What are Health Disparities?
The existence of racial and ethnic disparities in health care represents a failure of the healthcare system to provide equal, high quality health care to all individuals, regardless of ethnicity, race and other factors. The publication of Healthy People 2010 in 2000 advanced a goal for the elimination of all health disparities in the United States, and acknowledged that a comprehensive strategy incorporating research, education, policy changes, and community partnerships is fundamental to accomplishing this goal. Medical education is an important component of an overall strategy to eliminate health disparities. As the United States becomes increasingly diverse, the next generation of physicians is challenged to expand their knowledge of the different racial and ethnic populations and healthcare inequities facing the U.S. and develop new skills to take care of these patients effectively with cultural competency. As Unequal Treatment suggests, students must learn the underlying causes of health disparities to prepare themselves to care for diverse patient populations. These causes include disparities in healthcare access, resources, treatment, outcomes, and health status for racial and ethnic minority patients; the patient-physician relationship; the healthcare delivery system; language problems; understanding of cultural and folk illnesses; patient beliefs; provider biases; and stereotyping. In addition, students must appreciate the relationship between psychosocial issues and health disparities in order to become culturally competent physicians.
Access: Minorities are less likely than non-minorities to have access to regular medical care and to have health insurance
- Low-income Americans run the highest risk of being uninsured. In 2003, 45 million people lacked health insurance, and the numbers have increased since. Among minority groups, Hispanics are the least likely to have health insurance (32.7% uninsured), followed by American Indians and Alaska Natives (22.7% uninsured) based on a 2-year average (2002-2003). Compare this to 19.6% of Blacks, 18.8% of Asians and Pacific Islanders, and 11.1% of white non-Hispanics who lack health insurance.
Source: Income, Poverty, and Health Insurance Coverage in the United States: 2003, US Census Bureau, US Dept. of Commerce, August 2004.
For more information about access to care, please check out AMSA's Universal Health Care website.
Treatment: Minorities are more likely to received inappropriate or insufficient care than non-minorities
- Numerous studies over the past two decades have documented racial and ethnic differences in care for heart conditions. The strongest studies provide credible evidence that African Americans are less likely than whites to receive diagnostic procedures, revascularization procedures and thrombolytic therapy. Eighty-four percent of studies (done from 1984-2001) investigating this idea found racial/ethnic differences in cardiac care for at least one of the minority groups under study.
Source: Racial/Ethnic Differences in Cardiac Care, The Weight of the Evidence, October 2002
- HIV infection is now the leading cause of death among African Americans between the ages of 25 and 44 and the second leading cause of death among Latinos in this age group. The most telling data regarding adequacy of treatment for minorities come from the HIV Cost and Services Utilization Study that looked at the use of triple drug antiretroviral therapy, a treatment regimen that is very effective in delaying disability and prolonging the life of persons with HIV. African Americans were more than twice as likely as whites to not receive combination drug therapy and 1.5 times more likely to not get preventive treatment for pneumocystic carinii pneumonia (a common, but preventable, infection in people with HIV) than whites. Latinos were 1.5 times more likely than whites to not get combination drug therapy.
Source: Shapiro MF, Morton SC, McCaffrey DF, Senterfitt JW, Fleishman JA, Perlman JF, Athey LA, Keesey JW, Goldman DP, Berry SH, Bozzette SA (1999). Variations in the Care of HIV-Infected Adults in the United States: Results from the HIV Cost and Services Utilization Study. JAMA; 281(24):2305-2315.
Outcomes: Minorities are more likely to have worse health outcomes than non-minorities
- Heart disease is the leading cause of death for all racial and ethnic groups in the United States. In 1999, rates of death from cardiovascular disease were about 30% higher among African American adults than among white adults.
Source: HHS Fact Sheet, U.S. Dept of Health and Human Services, Sept. 2002
Health status
- The incidence of diabetes among American Indians and Alaska Natives is more than twice that of the total population, and the Pima Indians of Arizona have the highest known prevalence of diabetes in the world. The prevalence of diabetes is 70% higher among African Americans and nearly 100% higher among Hispanics than among Caucasian individuals.
Source: HHS Fact Sheet, U.S. Dept of Health and Human Services, Sept. 2002
- As recently as 2000, African Americans and Hispanics accounted for roughly 75% of all adult AIDS cases, although they only compromise 25% of the U.S. population. African American and Hispanics also make up 81% of all pediatric AIDS cases.
Source: HHS Fact Sheet, U.S. Dept. of Health and Human Services, Sept. 2002
- In women, racial and ethnic minority groups are more likely to be overweight or obese than non-Hispanic whites. The same holds true for Mexican-American men vs. non-Hispanic men. This risk factor contributes to the fact that 8.2% of all Hispanic Americans have diabetes.
Source: HHS Fact Sheet, U.S. Dept. of Health and Human Services, Sept. 2004, Health Gap Datastats, OMHRC
A disparity is an inequality. In the United States, we believe that health care should not differ by race, ethnicity, socioeconomic status, or geographic location. When these differences do exist, they are referred to as disparities. We see this when racial and ethnic minorities receive lower quality healthcare than whites. It is important to understand that differences in race and ethnicity (among other things) will always exist; it is wrong, however, when these differences lead to unequal care.
- Populations with Equal Access to Health Care
Figure 1 SOURCE: Gomes and McGuire, 2001, National Academy of Sciences