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Disparities in Health and Health Care: 5 Key Questions and Answers
Nambi Ndugga Follow @nambinjn on Twitter and Samantha Artiga Follow @SArtiga2 on Twitter Published: May 11, 2021
- Issue Brief
The disparate impacts of the COVID-19 pandemic, ongoing incidents of police brutality, and recent rise in Asian hate crimes have brought health and health care disparities into sharper focus among the media and public. However, health and health care disparities are not new. They have been documented for decades and reflect longstanding structural and systemic inequities rooted in racism and discrimination. Addressing these inequities could help to mitigate the disparate impacts of the COVID-19 pandemic and prevent further widening of health disparities going forward. Moreover, narrowing health disparities is key to improving our nation’s overall health and reducing unnecessary health care costs. This brief provides an introduction to what health and health care disparities are, the status of disparities and how COVID-19 has affected them, the broader implications of disparities, and current federal efforts to advance health equity.
What are health and health care disparities?
Health and health care disparities refer to differences in health and health care between groups that stem from broader inequities. There are multiple definitions of health disparities. Healthy People 2020 defines a health disparity as, “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” and notes that disparities, “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” The Centers for Disease Control and Prevention (CDC) identifies health disparities as, “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” A health care disparity typically refers to differences between groups in health insurance coverage, access to and use of care, and quality of care. The terms “health inequality” and “inequity” also are used to refer to disparities. Racism, which CDC defines as the structures, policies, practices, and norms that assign value and determine opportunities based on the way people look or the color of their skin, results in conditions that unfairly advantage some and disadvantage others, placing people of color at greater risk for poor health outcomes.
Health equity generally refers to individuals achieving their highest level of health through the elimination of disparities in health and health care. Healthy people 2020 defines health equity as the attainment of the highest level of health for all people, and notes that it requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and health and health care disparities. CDC defines the achievement of health equity as when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”
A broad array of factors within and beyond the health care system drive disparities in health and health care (Figure 1). Though health care is essential to health, research shows that health outcomes are driven by multiple factors, including underlying genetics, health behaviors, social and environmental factors, and access to health care. While there is currently no consensus in the research on the magnitude of the relative contributions of each of these factors to health, studies suggest that health behaviors and social and economic factors, often referred to as social determinants of health , are the primary drivers of health outcomes and that social and economic factors shape individuals’ health behaviors. Moreover, racism negatively affects mental and physical health both directly and by creating inequities across the social determinants of health.
Figure 1: Health Disparities are Driven by Social and Economic Inequities
Health and health care disparities are often viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions. For example, disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults. 1 , 2 Federal efforts to reduce disparities focus on designated priority populations , including people of color, low-income populations, women, children/adolescents, older adults, individuals with special health care needs, and individuals living in rural and inner-city areas. These groups are not mutually exclusive and often intersect in meaningful ways. Disparities also occur within subgroups of populations. For example, there are differences among Hispanics in health and health care based on length of time in the country, primary language, and immigration status. 3 , 4 Moreover, data for Asian people often mask underlying disparities among subgroups within the Asian population. 5
What is the status of disparities?
Prior to the COVID-19 pandemic, people of color and other underserved groups faced longstanding disparities in health. Major recognition of health disparities began nearly two decades ago with two Surgeon General’s reports published in the early 2000s that documented disparities in tobacco use and access to mental health care by race and ethnicity. Despite the recognition and documentation of disparities for decades and overall improvements in population health over time, many disparities have persisted, and, in some cases, widened. 6 Recent data from before the COVID-19 pandemic showed that people of color fared worse compared to their White counterparts across a range of health measures, including infant mortality, pregnancy-related deaths, prevalence of chronic conditions, and overall physical and mental health status (Figure 2). As of 2018, life expectancy among Black people was four years lower than White people, with the lowest expectancy among Black men. Research also documents disparities across other factors. For example, low-income people report worse health status than higher income individuals, 7 and lesbian, gay, bisexual, and transgender (LGBT) individuals experience certain health challenges at increased rates.
Figure 2: People of Color Fare Worse than their White Counterparts Across Many Measures of Health Status.
