 years of age and older) of the kibbutzim in the northern part of Israel were examined in order to determine the prevalence of chronic otitis media and cholesteatoma. In addition to demographic factors, the influence of altitude was investigated, but the differences were not found to be significant. The prevalence of chronic otitis media was found to be 0.95% and of cholesteatoma, 0.4%. Of the patients who had chronic otitis media, 41% suffered from cholesteatoma as well. Chronic otitis media was more prevalent in males than females (0.02 greater than p greater than 0.01) in the Ashkenazic than Sephardic populations (0.05 greater than p greater than 0.02), and in industrial and agricultural workers (0.05 greater than p greater than 0.02), as compared to others. Among cholesteatoma patients a family history was found in 64%. In 71% of patients, illness began in infancy. Fifteen percent of the patients did not know of their disease until they were examined in this study. These results suggest a high rate of cholesteatoma among chronic otitis media patients and emphasize the need for performing more extensive studies to determine the rate of cholesteatoma in the general population. The necessity for preventive ear examinations, earlier diagnosis, and treatment of cholesteatoma is emphasized.