Health Disparities: Understanding Disparities and Inequality

UNDERSTANDING DISPARITIES AND INEQUALITY
Research and critical thinking on the nature and impact of health disparities among African Americans, Native Americans, Asian Americans, Alaskan Natives, Pacific Islanders and Latinos have focused on defining what constitutes “health disparity” and how this concept can be measured. Articles in this section provide a foundation for exploring the history of thinking on this issue. Researchers point to racism, social and economic conditions and structural issues (e.g., access to health services, payment systems, quality of care) as possible determinants of disparity and address possible strategies to alleviate adverse impacts.

Carter-Pokras O, Baquet C. What is a “health disparity”? Public Health Reports [serial online]. 2002;117:426-434. Available at: http://www.publichealthreports.org/userfiles/117_5/117426.pdf. Accessed May 18, 2007.

This article explores the definitions of the terms “health disparity” versus “inequality” and “inequity.” While “disparity” and “inequality” share similar definitions (e.g., “difference in age, rank, condition or excellence” or “condition of being unequal”), “inequity” corresponds to “an instance of unjustness or unfairness.” The authors, however, explain how “disparities” are being looked at in terms of unjustness and unfairness. They discuss several determinants, classified as avoidable or unavoidable, for measuring disparities. These determinants include conditions such as education, culture, income, social status and working conditions, among others. Finally, the authors explore the policy implications of the many definitions of “disparity.”
Colorado Department of Public Health and Environment. Racial and ethnic health disparities in Colorado. Denver, CO: Office of Health Disparities; 2005. Available at: http://www.cdphe.state.co.us/ohd/ethnicdisparitiesreport/REHD-05.pdf. Accessed January 4, 2006.

This annual surveillance report illustrates the differences in health among groups and attempts to explore why these differences exist by examining socioeconomic, psychological and cultural factors that influence health. The report also outlines the social and economic costs of these disparities and urges a prevention-focused health agenda as well as multi-level approaches (i.e., individual, institutional, community, policy) to reduce disparities.
? Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. American Journal of Public Health [serial online]. 2000;90:1212-1215. Available at: http://www.ajph.org/cgi/reprint/90/8/1212. Accessed May 18, 2007.

This distinguished author outlines her theoretical framework for understanding racism on three levels: 1) institutionalized racism: differential access to goods, services and societal opportunities according to race; 2) personally mediated racism: prejudice, discrimination and differential assumptions about and actions toward others according to race and 3) internalized racism: the acceptance by members of a stigmatized race of negative message about their own abilities and intrinsic worth. She then uses an allegory, “The Gardener’s Tale,” to illustrate the relationships between the three levels of racism. This article has been used to stimulate dialogues about race and health inequities.
Kaiser Family Foundation. Key facts: race, ethnicity and medical care. Menlo Park, California: The Henry J. Kaiser Family Foundation; 2007. Available at: http://www.kff.org/minorityhealth/upload/6069-02.pdf. Accessed May 18, 2007.

This quick reference serves to highlight data, research and select literature on health, health insurance coverage and health care access and quality among racial and ethnic groups in the United States. The guide attempts to understand the causes of health disparities and the actions being taken to mitigate them. The presented data demonstrates whether health disparities are decreasing, increasing or continuing in certain minority communities. Specific health topics such as heart disease, cancer, asthma and HIV/AIDS relating to these communities are covered.
? Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Institute of Medicine. Washington, DC: National Academy Press; 2003. Available at: http://www.nap.edu/books/030908265X/html/. Accessed May 18, 2007.

This report, written at the request of Congress, 1) assesses the extent of racial and ethnic differences in health care not attributable to known factors such as access to care, 2) evaluates potential sources of racial and ethnic disparities in health care (at the individual, institutional and systemic levels) and 3) provides recommendations regarding the elimination of health care disparities. The committee reviewed over 100 studies published in peer-reviewed journals between 1993 and 2003 and searched for differences in health care services by patient socioeconomic status and geographic region. They found that health disparities exist in the context of broader historic and contemporary social and economic inequalities. Health systems and health providers may contribute to health disparities. The authors concluded that more research is needed to understand the prevalence and influence these factors have on patient compliance and clinical outcomes.
Williams DR, Ruckner T. Understanding and addressing racial disparities in health care. Health Care Financing Review [serial online]. 2000;21(4):75-90. Available at: http://www.cms.hhs.gov/HealthCareFinancingReview/Downloads/00summerpg75.pdf. Accessed May 18, 2007.

This article examines historical instances of racism and discrimination that led to policy creation or changes in the United States. The authors argue that the policies implemented to end discrimination have failed to eliminate problems, including personal discrimination, which occurs most commonly as unconscious or unintentional behavior and contributes to health disparities; however, other barriers in health care also should be addressed. The article highlights the importance of educating medical students and offers other ideas and solutions to improve policy.

Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. American Journal of Public Health [serial online]. 2003;93(2):200-209. Available at: http://www.ajph.org/cgi/reprint/93/2/200?ck=nck. Accessed May 18, 2007.

This article is a review of population-based studies of the association between health and racial and ethnic discrimination. The authors reviewed a total of 53 studies, completed between 1998 and 2003, in the areas of mental health, physical health and health behaviors. Results indicated that perceived discrimination might be a race-related stressor that negatively affects health; however, the evidence was insufficient to explain how exposure to discrimination can increase the risk of disease. Racial bias also may be a determinant that affects health, but has not been studied as a contributor to health disparities. The report notes the lack of an optimal consensus measure to capture exposure to discrimination. Nevertheless, findings consistently suggested an association between perceived discrimination and poorer health, especially among socially disadvantaged groups.

Back to top