Health Disparities

Early Sociological Background

Sociological research on inequalities and health has been one of the most long-standing concerns in medical sociology, and this concern within sociology is much older than specific U.S. government policy efforts in the area. The conclusions from numerous studies are that people of lower socioeconomic status have worse health and lower life expectancies than do those from a higher socioeconomic status (SES). Recent, more sophisticated studies still find that people with incomes below the poverty level in the United States have higher (in some studies two and sometimes even three times) chances of dying early, even when other basic factors such as age, race, and gender are controlled. Relationships of SES to poorer health outcomes hold in many countries in the world, not only in the United States, and the presence of national health insurance systems that cover the entire population generally may help somewhat to reduce these types of differences, but do not eliminate them. The presence of national health insurance systems tends to be more important in reducing disparities or inequalities in access to care. This conclusion is important for countries other than the United States; however, the United States remains one of the only major developed countries that does not ensure access to health care services for all its citizens. Given this, discussion of health disparities and inequalities in the United States includes both examinations of variation in health status and in access to, use of, and quality of health care services.

U.S. Government Efforts Related to Health Disparities

At the federal level of the U.S. government, one of the first pushes for concern about health disparities was a report by the secretary of the Department of Health and Human Services, Margaret Heckler (1983-1985). This landmark report revealed large and persistent gaps in health status among Americans of different [Page 408]racial and ethnic groups. Because of this report, the Office of Minority Health (OMH) within the Department of Health and Human Services (HHS) was created with a mission to address these disparities within the nation. The Centers for Disease Control (CDC), another U.S. federal government agency that focuses on public health and epidemiology, also established its own Office of the Associate Director for Minority Health (ADMH) in 1988 in response to the same report. This unit became the CDC's OMH in 2002, and was given the mission of promoting health and quality of life by preventing and controlling the disproportionate burden of disease, injury, and disability among racial and ethnic minority populations. In 2005, the OMH was expanded to create the new Office of Minority Health and Health Disparities (OMHD) in CDC. The mission of the renamed agency was broadened, with a focus on reducing health disparities experienced by populations defined by race/ethnicity, SES, geography, gender, age, disability status, and risk status related to sex and gender.

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