Eliminating Health Disparities

Georges Benjamin, Executive Director, American Public Health Association

Disparities in health continue to be a widespread problem across the United States. Advances in medical technology and the increased use of preventive medicine have extended life expectancy and improved overall health. However, not all Americans benefit equally from these advances, and the problem extends into individual states as this year's health rankings report attests.

The health status of racial and ethnic minorities lags far behind health outcomes for non-minority populations. For example, blacks are 29 percent more likely to die from heart disease than whites.¹ Hispanic women are 2.5 times more likely to get cervical cancer than white women.² In 2000, only 8 percent of whites were considered to be in fair or poor health compared to nearly 13 percent of Latinos, nearly 14 percent of African Americans and more than 17 percent of Native Americans.³ In fact, gaps in health vary depending not only on a person's race and ethnicity, but also on gender, economic status, disability and sexual orientation. In addition, there are differences in health outcomes between people who live in rural and urban communities. Rates of heart disease, cancer and diabetes, for example, are higher in rural areas, and men on average have a life expectancy of six years less than women.⁴

Several of these gaps reflect a lack of access for many Americans to affordable, quality health care. Impediments to access include inequities in health insurance coverage and inadequate numbers of high quality community providers. Even when individuals are fully insured, inappropriate differences in diagnosis and treatment exist among different population groups. These differences contribute significantly to inequities in the quality of care. Other contributing factors may include language barriers, lack of cultural competency among providers and discrimination. Regardless of the cause, health disparities exact a significant toll on our nation. Emergency and end-stage medical care are far costlier than prevention. In the end, all Americans wind up paying the bill. The ultimate costs include lost and wasted human potential and productivity.

The American Public Health Association (APHA) believes aggressive action is needed to address these disparities. Some of these actions include:

• Ensuring universal access to care
• Addressing the social determinates of health
  • Health literacy
  • Poverty
  • Racism
• Improving the quality of medical care
  • Reducing medical errors
  • Facilitating the delivery of scientific- and evidence-based care
• Increasing the cultural competency of health practioners and health systems
• Developing a diverse health provider and public health work force

The theme for this year's National Public Health Week was "Eliminating Health Disparities: Communities Moving from Statistics to Solutions." As a consequence, APHA and its many partners launched a series of initiatives that support targeted efforts to reduce and eliminate disparities. These efforts include:

• Town hall meetings, which were held around the country to highlight community programs that are working to eliminate health inequalities.
• A searchable, online database that contains information about community programs from nearly every state around the country.

The database, which was sponsored in part by the United Health Foundation and can be viewed at http://www.apha.org/NPHW/solutions/, contains about 600 community solutions. Upon searching, for example, a user may find a listing of health organizations in Washington, D.C., such as the Maternal and Child Health Community Leadership Institute, a Web-based program for maternal and child health professionals. Or, information can be found from the Environmental and Occupational Health Program of the Migrants Clinicians Network, or the National Public Health Initiative on Diabetes and Women's Health from the U.S. Centers for Disease Control and Prevention. APHA's solutions database is the most comprehensive, current resource on community programs.

By sharing best practices, communities can replicate solutions and make progress toward eliminating disparities in health. There are thousands of APHA members in communities across the nation, who stand ready to partner with their neighbors, their friends, their public officials and others to implement these ameliorative programs. But it means we all have to act immediately to eliminate these tragic differences. You can find the APHA affiliate in your area at www.apha.org. Contact them and get involved today.

¹HHS Fact Sheet, U.S. Department of Health and Human Services, 2004

²Ibid.

³Alliance for Health Reform

⁴"Healthy People 2010, An Overview", www.healthypeople.gov.