The reasons for these disparities are not fully understood. Differences in access to health care (that is, health insurance coverage and/or the ability to pay for health care) might explain part of these differences. Among persons under 65 years of age in 2001, 19.3 percent of African Americans and 34.8 percent of Hispanics did not have health insurance coverage, whereas 14.7 percent of whites and 17.1 percent of Asians did not (National Center for Health Statistics, 2003). Some racial and ethnic groups tend to have lower income and wealth levels than others and thus may be less able to afford health care. Significant and persistent differences in wealth across racial groups have also been documented (Barsky et al., 2002; Oliver and Shapiro, 1995).

But differences in access are only part of the story. Differences in health care treatment even among the insured and beyond differences in access to health care also contribute to disparities. For example, among Medicare beneficiaries aged 65 and older, white women were more likely to get mammograms and to receive angioplasties than black women (Gornick et al., 1996).

Disparities in health and health care illuminate weaknesses in the health care and public health systems. Interest in better understanding the causes of these differences and formulating strategies to ensure the highest quality of care for everyone has generated significant attention to disparities across racial and ethnic groups. In addition to studies being conducted across many disciplines in a variety of academic, clinical, governmental, and other settings, Congress has initiated several important projects to provide better information on health disparities. In 1999, Congress asked the Institute of Medicine (IOM) to assess the extent of racial and ethnic differences in health care beyond those that are attributable to access to care, to evaluate potential sources of racial and ethnic disparities in health care, and to recommend interventions to eliminate the biases. This study resulted in the 2003 IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (IOM, 2003a). A key finding in this report was that racial and ethnic disparities exist beyond what can be attributed to differences in access to care. The panel also found that these disparities contribute to worse outcomes in many cases (IOM, 2003a). This study also examined the factors that contribute to disparities and offered guidance on interventions to reduce and eliminate disparities.

In 1999, Congress required the Agency for Healthcare Research and Quality to produce an annual National Healthcare Disparities Report (NHDR) that would monitor disparities in health care by race, ethnicity, socioeconomic status, and geography. Congress also asked the IOM to provide guidance on the development of the NHDR, a study that culminated in the 2002 production of Guidance for the National Healthcare Disparities Report (IOM, 2002). The first of the NHDR annual reports was released in December 2003 (U.S.

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