HEALTH DISPARITY

Historically, infant mortality rates, infectious and chronic disease morbidity and mortality rates, and multiple other health events have had a greater negative impact on minority and underserved communities and populations, a trend that continues to this day.

• In 2002, the infant mortality rate for African Americans was 13.8 per 1,000 live births, compared to the rate for Whites of 5.8 per 1,000 live births – more than double the rate.

• The mortality rate for HIV/AIDS in 2003 was almost 8 times higher for African American males compared to White males, and almost 13 times higher for African American females compared to White females.

• In regards to health behaviors, 36% of poor persons (defined as below the poverty threshold) are obese, compared to 29% of the non-poor.

• Data from the National Health Interview Survey indicated that 20% of poor people self-reported fair or poor health compared to 6% of non-poor persons.

• When stratified by race, approximately 15% of African Americans and 14% of Hispanics reported fair or poor health compared to 8% of Whites.

• In a report by the Institute of Medicine, minorities were less likely than non-Hispanic Whites to receive needed health services even after correcting for access-related factors. Disparities were found across a range of clinical settings that resulted in lower quality of care, less desirable clinical services, and higher mortality among minorities not receiving the same services as whites.

What is health disparity?

Health disparity implies an inequality in overall health care. In the context of its use in the United States, the term is used to describe inequities (inherently unfair differences) in health based on differences in race, ethnicity, socioeconomic status, education, access to health care, insurance coverage, age, gender, language, culture, and community size, community location and community wealth. These disparities disproportionately effect underserved populations and are seen in higher morbidity and mortality rates among these populations as compared to the non-minority population.

Healthy People 2010, our nation’s health blueprint, has two overarching goals:

1. To increase the quality and years of healthy life; and

2. To eliminate health disparities

According to the Centers for Disease Control and Prevention Office of Minority Health, demographic changes anticipated over the next decade underscore the importance of addressing health disparities. Because groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population, the health of the nation as a whole will be significantly influenced by the health of these groups.

The elimination of health disparities requires an increased emphasis on disease prevention and health promotion, in addition to the delivery of appropriate care to all segments of the population. As researchers, our task is to understand the determinants of health disparities and to develop effective interventions. The elimination of health disparities is a multi-disciplinary challenge that requires improved collection and use of data, improved access to health services, as well as improved partnerships between the health care system, community organizations, academia, and local, state, and federal governments.

For more information on health disparity, the following articles are recommended:

Health Disparity Defined:

1. What is a “Health Disparity”?
   Carter-Pokras, O., & Baquet C. (2002). Public Health Reports, 117, 426-434.

2. The concepts and principles of equity and health.
   Whitehead, M. (1992). International Journal of Health Services, 22, 429-445.

3. Why genes don’t count (for racial differences in health)
   Goodman, A.H. (2000). American Journal of Public Health, 90(11), 1699-1702.

4. Use of race and ethnicity in biomedical publication
   Kaplan, J.B., & Bennett, T. (2003). JAMA, 289(20), 2709-2716.

5. Abandoning “race” as a variable in public health research – an idea whose time has come. Fullilove, M.T. Comment in American Journal of Public Health, 88(9), 1297-1298.

Health Disparity Frameworks:

1. The need for a new medical model: a challenge for biomedicine
   Engel, G.L. (1977). Science, 196(4286), 129-136.

2. Socioeconomic position and health: The independent contribution of community socioeconomic context.
   Robert, S.A. (1999). Annual Review Sociology, 25, 489-516.

3. Life course accumulation of disadvantage: childhood health and hazard exposure during adulthood.
   Holland P., Berney, L., Bland, D., Davey Smith G., Gunnell, D.J., & Montgomery, S.M. (2000). Social Science and Medicine, 50, 1285-1295.

Health Disparity Measurement:

1. Methodological issues in measuring health disparities
   Keppel, K., Pamuk, E., Lynch, J., Carter-Pokras, O., Kim, I., Mays, V., Pearcy, J., Schoenbach, V., & Weissman, J.S. (2005). National Center for Health Statistics. Vital and Health Statistics, 2(141):2005.

2. Socioeconomic status in health research: one size does not fit all
   Braveman, P.A., Cubbin, C., Egerter, S., Chideya, S., Marchi, K.S., Metzler, M., & Posner, S. (2005). JAMA, 294(22), 2879-2888.

3. The measurement of social class in epidemiology.
   Liberatos, P., Link, B., & Kelsey, J.L. (1988). Epidemiology Reviews,10, 87-121.

4. Social/economic status and disease
   Marmot, M.G., Kogevinas, M., & Elston, M.A. (1987). Annual Review of Public Health, 8, 111-135.

1. Disparities in health care: from politics to policy
   Steinbrook, R. New England Journal of Medicine, 350, 1486-1488.

2. Professional and hospital discrimination and the US Court of Appeals Fourth Circuit 1956-1967.
   Reynolds, P.P. (2004). American Journal of Public Health, 94(5),710-720.