There also are longstanding disparities in health care. The Affordable Care Act health coverage expansions led to large gains in coverage across groups. Despite these gains, however, people of color and low-income individuals remain at increased risk of being uninsured (Figure 3), contributing to greater barriers to accessing health care. Further, starting in 2017, coverage gains stalled and began reversing, reflecting a range of actions by the Trump administration, including decreased funding for outreach and enrollment assistance, approval of state waivers to add new eligibility restrictions for Medicaid coverage, and immigration policy changes that increased fears among immigrant families about participating in Medicaid and CHIP. These coverage losses eroded some of the previous coverage gains under the ACA, particularly among Hispanic people , who already were at increased risk of being uninsured. Coverage losses have likely continued due to the COVID-19 pandemic as people have lost jobs and experienced declining income. Beyond disparities in coverage, people of color and lower income individuals also receive poorer quality of care . Recent KFF/The Undefeated survey data find that Black adults are more likely than White adults to report certain negative health care experiences, such as a provider not believing them and refusing them a test, treatment, or pain medication they thought they needed.
Figure 3: People of color face longstanding disparities in health coverage.
How has the COVID-19 pandemic affected disparities?
Data consistently show that American Indian and Alaska Native (AIAN), Black, and Hispanic people have experienced disproportionate rates of illness and death due to COVID-19 (Figure 4). Analysis further finds that AIAN, Black, Native Hawaiian and Other Pacific Islander (NHOPI), and Hispanic people had over three times premature excess deaths per 100,000 people in the US in 2020 than the rate among White or Asian people. The higher rates of illness and death among people of color reflect increased risk of exposure to the virus due to living, working, and transportation situations, increased risk of experiencing serious illness if infected due to higher rates of underlying health conditions, and increased barriers to testing and treatment due to existing disparities in access to health care.
Figure 4: People of color have had higher rates of infection, hospitalization, and death due to COVID-19.
Beyond the direct health impacts of the virus, the pandemic has taken a disproportionate toll on the financial security and mental health and well-being of people of color, low-income people, LGBT people , and other underserved groups. For example, KFF survey data from February 2021, showed that about six in ten Hispanic adults (59%) and about half of Black adults (51%) said their household lost a job or income due to the pandemic, compared to about four in ten White adults (39%) who say the same. Moreover, adults with a household income under $40,000 were three times as likely as those with a household income of $90,000 or more to say they have had trouble paying for basic living expenses in the last three months (55% vs. 19%). As of late March 2021 , Black and Hispanic adults were more likely than White adults to report lack of confidence in their ability to make their next housing payment and to report food insufficiency.
Despite being disproportionately affected by the pandemic, as of April 2021, Black and Hispanic people were less likely than White people to have received a COVID-19 vaccine. Data across states show a consistent pattern of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases, deaths, and the total population, resulting in lower vaccination rates compared to their White counterparts. While vaccination rates are increasing across all groups, the gaps in vaccination rates for Black and Hispanic people are persisting (Figure 5). These disparities in vaccinations reflect the longstanding inequities that create increased barriers to health care for people of color and other underserved groups. Moreover, they leave people of color at increased risk for infection and illness and hinder efforts to achieve population level immunity.
Figure 5: Although vaccination rates are increasing across groups, Black and Hispanic people face persistent gaps.
What are the broader implications of disparities?
Addressing disparities in health and health care is important not only from and social justice and equity standpoint, but also for improving the nation’s overall health and economic prosperity. People of color and other underserved groups experience higher rates of illness and death across a wide range of health conditions, limiting the overall health of the nation. Research further finds that health disparities are costly. Analysis estimates that disparities amount to approximately $93 billion in excess medical care costs and $42 billion in lost productivity per year as well as additional economic losses due to premature deaths. As the population becomes more diverse, with people of color projected to account for over half of the population by 2050 (Figure 5), it is increasingly important to address disparities.
Figure 6: People of color are projected to make up over half of the U.S. population as of 2050.
The COVID-19 pandemic has exacerbated underlying disparities in health and health care and increased the importance of addressing them. This disparate impacts of the COVID-19 pandemic for people of color and other underserved groups may lead to even further widening of health disparities and greater health risks for the community as a whole, particularly if some groups remain at increased risk from COVID-19 due to lower vaccination rates and/or increased risk of exposure to the virus. As such, prioritizing equity in COVID-19 response efforts is not only important for mitigating the disproportionate impacts of the pandemic itself, but for protecting against even larger health disparities in the future.
What are current federal efforts to address health disparities?
