What is a health disparity? The National Institutes of Health (NIH) defines health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Examples of health disparities include differences in access to care, differences in health outcomes, differences in health care services delivery and differences in disease patterns in relation to race, ethnicity, gender, social class, geography or sexual orientation.
The U.S. Department of Health and Human Services states that ”There are continuing disparities in the burden of illness and death experienced by African Americans, Hispanic Americans, Asian Americans/Pacific Islanders, and American Indians/Alaska Natives, as compared to the U.S. population as a whole. Statistical reviews of the disproportionate toll of certain diseases on racial and ethnic populations highlights the need for prevention, treatment and resources toward reducing the loss of life.”
Health Disparities are most pronounced in these six health areas:
1. Infant Mortality - The United States has made substantial improvements in infant mortality, but disparities still exist. In 2001, the infant mortality rate for African American infants more than twice the rate for White infants (13.3 deaths per 100,000 for African Americans vs. 5.7 for Whites). In American Indian and Alaska Native populations, the death rate is 70 percent higher than in Whites. Although the infant death rate for Hispanic infants is less than the rate for White infants, within the Puerto Rican subgroup, the rate of infant deaths from Sudden Infant Death Syndrome (SIDS) is 1.5 times higher than Whites. SIDS rate for African Americans was 2.2 times that for Whites.
2. Cancer – African Americans are more likely to develop cancer than persons of any other ethnic group and have the highest cancer death rate relative to other racial or ethnic groups. As for women, although the rate of newly diagnosed cases of breast cancer is about 13 percent lower than in White women, African American women have higher mortality rates than any other racial or ethnic group. For Hispanic women, the incidence of cervical cancer is two and half times higher than the rate of White women. Asian American/Pacific Islanders and American Indians have higher rates of stomach cancer than Whites, and cervical cancer incidence rates are highest among Hispanic and Vietnamese American women than White women.
3. Cardiovascular Disease and Stroke – Although heart disease is the leading cause of death among all racial and ethnic groups African Americans suffer the most from the disease and they are more likely to die from the disease. Mexican Americans, who make up the largest share of the U.S. Hispanic population, also suffer in greater numbers from overweight and obesity than Whites, two of the leading risk factors for heart disease. More than 25 percent of deaths in the Asian and Pacific Islander community and 20 percent of deaths in the American Indian community are caused by heart disease.
In addition, stroke deaths are substantially higher among African Americans than Whites
4. Diabetes - Racial and ethnic minority groups, especially the elderly among these populations, are disproportionately affected by diabetes. African Americans are twice as likely to have diabetes as Whites. The highest incidence of diabetes in African Americans occurs between 65-75 years of age. African American women are especially affected, with nearly 12 percent of African American women over 20 years of age having diabetes, in comparison to 8.5 percent of men in the same age group. African Americans with diabetes are more likely to experience complications of diabetes.
Diabetes is more prevalent in older Hispanics, with about 25 to 30 percent of Hispanics age 50 or over having the disease. About one-third of Hispanics with diabetes are undiagnosed. Hispanics are 1.5 times as likely to have diabetes as Whites. And, in 2001 the death rate from diabetes in Hispanics was 40 percent higher than the death rate of Whites.
The incidence of diabetes among American Indians and Alaska Natives is more than twice that of Whites. As of 2003, 14.5 percent of the American Indian and Alaska Natives served by the Indian Health Service had been diagnosed with diabetes.
5. HIV/AIDS - HIV/AIDS has had a devastating impact on minorities in the United States. Racial and ethnic minorities accounted for almost 70 percent of the newly diagnosed cases of HIV and AIDS in 2002. More than 90 percent of babies born with HIV belong to minority groups.
In the African American community, HIV/AIDS has become an epidemic. More than 54 percent (14,398) of HIV/AIDS diagnoses in 2002 were in African Americans. African Americans are ten times more likely to die of AIDS than Whites. AIDS is the leading cause of death in African American women aged 25-34 and the third leading cause of death in African American men in the same age group. More than 64 percent of HIV positive infants are African American. HIV/AIDS is spreading at a rapid rate in the Hispanic community. Hispanics accounted for around 20 percent of AIDS cases in 2002, despite making up only 14 percent of the U.S. population. Hispanics are 60 percent more likely to be diagnosed with AIDS than Whites. American Indians are three times more likely to have AIDS than Whites.
6. Immunizations - In 2003, 69 percent of older White persons received influenza vaccination, compared to only 49 percent and 47 percent of older African American and Hispanic persons, respectively. Disparities for pneumococcal vaccination coverage were even wider. Vaccination rates were nearly 60 percent for Whites, compared to 37 percent for African Americans and 31 percent for Hispanics.
Healthy People 2010 is a set of health objectives for the Nation to achieve over the first decade of the new century. It can be used by many different people, States, communities, professional organizations, and others to help them develop programs to improve health. Healthy People 2010 has 2 overarching goals: To Increase Quality and Years of Healthy and To Eliminate Racial and Ethnic Health Disparities.
Healthy Beginnings Program is a program designed to improve infant mortality rates among African Americans in North Carolina.
UNC Program on Ethnicity, Culture and Health Outcomes (ECHO) The mission of ECHO is to eliminate health status and health outcomes disparities through translatable, evidence-based research, multidisciplinary training and education, and culturally sensitive service to North Carolina communities.
The Office of Minority Health issues a report titled: "Eliminating Health Disparities in the U.S". The report can be found on their website.
The Health Disparities Collaboratives strive to achieve excellence in practice through the following goals:
The American Medical Association (AMA) has encouraged physicians to examine their own practices to ensure equality in medical care. Learn about AMA programs and activities committed to the elimination of racial and ethnic health care disparities.
U.S. Department of Health and Human Services. HHS Fact Sheet: The Initiative to Eliminate RAcial and Ethnic Disparities in Health. 2004 Accessed at: http://raceandhealth.hhs.gov/glance.htm
Healthy People 2010 Accessed at: http://www.healthypeople.gov/