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Recent medical developments have led to increased health and quality of life for many Americans; however not all Americans are benefiting equally from these advances.  For too many minority populations in the United States, excellent health continues to be beyond their grasp.  Any overhaul of our health care system will be incomplete as long as segments of our population experience more limited access to, and poorer outcomes from, health care than the rest of America.  This Alert provides basic information about health disparities: the populations affected, the costs, the causes, and possible means of addressing the problem.

Defining Health Disparities

The term "health disparities" is often defined as "a difference in which disadvantaged social groups such as the poor, racial/ethnic minorities, women and other groups who have persistently experienced social disadvantage or discrimination systematically experience worse health or greater health risks than more advantaged social groups"[1]  As the term health disparities relates to certain ethnic, racial, and disadvantaged social groups, it is descriptive of the increased presence and severity of certain diseases common to all peoples, of poorer health outcomes, and of heightened problems of obtaining access to healthcare.[2]  Likewise, when these differences are avoidable - and need not occur but for systematic barriers to good health - they are often referred to as "health inequities". The populations that have customarily been underserved in the American health care system are African Americans, Latinos, Native Americans, and Asian Americans, as well as rural populations and women.[3]

The High Cost of Health Disparities

Reducing health disparities is critical to reining in health care costs and achieving a healthier nation. A joint study by Johns Hopkins University and the University of Maryland found that between 2003 and 2006, 30.6 % of medical costs of African Americans, Hispanics, and Asian Americans were due to health disparities.[4]  A recent Urban Institute study concluded that eliminating health disparities for African Americans and Latinos with respect to just two diseases – diabetes and heart disease – would save the U.S. health care system more than $24 billion in 2009 alone.[5] As a consequence, any health reform that is implemented this year must seriously address the elimination of health disparities.

Common Causes of Health Disparities

A.        Race, Language, and Culture

Although it is commonly believed that health disparities occur simply because of a lack of health insurance and access to health care, disparities exist even after access to the health care system has been improved.  For instance, new studies have shown that there are stark differences in health outcomes of black and white patients with the same conditions even when they are treated by the same doctor.[6]  Studies have shown that diagnoses, treatments, and quality of care can vary greatly depending on a number of factors that affect minority communities including language barriers, lack of insurance coverage, and differential treatments based on the population group.[7]  The differences in health outcomes are not always attributable to providers' delivering a different quality or quantity of care for certain patients with the same health conditions as others. Health inequities can also result when the exact same medical treatment is provided to all patients who have the same health condition without regard to the patient's cultural norms.

B.        Income, Housing, and Environment

Disparities can be linked to factors that are both inside and outside of the health care system.  Disparities in health care have been known to be linked to income levels, adequacy and safety of housing, employment status, education level, lifestyle choices, environmental conditions, and social conditions.[8]  Barriers that may prevent traditionally underserved populations from entering the health care system may include lack of resources, cultural norms that discourage medical treatment, and prior negative experiences with medical treatment.  Additional systemic barriers to seeking health care may include lack of providers, lack of transportation, no or poor health insurance coverage, or legal or other barriers to receiving public aid.[9]  Nearly one half of Hispanic adults (45%), along with 41% of Asian American adults and 35% of African American adults, report that they have difficulty in paying for medical care.  These difficulties have led 30 percent of African Americans and 25 percent of Hispanics with chronic conditions to forgo prescription drug purchases.[10]  In the Government Accountability Office (GAO) report on minority health, the GAO reported that some people who are eligible for Medicaid or SCHIP do not enroll because they cannot understand the complex eligibility criteria and enrollment process.  This may be an explanation as to why one in three Hispanic children that are eligible for Medicaid and SCHIP are not insured.[11]

C.        Health Care Provider Awareness and Sensitivity

Generally speaking, provider cultural competency allows health care providers to successfully interact with patients from a variety of ethnic and cultural groups.  There are many factors that make up patients' cultural or ethnic identity including: their country of origin, the language spoken at home, their religion or spiritual traditions, family traditions, cultural diet and nutrition, traditional medical practices, or cultural attitudes about illness or death.  Health care providers should be aware of potential cultural influences and be prepared to apply this knowledge in their patient care.  Certain patient populations may have different names for diseases as well as different understandings of how illnesses start or may be treated.  These cultural understandings must be addressed in the delivery of care if the provider hopes to have a significant impact on the health of the patient.

Clear communication between a patient and his/her health care provider is a critical factor in assuring appropriate treatment and ongoing care for any medical condition.  Provider/patient miscommunication can lead to, among other things, a misdiagnosis of symptoms, inability to understand how to take medications or what the uses of the medication are, and inappropriate or complete lack of follow up care.  The communication problems between patients and providers are often exacerbated by limited or no access to interpreters for speakers with limited English proficiency.  Translation and interpretation tools for hearing and vision impaired persons may also be lacking.

Addressing Health Disparities

Health care reform should address barriers to quality care by focusing on a universal and equitable approach to providing affordable health insurance with a focus on preventive care, effective management of chronic conditions, and care coordination to all populations in the United States.  Other steps to reducing health care disparities include focusing on training health care providers in cultural competency, recruiting a diverse health care workforce, eliminating language barriers in the health care setting, and coordinating community- based programs in health centers that target disparities.  Evidence suggests that communication, trust, and understanding are greatly improved between a physician and patient when they share the same ethnic, cultural or primary language background.[12] Data collection strategies designed to capture and report health disparities data through the use of Health Information Technology are also a key step to increasing understanding of why these health disparities exist and monitoring their eradication.

Conclusion

Solutions to address health care disparities must be included in health reform legislation currently under consideration in the Congress.  Many of the problems encountered by those populations that suffer from health disparities will not be automatically solved simply by increased access to care.[13] Addressing the health care disparities of the minority populations of the United States must be a deliberate priority of health care reform. Unless the root causes of the inequities are treated, individuals will continue to receive inadequate or no health care and the country will continue to face the increasing health care costs associated with disparities.  Any health care reform legislation should do all that it can to improve health outcomes for everyone living in the United States, saving the U.S. health care system significant amounts of money along the way.