The Biden administration has identified racial equity, including health equity, as a key priority , which has been reflected in several recent agency actions. Immediately after taking office, President Biden issued a series of executive orders and actions focused on advancing health equity. These included orders that outline equity as a priority for the federal government broadly and as part of the pandemic response and recovery . Reflecting the prioritization of health equity, in March 2021, the National Institutes of Health (NIH), launched the UNITE Initiative to address structural racism and racial inequities in biomedical research. In early April 2021, the Centers for Disease Control and Prevention (CDC) declared racism a serious threat to the public’s health and noted that it would lead in efforts to confront systems and policies that have resulted in the generational injustice that has given rise to racial and ethnic health inequities. The Department of Health and Human Service’s (HHS’s) Office of Minority Health is focused on the “success, sustainability, and spread of health equity promoting policies, programs, and practices,” and has three overarching programmatic priorities for FY2020 and 2021, including supporting states, territories, and tribes in identifying and sustaining health equity-promoting policies, programs, and practices; expanding the utilization of community health workers to address health and social service needs within communities of color, and strengthening cultural competence among healthcare providers throughout the country.
Federal COVID-19 response efforts have included a focus on equity. In January 2021, President Biden issued an Executive Order on Ensuring an Equitable Pandemic Response and Recovery to address the disproportionate and severe impact of COVID-19 on communities of color and underserved populations. The order establishes a COVID-19 Health Equity Task Force, directs agencies to strengthen equity data collection and reporting and ensure response plans and policies provide for equitable allocation of resources, and directs HHS to conduct an outreach campaign focused on building vaccine confidence among communities of color and other underserved populations. The COVID-19 relief American Rescue Plan Act, enacted in March 2021, provides new funding to support COVID-19 vaccination and other public health efforts , with a focus on enhancing access to vaccines and resources to protect against and respond to COVID-19 among underserved populations. In part, through this funding, HHS will invest nearly $10 billion to expand access to vaccines and better serve communities of color, rural areas, low-income populations, and other underserved communities. This includes $6 billion that will be provided to community health centers, which data show have been vaccinating larger shares of people of color compared to overall vaccination efforts.
The administration and Congress have taken a range of actions to expand access to and enrollment in health coverage. As noted, beginning in 2017, health coverage gains stalled and began reversing. The COVID-19 pandemic has likely further increased coverage losses as people have experienced job loss and decreases in income. In January 2021, President Biden issued an Executive Order on Strengthening Medicaid and the Affordable Care Act , which established a Special Open Enrollment Period for the Health Insurance Marketplaces and directed federal agencies to review policies and practices to ensure they support access to health coverage. The American Rescue Plan Act also contains provisions designed to increase access to health coverage and make health coverage more affordable. These include increases and expansions in eligibility for subsidies to buy health insurance through the Marketplaces as well as Medicaid provisions that offer incentives to encourage states that have not yet adopted the ACA Medicaid expansion to do so and provide a new option for states to extend the length of Medicaid coverage for postpartum women . The administration also restored funding for navigators to help eligible people enroll in health coverage and increased outreach activities. These actions will particularly benefit people of color and low-income people who are more likely to be uninsured. Six in ten uninsured adults who would become eligible if all remaining states expanded Medicaid are people of color, and over seven in ten are adults living below poverty. Overall, research shows that Medicaid expansion is associated with reductions in racial/ethnic disparities in health coverage as well as narrowed disparities in health outcomes for Black and Hispanic individuals, particularly for measures of maternal and infant health.
The administration has reversed policies implemented under the Trump administration that contributed to reduced access to health care and other programs for immigrant families. In February 2021, President Biden issued an Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans , which declared that the federal government should develop welcoming strategies that promote integration, inclusion, and citizenship. The order directed federal agencies to review existing actions to ensure they are consistent with this policy, reduce barriers that impede access to immigration benefits, and review changes to public charge policies made under the Trump Administration, which contributed to reduced access to health care and other programs for immigrant families. The administration subsequently took action to reverse these public charge policy changes. The Department of Homeland Security also issued a statement to clarify that all individuals, regardless of immigration status, should receive the COVID-19 vaccines, and that it will not carry out enforcement operations at or near health care facilities, except in the most extraordinary circumstances.
The administration has launched several initiatives focused on addressing inequities in maternal health. In April 2021, President Biden issued a proclamation to recognize the importance of addressing the high rates of Black maternal mortality and morbidity. In addition, the Centers for Medicare and Medicaid Services (CMS) has approved several state waivers to extend the Medicaid postpartum coverage period, a policy which will become available as a state option beginning in 2022, under the American Rescue Plan Act. The Human Resources and Services Administration has also announced $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program, which is designed to develop models and implement strategies to improve maternal health in rural communities.
