Chapter 6: Health Disparities and Community-Based Participatory Research: Issues and Illustrations

OVERVIEW OF HEALTH DISPARITIES

Some health experts argue that we may have entered a third wave of health.¹ After combating communicable diseases in the first wave and chronic disease in the second, an era may emerge in which people are living longer with increasingly less disease burden, technological advances are promising to halt the encroachment of disease, and a growing number of people are considering themselves to be in good health.¹ At the same time, however, millions of people worldwide are suffering and dying from diseases and disabilities that are easily preventable or curable. Diseases such as polio, measles, and tuberculosis, are rare or nonexistent among populations with access to resources, but far too commonplace for those living in impoverished or disadvantaged conditions. In developing countries, one million children die each year from measles, infant mortality rates are seven times higher than in industrialized countries, and the AIDS virus threatens to undo any gains made in childhood survival rates.² Such statistics are not isolated to developing nations. In more developed regions of the world, such as North America and Europe, many people still receive substandard care or suffer from significantly higher rates of disease and lower levels of favorable health outcomes than others. Although by no means universally agreed upon, the concept of health disparities refers to differences in one or more health-related variables associated with membership in some population group or subgroup.

Initially, the United States may have lagged behind other nations in recognizing the health disparities concept, as well as in efforts to research and redress health disparities. The last 12–15 years, however, have witnessed increasingly strong governmental and philanthropic efforts in this area. A strategically important landmark in this regard was the setting of national health objectives embodied in the Healthy People 2010 endeavor under the auspices of the U.S. Department of Health and Human Services (DHHS).³ Goals of Healthy People 2010 include (a) increasing life expectancy and improving quality of life for all individuals and (b) eliminating disparities among population segments, including socioeconomic position, gender, race/ethnicity, disability, geographic location, or sexual orientation. These goals went beyond those of Healthy People 2000 that were principally concerned with population groups that were believed to be at high risk for death, disease, or disability. Cascading from Healthy People 2010 have been strong health disparity research and monitoring efforts emanating from other federal agencies, each conditioned by its particular substantive focus. For instance, the Institute of Medicine's 2003 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care⁴, concluded that after controlling for socioeconomic status (SES) and health insurance, African Americans and Latinos received inferior health care in part related to physicians' stereotypes of minority patients. The Institute of Medicine separates these issues of bias together with those of health-care system inequities from differences due purely to clinical considerations. Other government entities have also substantially contributed to the overall effort. These include ...