DISPARITIES IN HEALTH AND HEALTH CARE

Examples of Racial, Ethnic, and Socioeconomic Position Disparities

An extensive body of literature covering a number of health and social science disciplines has documented persistent racial, ethnic, and socioeconomic disparities in health status and health care in the United States. For some measures of health and health care, these disparities have existed over a long period of time, or at least since data were available to measure them; in some cases they have decreased over time, and in others increased.

The causes of these disparities are not well understood. Differences in economic conditions across racial and ethnic groups (in general, racial and ethnic minorities and recent immigrants are poorer than nonminorities) probably contribute to disparities, as they are likely to result in less access to health care, inability to afford higher-quality care, and greater exposure to harmful occupational and environmental factors. Differences in education may contribute to disparities, as may health-related behavior patterns (e.g., diet, exercise). And, of course, bias and discrimination may also contribute to racial and ethnic disparities. In this section, we highlight a few examples of disparity problems.1

Table 2-1 shows infant mortality rates by racial and Hispanic origin of the infant’s mother from 1983-2000. In the most recent period shown, 1998-2000, non-Hispanic black infants had the highest infant mortality rates by far, with nearly 14 deaths per thousand live births. This contrasts sharply with the infant mortality rate among non-Hispanic whites, which is just under 6 deaths per thousand live births. The table also shows wide variation within broad racial and ethnic groups. For example, the overall infant mortality rate for Asian and Pacific Islanders is 5 deaths per thousand live births. Within this category, however, the infant mortality rate for Chinese Americans is 3.5 deaths per thousand live births, while the infant mortality rate for Filipinos is almost 6 deaths per thousand live births and the infant mortality rate for Hawaiians is almost 9 (National Center for Health Statistics, 2003, p. 122). With other health measures, the combined categorization of Asians and Pacific Islanders into a single subgroup has also masked variation among ethnicities within this subgroup—for example, Pacific Islanders have elevated levels of morbidity and mortality compared to the U.S. population (Frisbie, Cho, and Hummer, 2001).

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There are also substantial urban versus rural disparities in health and health care (Ricketts, 2002; Skinner et al., 2003). These disparities are also of concern to the federal government and were discussed in the recently released National Healthcare Disparities Report (U.S. DHHS, 2003a). The data collection needs for understanding geographic disparities are beyond the scope of this panel’s charge, but better measurement of racial, ethnic, and socioeconomic disparities should help in the measurement and interpretation of geographical disparities.



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