In sum, disparities in health and health care for people of color and underserved groups are longstanding challenges. The COVID-19 pandemic has exacerbated these disparities and heightened the importance of addressing them. Health disparities are driven by underlying social and economic inequities that are rooted in racism. Addressing disparities is important not only from a social justice standpoint but for improving our nation’s overall health and economic prosperity. The federal government has identified equity as a priority and launched a range of initiatives to address disparities both in response to COVID-19 and more broadly. States, local communities, private organizations, and providers also are engaged in efforts to reduce health disparities. A broad range of efforts both within and beyond the health care system will be instrumental in advancing equity, including: prioritizing equity across sectors; providing resources to support efforts to advance equity; increasing availability of data; supporting and building on existing community strengths and resources; establishing incentives, accountability, and oversight for equity; and recognizing and addressing racism as a root cause of disparities.
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Health Disparities: What They Are and Why They Matter
Keri Peterson, MD, is board-certified in internal medicine and has her own private practice on the Upper East Side of Manhattan. She holds appointments at Lenox Hill Hospital and Mount Sinai Medical Center.
Addressing Health Disparities
Different groups and communities can have markedly different levels of health. Some populations can have higher rates of cancer , for example, while others might be more likely to be obese or use tobacco. These differences in health or medical conditions are called health disparities, and they can have a profound impact on the public health of a community.
Verywell / Dennis Madamba
The U.S. government defines health disparity as “a particular type of health difference that is closely linked with social or economic disadvantage.” These disparities negatively impact whole groups of people that already face significantly more obstacles to maintaining good health, often because of specific social or economic factors, such as:
- Socioeconomic status or income
- Race or ethnicity
- Sex or gender
- Geography, ex. rural vs. urban
- Sexual orientation
- Immigrant status
- Mental health status
Historically, these characteristics have been linked to discrimination or exclusion. When a particular group of people doesn’t have the same kind of access to health care , education, or healthy behaviors, it can cause them to fall behind their peers on all kinds of health measures. These disparities can often persist for generations.
The negative repercussions of health disparities go beyond just the individual and extend to their children, whole communities, and society at large. Health disparities are often self-perpetuating. Parents too sick to work, for example, can become low-income. Unemployed, low-income individuals are less likely to have access to health insurance. If they’re unable to afford health care, they could get sicker, making them even less able to find a new job, and so on. Getting healthy and out of poverty becomes increasingly difficult.
This downward spiral can impact future generations , too. One area of health where this is clear is in pregnant women and new moms. How healthy a mom is before and during pregnancy can have a major impact on her babies. For example, a woman who experiences chronic stress while pregnant—such as stress about one’s financial situation—is more likely to have a preterm baby. Babies born too early are at a greater risk for serious health issues later in life. Many of those medical conditions can lead to pregnancy complications such as, again, preterm delivery.
Health disparities, however, cost Americans more than lives and livelihoods. Persistent gaps in health-related outcomes can also have economic consequences. One study in North Carolina estimated that the state could save $225 million a year if disparities in diabetes could be eliminated. Another report estimated that reducing health disparities on a national scale could have saved the United States nearly $230 billion between 2003-2006.
Health disparities exist all over the world, including in the United States, and affect every age, race/ethnicity, and sex. Here are just a few examples:
- Infant mortality: Babies born to Black women in the United States die at more than double the rate of babies born to white women.
- Dementia: Black people also have the highest risk for dementia , and are twice as likely to develop Alzheimer’s disease than whites in the United States.
- Cancer: People with lower incomes and education levels are more likely to get cancer and to die from it compared to their more affluent peers, and that gap appears to be widening.
- Obesity: Even after controlling for family income, rates of obesity in Black women and Mexican-American men are substantially higher than in other races or ethnic groups.
- Smoking: Native American/Alaska Native men and women have disproportionately higher rates of smoking , as do individuals living below the federal poverty level and those who are unemployed.
- Binge drinking: Young white men are more likely than other groups to binge drink (5+ drinks in a two-hour period).
Like many aspects of public health, the root causes of health disparities are complex. Health is influenced by so many factors that it can be difficult to pinpoint just why a gap between two groups is so wide. That said, disparities are often the result of health inequities —that is, differences in how resources are distributed among different groups. These resources could be tangible, like in the case of physical parks where kids can exercise safely, or intangible opportunities, such as being able to see a doctor when ill. Disparities often have multiple root causes, but there are a few major inequities in the United States that are known to contribute to health gaps between groups.
The U.S. healthcare system is one of the most expensive in the world, spending roughly twice as much on health care as other high-income nations. On average, the country as a whole spent an estimated $10,348 per person in 2016, and healthcare spending accounts for nearly 18% of the U.S. gross domestic product (GDP), a rate that’s increased year after year. Americans pay more for health services like clinic visits, hospital stays, and prescription drugs.
