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.
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" 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. 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.
The High Cost of
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.
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.
As a consequence, any health reform that is implemented this year
must seriously address the elimination of health disparities.
Common Causes of
A. Race, Language,
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.
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.
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.
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. 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.
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.
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.
C. Health Care
Provider Awareness and Sensitivity
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.
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.
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.
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.
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.
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.
Braveman, P, M.D., M.P.H., quoted in "International
Perspectives on Health Disparities and Social Justice:
Ethnicity and Disease, Vol. 17, Spring 2007. See, also,
Braveman, et. al., "An Approach to Studying Social
Disparities in Health and Health Care," American Journal
of Public Health, Vol. 94, No. 12 (December 2004).
Goldberg, J., Hayes,
W., and Huntley, J. "Understanding Health Disparities,"
Health Policy Institute of Ohio (November 2004).
Smedley, Brian M. "The
Cost of Health Inequality." InsightNews.com. 05 Oct.
2009. Web. 19 Oct. 2009. <http://www.insightnews.com/commentary/4993-the-cost-of-health-inequality>.
Waidman, T. "Estimating the Cost of Racial and Ethnic Health
Disparities," The Urban Institute, September 2009, available
Sack, Kevin. "Doctors Miss Cultural Needs, Study Says."
New York Times. June 10, 2009. <http://query.nytimes.com/gst/fullpage.html?res=9B0CE5DD1E3EF933A25755C0A96E9C8B63&scp=2&sq=Kevin+Sack&st=nyt>
U.S. General Accounting Office (GAO), Health Care:
Approaches to Address Racial and Ethnic Disparities.
(GAO-03-862R, July 2003)
Kate Meyers, Racial and Ethnic Health Disparities (Oakland,
CA: Kaiser Permanente Institute for Health Policy, 2007).
Available online at http://www.kpihp.org/publications/docs/disparities_highlights.pdf.
"Ensuring that Health
Care Reform Will Meet the Health Care Needs of Minority
Communities and Eliminate Health Disparities." Health and
Human Services Office of Minority Health, July 2009. Web.