The National Institutes of Health (NIH) defines health disparities as differences in the incidence, prevalence, mortality, and burden of diseases and other health conditions that exist among specific population groups. These differences in treatment are not justified by the underlying health condition, nor the preferences of patients.
At CHDR, we tend to focus on health disparities related to three core areas:
- Race and Ethnicity: Based on the Institute of Medicine (IOM) report on racial and ethnic disparities, many sources of disparities exist. For example, lack of adequate medical knowledge or information sources, lack of trust, racial/cultural differences, lack of social support and resources, and health care facility characteristics.
- Socioeconomic Status: Social and environmental factors, such as where you live, work, play, and exercise can also impact your health. For example, where you live could result in a lack of access to grocery stores that provide healthy foods or access to safe areas to exercise. At the same time, economic factors such as unemployment and lack of health insurance restrict access to health care. According to the 2013 National Healthcare Disparities Report, those with low-income received worse care than high-income for approximately 60% of the quality measures, and those with low-income had worse access to care for all measures but one.
- Regional & Rural/Urban Location: Disease also differs between those living in rural communities and those in urban communities. Based on a report by the National Academies Press on rebuilding health in rural America, factors such as poverty, isolation, limited access to medical services, and greater prevalence of obesity may lead to some of these differences. The number of people in a community, the local workforce, and cultural norms of the area, also influence the delivery of health care to rural areas and could lead to disparities.
Disparities in health continue in the United States, even in equal access systems, such as the VA where many barriers to care have been addressed. Differences are shown to exist in disease incidence, prevalence, morbidity, and mortality. In South Carolina, if you are black, you are twice as likely to have diabetes compared to someone who is white, and you are almost one and a half times more likely to die from diabetes than someone who is white and a similar age. This provides a dramatic example of health disparities related to race, though there are many others that we seek to understand and erase.
1. Institute of Medicine. Unequal Treatment – Confronting Racial and Ethnic Disparities in Health Care. Smedley BD et al. (Eds). National Academy Press, Washington, DC 2002.
2. S. Saha, M. Freeman, J. Toure, K. M. Tippens, and C. Weeks, Racial and Ethnic Disparities in the VA Healthcare System: A Systematic Review. 2007, Department of Veterans Affairs. Veterans Health Administration. Health Services Research & Development: Washington.
3. Agency for Healthcare Research and Quality. 2013 National Healthcare Disparities Report. AHRQ Publication No. 14-0006. May 2014.
4. J. Merchant, C. Coussens, and D. Gibert, Eds. Rebuilding the Unity of Health and the Environment in Rural America. 2006, The National Academies Press: Washington, DC.