The Foundation’s work to address health care disparities builds on existing programs aimed at improving health care for an increasingly diverse American public. For example, research has shown that many patients who are not proficient in English often delay seeking the health care they need. Hablamos Juntos, the RWJF national program to reduce language barriers for Latino patients, awarded 10 demonstration grants in 2003. Grantees, ranging from major hospital systems in Virginia and California to a community health plan in Providence, R.I., are working to develop affordable models for health care systems to increase language access for Latino patients, emphasizing skilled translator services and high-quality bilingual signage and health education materials. Communicating and connecting with patients is a key factor in providing high-quality health care. Thus, the Foundation is supporting a group of Local Initiative Funding Partners Program grantees working to make health services more culturally sensitive. In Cleveland, El Barrio, a social service agency, is establishing a health care careers center to increase the number of Hispanic community residents entering nursing and related health careers.

Recent public attention to issues of care at the end of life have highlighted the long-standing Foundation focus on a serious concern for Americans and their health care systems. During the past decade, the Foundation has funded nearly $160 million in grants to educate physicians and nurses on palliative care, improve end-of-life care in hospitals and hospices, and change the way that health care professionals and the public think about and care for people at the end of life. This year, the Foundation took stock of its active end-of-life grants to determine which programs are firmly established and which may need further support to complete their work or to make the transition to other funding.

• Foundation-funded institutional change efforts continue to be led by the Center to Advance Palliative Care at Mount Sinai School of Medicine and Promoting Palliative Care Excellence in Intensive Care at the University of Montana College of Arts and Sciences.

• The highly effective Community-State Partnerships to Improve End-of-Life Care program closed in 2003. Its legacy of public engagement continues with Rallying Points, now working with 360 state and local coalitions nationwide.

• Last Acts^® has created a new entity—Last Acts Partnership—that will increase its consumer education and advocacy efforts, working with and through more than 1,200 organizational partners.

The Foundation expects to complete its investments in improving end-of-life care within the next few years. The work accomplished during this past decade has transformed both public dialogue and public policy on end-of-life care. We are confident this progress will continue, and will remain vigilant to ensure that it does.