A growing income gap between the rich and the poor in the United States has made it harder for poor Americans to keep up. While top incomes skyrocketed between 1980 and 2015, real wages for low-income individuals fell, making it increasingly difficult for poor people in the United States to afford basic medical care or engage in healthy behaviors. This, in turn, makes it harder to stay healthy or treat and manage health conditions.
Systemic Discrimination or Exclusion
Social drivers—like racism, sexism, ableism, classism, or homophobia—can perpetuate inequities by prioritizing one group over another. These forces are so deeply ingrained in cultural practices and norms that many people might not realize they’re happening. Oftentimes, these forces are the result of past inequities that still affect communities today. Take, for example, mid-20th-century discriminatory housing practices. These policies forced many minority families into neighborhoods without nearby access to community resources, like public transportation, quality education, or job opportunities—all of which affect a family’s financial stability and, therefore, long-term health .
Researcher Camara Phyllis Jones used a gardening analogy in the American Journal of Public Health to illustrate just how this happens. Imagine, for example, two flower boxes: One with new, nutrient-rich soil and another with poor, rocky soil. Seeds planted in the nutrient-rich soil will flourish, while seeds in the poorer soil will struggle. As the flowers go to seed, the next generation will drop into the same soil, experiencing similar struggles or success. As this happens year after year, one box of flowers will always be more vibrant than the other due to the original condition of the soil. When people are separated and given different resources to start with, that is going to have an impact for generations to come.
Many health outcomes are the result of personal choices, like eating healthy foods or getting enough exercise. But many of those choices are shaped, influenced, or made for us by the environment we’re in. Environmental health is the physical, chemical, and biological forces that can impact our health, and they can be a driving force behind health disparities. It’s hard for people to eat healthy food , for example, when they don’t have access to it in their neighborhood (areas known as food deserts ).
Neglected tropical diseases (NTDs) are an example of environmentally-driven health disparities. This collection of 20+ conditions primarily impact the poorest of the poor, both in the United States and worldwide, often due to a lack of clean water or bathrooms. These conditions make it harder for kids to learn and adults to work, exacerbating the effects of poverty on people’s health and well-being.
Closing the gap in health outcomes is no easy task. Causes are often multi-layered. Solutions would need to address not only the root cause of a given disparity but also the context that made it possible in the first place.
For its part, the Healthy People 2020 objectives—a set of goals laid out by the U.S. government to improve the health of Americans by the year 2020—aims to reduce health disparities by addressing key factors known as social determinants of health .
Social determinants of health are the environmental conditions and circumstances that affect and shape how healthy we are. Many things in our social circles and environment can impact our behaviors and limit our ability to make healthy choices. These include things like cultural norms (ex. distrust of authority figures) or community design (ex. bike lanes). There are dozens of social factors exacerbating health disparities, but the Healthy People 2020 objectives have put just five front and center: economic stability, education, social and community context, health and health care, and neighborhood and built environment.
Improving Economic Stability
Economic stability refers to things like food security, income or wealth, housing stability , and employment opportunities, and research shows addressing some of these issues could help reduce disparities associated with a whole range of health issues. Providing housing assistance , for example, has been shown to improve both the psychological and physical health of individuals. Similarly, providing influenza vaccination in poorer neighborhoods could help reduce gaps in hospitalization due to flu. And increasing economic opportunities for financially insecure women might help prevent the disproportionately high number of cases of HIV in that population.
Ensure Everyone Receives a Quality Education
Investing in things like language and literacy, early childhood education, high school graduation, and higher education could help close health gaps in a number of ways. Increased access to center-based early childhood education, for example, has been shown to decrease crime and teen births . High school completion programs also have strong returns on investment—often resulting in improved economic benefits that exceed any costs associated with the program—in part because of averted healthcare costs.
Address Issues Within a Social and Community Context
While not always apparent, social influences and dynamics can significantly impact the health of both individuals and the overall community. These include things like incarceration, discrimination, civic participation, and social cohesion. Because incarceration can disrupt families and impact access to things like education, employment, and housing, some researchers have called for policy changes that address sentencing laws that disproportionately impact certain Black communities as a means to reduce several disparities, including HIV.
Expand Access to Health Care and Improve Health Literacy
Helping ensure people are able to see a medical professional when they’re sick is important for curbing health disparities. But perhaps equally important is their ability to see a doctor when they’re healthy. Many medical issues in the United States could be prevented with routine, preventive care like health screenings, vaccinations, and lifestyle changes.
