Keeping Your Heart Healthy

Eliminating Health Disparities

Despite major advances in the fields of medicine and healthcare services over the past years, a significant health gap between rich and poor remains. As populations grow, so apparently do health disparities. The poor continue to shoulder a particularly disproportionate social burden in terms of inequitable access to decent healthcare, rising costs and higher rates of morbidity and mortality.

People of color are receiving special attention in medical, social, and political literature due to disparities in health status. In recent years, evidence has shown a relationship between race/ethnicity and health disparities among the U.S. population. If racial and ethnic disparities in health are not addressed, demographic changes over the next decade will amplify the importance of this issue. As racial and ethnic minority populations grow, so will the poorer health status of our communities.

The factors contributing to these health disparities include reduced health care access, increased risk of disease due to work environment or housing conditions, and increased illness due to underlying cultural, socioeconomic, and medical factors.

Improving access to health care will require increasing the number of people with insurance and removing a host of other barriers blocking large numbers of Americans from receiving needed care. The problem of access reaches beyond the 44 million Americans who lack health insurance-a number that is expected to reach 52 to 54 million over the next 10 years. The growing numbers are of concern because those without coverage tend to delay or forego important preventative and primary care services. Community-based efforts are needed to track health problems and assess unmet needs.

The design of the health care delivery system has created a variety of obstacles to those seeking care. Strategies are needed to address such impediments. Improving the primary care system and access to it by conducting community assessments to determine gaps in services and engaging stakeholders in the process of access improvement. It is also important to focus on equalizing access to care by improving the quality of existing care.

Underprivileged people are also more likely to have poor health, and a disproportionate number of poor people are minorities. For example, African-Americans tend to have lower paying jobs, fewer income-producing sources such as investments. Less money leads to substandard housing in inner city and urban environments. Housing may contain unacceptable levels of paint, asbestos insulation, roach and rat remains or other environmental hazards. Poor people may also experience stress associated with poverty including abuse and violence, homicides, and suicides. Thus, poverty, inadequate employment and substandard housing available to poor African Americans and other minorities present a health problem that wealthier people are able to avoid.

Adding to the increasing evidence of cultural expectations, assumptions, and language as factors affecting the quality of care, an ongoing study by AHRQ-supported researchers in San Francisco is surveying African American, Hispanic, and white patients to examine how interpersonal processes--the way patients and clinicians interact--affect the health care that patients get and the outcomes of their care.

There also exist unequal power relations between blacks and the medical profession. It has worked effectively to keep blacks out of the profession, even though a large percentage of those who manage to enter medicine return to practice in minority communities where the need for medical professionals is greatest. Many African Americans and poor people experience long waits, are unable to shop for services, and often receive inadequate quality and discontinuous health care. Moreover, many government programs do not target African Americans as a group. Racial and ethnic minorities suffer from shorter overall life