VI. Key Issues: Financing & Delivery >> Access to Care >> Health Disparities (last updated 1.7.17)
Health disparities includes disparities in health status attributable to racial, ethnic, and cultural barriers to access. Five determinants of population health are generally recognized in the scientific literature: biology and genetics (e.g., sex), individual behavior (e.g., alcohol or injection drug-use, unprotected sex, smoking), social environment (e.g., discrimination, income, education level, marital status), physical environment (e.g., place of residence, crowding conditions, built environment [i.e., buildings, spaces, transportation systems, and products that are created or modified by people]), and health services (e.g., access to and quality of care, insurance status). Thus, observed health disparities typically have more than a single cause.
In general, the limited evidence available for the first half of the 20th century indicates that mortality differentials by socioeconomic status narrowed sometime between 1900 and the 1930s or 1940s. More recent data covering roughly the second half of the 20th century indicate that mortality differentials by socioeconomic status have generally widened from around the 1950s or 1960s through the 1990s.
Economic Impact of Health Disparities
- The Office of Minority Health and Disparities has a series of fact sheets on six major focus areas in which racial and ethnic minorities experience serious disparities in health access and outcomes, including cancer, cardiovascular disease, diabetes, HIV/AIDS, immunizations, and infant mortality. These six health areas were selected for emphasis because they reflect areas of disparity that are known to affect multiple racial and ethnic minority groups at all life stages. The fact sheets contain basic information about the burden (health and economic) associated with each area.
- There are four other major diseases and conditions that disproportionately impact racial and ethnic minorities, including mental health, hepatitis, syphilis, and tuberculosis. OMHD fact sheets have been developed for mental health, tuberculosis, and lupus.
- At least some of the foregoing disparities relate to racial and ethnic disparities in tobacco use.
- Kristin Suthers. Evaluating the Economic Causes and Consequences of Racial and Ethnic Health Disparities. American Public Health Association, Issue Brief. November 2008. This report discusses the economic impact of disparities at the level of the individual and society, but provides no hard dollar estimates for the U.S.
- The following articles have quantified the costs in the U.S. for each year of life lost due to health disparities and the resulting economic burden:
- Timothy Waidmann, Estimating the Cost of Racial and Ethnic Health Disparities. The Urban Institute (September 2009). Disparities among African Americans, Hispanics and non-Hispanic whites cost the health care system $23.9B in 2009. Of this, Medicare will finance $15.6B while private health insurers will cover $5.1B.
- Thomas A. LaVeist, Darrell J. Gaskin, and Patrick Richard. The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies (September, 2009). In 2008 dollars, the annual health-related costs of disparities exceed $76B; annual productivity losses related to disparities amount to $401B (95% of this relates to the costs of premature death). More than 30 percent of direct medical costs for African Americans, Hispanics and Asian Americans represent excess costs attributable to health disparities.
- Hart J, Williams DR. Toward health equity—the cost of U.S. health disparities. Ann Arbor, MI: Altarum Institute Research Report. 2009:39-48.
- Colorado Department of Public Health and Environment. (2005). The Cost of Health Disparities in Colorado. This assessment examined the cost of disparities in diabetes, obesity, and HIV/AIDS.
- Healthy People 2010 is designed to achieve two overarching goals: 1) Increase quality and years of healthy life; 2) Eliminate health disparities.
- Congressional Budget Office. Growing Disparities in Life Expectancy (2008)
- Chapter 10 – Disparities (Alliance for Health Reform)
- Race and Health Issues and Web Links (HealthHippo)
- Cancer Research Among Minorities and the Medically Underserved
- Kaiser’s Monthly Update on Health Disparities (The Henry J. Kaiser Family Foundation page)
- Minority Health: Racial Disparities (The Henry J. Kaiser Family Foundation page)
- Moises Velasquez-Manoff. Status and Stress. New York Times, July 27, 2013. “In the United States, whites live longer on average by about five years than African-Americans. But a 2012 study by a Princeton researcher calculated that socioeconomic and demographic factors, not genetics, accounted for 70 to 80 percent of that difference. The single greatest contributor was income, which explained more than half the disparity.”
- Political Calculations. The Disproportionate Killers. Summarizes the disproportionate killers of blacks in the U.S.
- Race and Ethnic Disparities in Health Care Access and Utilization: An Examination of State Variation (Urban Institute Health Policy Center)
- M. Ezzati et al. The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine, Vol. 5, 2008, p. e66.
- Waldron, Hilary. Trends in Mortality Differentials and Life Expectancy for Male Social Security–Covered Workers, by Average Relative Earnings. Social Security Administration, October 2007.
- Council of State Governments, Knowledge Center. Health Equity and Disparities.
- Harper, Sam and John Lynch. Health Inequalities: Measurement and Decomposition. 9.5.16. In this paper we focus on reviewing ways of measuring health inequalities — that is, observable differences in health among individuals of different social groups. We cover a number of fundamental issues involved in choosing a measure of health inequality, and we demonstrate that measures of inequality inherently reflect, to a greater or lesser extent, different ethical and value judgments about what aspects of health inequality are important to capture. We provide definitions and empirical examples for of a number of measures of health inequality. We also emphasize developments in the literature on measuring health inequalities since the mid 2000s, particularly a recent emphasis (at least in health research) on socioeconomic inequalities and inequality decomposition.
- Kaiser Health News. Health Disparities.