The Affordable Care Act attempted to expand access to primary care by making it easier to get health insurance and requiring insurance companies to cover the whole cost of preventive services , like blood pressure screenings and obesity counseling. The law also called on medical and public health professionals to address health literacy by ensuring everyone can obtain, understand, and communicate information essential to health decisions. More than 28 million people , however, still lack health insurance, and more can be done to ensure increased access to health care in the United States.
Neighborhood and Built Environment
Just like a person’s social environment can impact their health and well-being, so can their physical surroundings. Improving access to healthy foods, supporting healthy eating behaviors, improving the quality of housing, reducing crime and violence, and protecting the environment are all things that can be done to improve the environmental health of a community and reduce health disparities as a result.
One important example of ways the United States could reduce health disparities in obesity rates is addressing the issue of food deserts and food swamps. Building partnerships between local governments, food retailers (such as grocery stores), and communities could help bring more affordable and healthier food options to areas where such foods are scarce. This, combined with increased targeted education on why and how to incorporate healthy foods into a family’s favorite meals, could go a long way to cutting disparities in obesity rates.
- Centers for Disease Control and Prevention. Social determinants of health: Know what affects health .
- Healthy People 2020. Social Determinants of Health . Office of Disease Prevention and Health Promotion.
By Robyn Correll, MPH Robyn Correll, MPH holds a master of public health degree and has over a decade of experience working in the prevention of infectious diseases.
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Minority Health & Health Disparities
Health disparities are gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education level. These disparities may stem from many factors, including accessibility of health care, increased risk of disease from occupational exposure, and increased risk of disease from underlying genetic, ethnic, or familial factors. NIH-designated U.S. health disparity populations include American Indians/Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual and gender minorities, socioeconomically disadvantaged populations, and underserved rural populations.
Why Is Minority Health a Priority for NIAID?
NIAID has long recognized that racial and ethnic differences affect susceptibility to infection and disease. For example, African Americans account for about 13 percent of the U.S. population, yet represent almost half of new AIDS diagnoses. Native Americans experience higher rates of meningitis and invasive bacterial disease from Haemophilus influenzae type B (Hib) than do other groups. Year after year, asthma has a disproportionate affect on inner-city populations, particularly among African American and Hispanic/Latino children.
How Is NIAID Addressing This Critical Topic?
NIAID is committed to research that helps reduce these and other health disparities. Its efforts have led to the development of better drugs for HIV/AIDS, vaccines that have almost eliminated Hib-related disease, and educational programs and other interventions to improve asthma control among inner-city children.
NIAID also works to attract minorities to careers in biomedical research through programs such as Intramural NIAID Research Opportunities, which provides training in NIAID labs for undergraduate, graduate, and medical students from underrepresented groups, and Research Centers in Minority Institutions, which is partly funded by NIAID and aims to enhance research infrastructure at minority colleges and universities that offer doctorates in health sciences.
Related Public Health and Government Information
To learn about risk factors related to minority health visit the MedlinePlus Health Disparities site.
- Viral hepatitis studies
- Inner-City Asthma Consortium clinical studies
- APOL1 Long-term Kidney Transplantation Outcomes Network (APOLLO)
NIAID Research Aims to Reduce Health Disparities
- Diversity Programs Supported by NIAID
- The NIH Office of Research on Women’s Health provides the Women of Color Health Information Collection , which presents data on race/ethnicity and disease.
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Reducing disparities in health care
Recent studies have shown that despite the improvements in the overall health of the country, racial and ethnic minorities experience a lower quality of health care—they are less likely to receive routine medical care and face higher rates of morbidity and mortality than nonminorities.
The American Medical Association (AMA) encourages physicians to examine their own practices to ensure equality in medical care.
The AMA's mission is to achieve health equity by mitigating disparity factors in the patient population.
- Helping ensure equal access to health care
- Health disparities physician resources
Health Disparities Toolkit . This kit focuses on the theme of “Working Together to End Racial and Ethnic Disparities: One Physician at a Time.” Access DVD interviews with physicians, nurses and patients, and a CD of information on topics such as cultural competence and literacy. Use the facilitation guide to work with other health care providers and physicians.
Explore the AMA's Code of Medical Ethics to answer questions on ethical and professional issues for physicians.
Access the white paper on “ Collecting and Using Race, Ethnicity and Language Data in Ambulatory Settings (PDF)” to find recommendations from the Commission to End Health Care Disparities on how to use demographic data to achieve practical goals.
- Research on eliminating health care inequalities
The Institute of Medicine (IOM) performed an assessment on the differences in the kinds and quality of health care received by U.S. racial and ethnic minorities and nonminorities.
The IOM report found that:
- Disparities in health care exist and are associated with worse health outcomes.
