In its 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” the Institute of Medicine recommended six aims for improvement. It states that health care systems in the 21st century must be safe, effective, patient-centered, timely, efficient and equitable. While there has been significant progress in the first five of those areas, progress on “equitable” has been slow. The 20-year gap between recommendation and action on equitable health care is far too long.