The IOM report has demonstrated the complexities of health care disparities. For example, racially and ethnically diverse elders are more likely to live in poverty and to be underinsured. In addition, the problems of health disparities are present even when income and access are plentiful. African American older adults, for example, are much less likely to receive routine diagnostic screenings for cancer, and are less likely to be referred to specialists for heart disease, pain control and a host of other disorders. The IOM report concluded that many social factors were at the root of disparities, including racism and unconscious stereotyping. Multicultural competencies are thus necessary to assist practitioners in avoiding, sustaining or increasing disparities through subtle behaviors and attitudes.