- Health care disparities occur in the context of broader inequality.
- There are many sources across health systems, providers, patients and managers that contribute to disparities.
- Bias, stereotyping, prejudice and clinical uncertainty contribute to disparities.
- A small number of studies suggest that racial and ethnic minority patients are more likely to refuse treatment.
Read a summary the IOM findings (PDF) and recommendations, or access the complete IOM report .
The IOM concluded that a comprehensive, multilevel strategy is needed to eliminate these disparities.
Access the National Healthcare Quality & Disparities Report for additional information. This annual report is produced by the Agency for Healthcare Research and Quality.
- Related articles on health care disparities
- Addressing Health Care Disparities: Recommended Goal, Guiding Principles and Key Strategies for Comprehensive Policies (PDF) Find information on the goals of the Commission to Reduce Health Care Disparities, the principles that guide all policy work in this area and a full list of commission members.
- Development of a Measure of Physician Engagement in Addressing Racial and Ethnic Health Care Disparities (PDF) Review the research results that examine the engagement levels of a sample of physicians in addressing gaps in health care and understand how these results can be used to increase physician engagement at a group or institution level.
- Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Understand the background of how racial and ethnic disparities exist in health care.
- Immigration Reform as a Means to Eliminate Health Care Disparities (PDF) Review the opinions from one commission member, the National Council of Asian Pacific Islander Physicians, in regards to immigration reform.
- Reducing Health Disparities: Where Are We Now? (PDF) Discover how the field of health care disparities has evolved in recent years by examining emerging perspectives, reviewing progress and current activity and looking at outstanding needs.
- Access to Care for Patients with Disabilities: Strategies for Ensuring a Safe, Accessible and ADA Compliant Practice (PDF) Review the important considerations in ensuring a health care facility not only meets required standards, but provides a safe, accessible and comfortable environment for patients with disabilities.
- AMA’s work to reduce health care disparities
- The AMA works to increase the number of minority physicians to reflect the diversity of the U.S. population through its policies and advocacy work.
- The AMA's House of Delegates prioritizes the elimination of racial and ethnic health disparities as a top importance.
- The AMA is partnering with the AMA Foundation to help physicians become aware and manage low health literacy among patients through its public health grants .
- AMA’s policy to reduce health care disparities
AMA has enacted policies that support the research findings from the IOM and support the goals of reducing disparities in health care.
These policies aim to:
- Increase awareness of racial and ethnic disparities in health care among the general public.
- Strengthen patient-provider relationships in publicly funded health plans.
- Apply the same managed care protections to publicly funded HMO participants that apply to private HMO participants.
Explore more in AMA’s PolicyFinder .
- History of the commission to end health care disparities
In 2000, the U.S. Department of Health and Human Services launched Healthy People 2010 , which had two broad goals: to improve the overall health status of Americans and to eliminate racial and ethnic health care disparities.
Health and Human Services officials deemed the AMA was ideally positioned to bring national leadership to initiatives in disease prevention and health promotion while working to eliminate health care inequalities.
The AMA agreed to raise awareness of health imbalances and the importance of understanding culturally competent health care and health literacy by working with state medical societies, medical schools, medical students and policymakers.
In 2004, the Commission to End Health Care Disparities was established by the AMA and the National Medical Association to address gaps in health care. The National Hispanic Medical Association joined shortly after.
In June of 2016, the commission was retired, but the resources and materials produced by the commission are available on this page for physicians.
Table of Contents
- Health Care Disparities
- Health Care Equity
- Commission to End Health Care Disparities
- Catalog of Topics
Essential Tools & Resources
Read AMA policies on health equity
Explore health equity on JAMA Network™️
Read the latest on health equity from AMA Journal of Ethics®️
Learn more about health disparities on AMA Ed Hub™️
COVID-19 Q&A: health equity in pandemic
Release the Pressure: Heart health equity with Essence
Recognizing and addressing disparities in health care with camara phyllis jones, md, mph, phd, recognizing and addressing disparities in health care with camara phyllis jones, md, mph, phd [podcast], q&a: calling out systemic racism’s impact in medicine.
What doctors wish patients knew about long covid-19 brain fog.
Why minnesota changed key query to promote physician well-being.
Thriving in Residency
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- Improve health equity by collecting patient...
- The history of African Americans and organized medicine
- What drives Black maternal health inequities...
An official website of the Department of Health and Human Services
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Research Findings & Reports
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Quality and Disparities Report
Latest available findings on quality of and access to health care
- Data Infographics
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- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
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- Data Sources Available from AHRQ
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Notice of funding opportunities, research policies.
