Health Disparities

Health Status Disparities

The term health disparities is widely used in the United States and is similar in meaning to health inequalities, which is the term more commonly used in Europe. Most existing definitions of health status disparities describe them as differences in the incidence, prevalence, morbidity, mortality, and survival rates related to diseases and other adverse health conditions that exist among specific population groupings, such as race, ethnicity, culture, sex, socioeconomic status, education, or geopolitical residence. However, not every difference is necessarily a disparity in this sense. There may be differences in the distribution of morbidity and/or mortality between groups that are not indicative of underlying inequality. For example, higher rates of breast cancer among women compared with men or lower rates of skin carcinoma among African Americans compared with whites are due to lower risks of the disease in one group versus another due to biological factors, not social inequalities. In contrast, higher morbidity rates due to breast cancer in African American versus Caucasian women are often cited as a health status disparity because there are no known biological reason for this difference and it is believed to be due in large part to socioeconomic and health care access factors.

Health Care Disparities

Health care disparities are differences in the access, utilization, quality, or outcomes of health care services among specific population groupings, such as those based on race, ethnicity, culture, sex, socioeconomic status, education, or geopolitical residence. In their seminal report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, the Institute of Medicine (IOM) limited their definition to race and ethnicity and to the quality dimension of health care disparities, which they defined as ‘racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences and appropriateness of interventions’ (Institute of Medicine, 2002a, pp. 3–4). The IOM reported that racial and ethnic minorities tend to receive a lower quality of health care than nonminorities, even when access-related factors, such as patients’ insurance status and income, were controlled. They found that the sources of these disparities were rooted in historic and contemporary inequities (i.e., stereotypes, biases, high time pressure, cost containment issue, cognitive complexity, financial and institutional arrangements, and barriers of language, geography, and cultural familiarity) and involved many participants at several levels, including health systems, their administrative and bureaucratic processes, utilization managers, health care professionals, and patients. In conclusion, the IOM offered a multilevel strategy to address these disparities.

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