Health Equity - Ethnic and Racial Disparities

Ethnic and Racial Disparities

See Ethnicity and health and Race and health.

The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these racially-centered disparities continue to exist and are a significant social health issue. The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race. The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.

There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory care.

A 20110 study on racial and ethnic disparities in health done by the Institute of Medicine showed that these differences cannot be accounted for in terms of certain demographic characteristic like insurance status, household income, education, age, geographic location and severity of conditions is comparable. Even when the researchers corrected for these factors, the disparities persist.

It is pretty widely recognized that minority groups generally have higher death rates from cancer, heart disease and diabetes than whites. Gerard Boe’s article cites studies that show major disparities in health care as it relates to specific diseases:

• Heart Disease: African Americans are 13% less likely to be recommended for and undergo coronary angioplasty and 1/3 less likely to undergo bypass surgery than whites. Death rates from heart attack and stroke are 29% and 40% higher, respectively, among African Americans than whites
• Asthma: Of preschool aged children who were hospitalized for Asthma related conditions, only 7% of African American children, 2% of Hispanic children compared to over 20% of White children are prescribed medications to prevent future Asthma related hospitalizations.
• Breast Cancer: Studies have found that the length of time between and abnormal mammogram and further diagnostic testing to determine if a patient has cancer is more than twice as long in Asian-American, African American and Hispanic women than it is in White women. African American women are more than twice as likely as white women to die of cervical cancer and have the highest rate of breast cancer death of any racial or ethnic group
• Compared with rates in whites, the rates of diabetes are 1.9 times higher among Hispanics, two times higher among African Americans, and 2.6 times higher among Native Americans
• Some of these disparities are actually worsening. For example, the African American–to-white ratio of infant mortality has steadily increased during the past 2 decades and now is at 2.5:1

His article also discusses the increased incidence of receiving little or no routine and usual care and therefore, reduced chance of receiving preventative care and other health services.

• Hispanic children are almost three times as likely to receive no routine and usual source of health care as White children.
• Only 16% of White patients have a lack of routine and usual sources of health care compared to about 20% of African Americans and 30% of Hispanic patients.

Racial and Ethnic disparities in children: 31.4 million Children in the United States are of non-white race or ethnicity (March 2010), this compromises 43% of American children and shows an increase over 11% since 2000. Mortality rates are substantially higher in minority children for all-cause mortality. Overall mortality rates are consistently found to be significantly higher in African American and other minority children. Specifically, disparities are found in specific mortality rates for certain diseases, acute-lymphoblastic leukemia and congenital heart defect among others. Asthma has also been a topic of many studies.

Race is considered to be more strongly associated with higher rates of African American children with unmet health care needs and lower access to primary health care providers than income is.

One of the most important ways to help reduce health disparities is to work to reduce language barriers between patients and physicians. Language barriers are a major problem because of five main difficulties:

• First, arriving at an accurate diagnosis is difficult, because an adequate history cannot be obtained.
• Second, treatment options cannot be adequately explained and discussed.
• Third, it is impossible to obtain truly informed consent for diagnostic and therapeutic procedures.
• Fourth, any attempts to provide health education are severely compromised.
• Finally, it is very difficult for physicians to act as effective advocates for patients we do not really know.

If physicians and other clinicians are able to reduce language barriers the resulting improved communication can improve compliance, reduce the number of emergency room visits, and enhance patient understanding. Gunderman suggests that there are a few ways for physicians and the health care system in general to reduce language barriers like using nonverbal communication through gestures, the use of visual aids, and printed materials and videos in patients' native languages. They can also improve their fluency in the non-English equivalents of basic medical terms. The use of trained interpreters can also prove extremely valuable.

There is debate about what causes health disparities between ethnic and racial groups. However, it is generally accepted that disparities can result from three main areas:

The Institute of Medicine report, Race, Ethnicity, and Language Data identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement.

A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast cancer, prostate cancer and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.

The National Partnership for Action to End Health Disparities (NPA) was established to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. http://minorityhealth.hhs.gov/npa/

The National Stakeholder Strategy (NSS)for Achieving Health Equity is a product of the NPA. This document provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities—and other underserved groups—reach their full health potential. The strategy incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. Local groups can use the National Stakeholder Strategy to identify which goals are most important for their communities and adopt the most effective strategies and action steps to help reach them. http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286