- Notice of Funding Opportunity Guidance
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Grant application, review & award process.
- Grant Application Basics
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Post-Award Grant Management
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- Getting Recognition for Your AHRQ-Funded Study
- Grants by State
- No-Cost Extensions (NCEs)
AHRQ Grants by State
Searchable database of AHRQ Grants
AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund.
- Press Releases
- AHRQ Social Media
- Impact Case Studies
- AHRQ News Now
- AHRQ Research Summit on Diagnostic Safety
- AHRQ Research Summit on Learning Health Systems
- National Advisory Council Meetings
- AHRQ Research Conferences
- Mission and Budget
- AHRQ's Core Competencies
- National Advisory Council
- Careers at AHRQ
- Maps and Directions
- Other AHRQ Web Sites
- Other HHS Agencies
Organization & Contacts
- Centers and Offices
- Organization Chart
- Key Contacts
- Evidence-based Practice Center Reports
- Data Spotlights
- Making Healthcare Safer Reports
2019 National Healthcare Quality and Disparities Report
The National Healthcare Quality and Disparities Report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings.
AHRQ no longer offers print copies of the report, but the files are set up for two-sided color printing and may be downloaded free of charge. If you have questions about printing or copying, contact Doreen Bonnett at 301-427-1899 or [email protected] .
- Introduction and Methods (PDF, 956 KB)
- Executive Summary ( Powerpoint , 2.5 MB) ( PDF , 794 KB)
- Appendix A. Data Sources Used for 2019 Report
- Appendix B. Definitions and Abbreviations Used in 2019 Report
- Quality Trends data tables (PDF, 848 KB)
- Disparities data tables (PDF, 2.9 MB)
- Data Sources (PDF, 433 KB)
- Measure Specifications (PDF, 4 MB)
- Methods Applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) Data for the 2019 National Healthcare Quality and Disparities Report
- Detailed Methods for the Medical Expenditure Panel Survey (PDF, 194 KB)
Related Data and Tools
- Quality and Disparities Report Data and Tools
- Data Query (search data across specific measures)
Internet Citation: 2019 National Healthcare Quality and Disparities Report. Content last reviewed June 2021. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr19/index.html
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. 1
Despite significant progress in research, practice, and policy, disparities in youth health risk behaviors persist. Populations can be defined by factors such as race or ethnicity, gender, education or income, disability, geographic location (e.g., rural or urban), or sexual orientation.
Health disparities are inequitable and are directly related to the historical and current unequal distribution of social, political, economic, and environmental resources.
We can improve health risks and reduce disparities and inequities by addressing social determinants of health .
Health disparities result from multiple factors, including
- Environmental threats
- Inadequate access to health care
- Individual and behavioral factors
- Educational inequalities
The Education–Health Disparities Link
Health disparities are related to inequities in education. Dropping out of school is associated with multiple social and health problems. 2-3 Overall, individuals with less education are more likely to experience a number of health risks, such as obesity, substance abuse, and intentional and unintentional injury, compared with individuals with more education. 4 Higher levels of education are associated with a longer life and an increased likelihood of obtaining or understanding basic health information and services needed to make appropriate health decisions. 5-7
At the same time, good health is associated with academic success . Higher levels of protective health behaviors and lower levels of health risk behaviors are been associated with higher academic grades among high school students. 8 Health risks such as teenage pregnancy, poor dietary choices, inadequate physical activity, physical and emotional abuse, substance abuse, and gang involvement have a significant impact on how well students perform in school. 9-13
Addressing Adolescent Health Disparities
Understanding unequal health risks and experiences of lgbtq youth.
Health disparities are driven by underlying social and economic inequities that are rooted in racism. Addressing disparities is important not only from a social justice standpoint but for...
The U.S. government defines health disparity as “a particular type of health difference that is closely linked with social or economic disadvantage.” These disparities negatively impact whole groups of people that already face significantly more obstacles to maintaining good health, often because of specific social or economic factors, such as:
NIH-designated U.S. health disparity populations include American Indians/Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual and gender minorities, socioeconomically disadvantaged populations, and underserved rural populations.
Disparities in health care exist and are associated with worse health outcomes. Health care disparities occur in the context of broader inequality. There are many sources across health systems, providers, patients and managers that contribute to disparities. Bias, stereotyping, prejudice and clinical uncertainty contribute to disparities.
The annual National Healthcare Quality and Disparities Report is mandated by Congress to provide a comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. The report is produced with the help of an Interagency Work Group led by ...
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. 1 Despite significant progress in research, practice, and policy, disparities in youth health risk behaviors persist.