In the United States, health disparities are differences that exist between specific populations that affect their access to and achievement of optimal health care. Health disparities are measured in disease burden, prevalence, mortality, disease incidence, and other adverse outcomes. Although the term is synonymous with disparities between racial and ethnic groups, these differences can exist across many other dimensions, such as geographic location, gender, sexual orientation, age, socioeconomic status, and disability status. Here are a few dimensions in which health disparities currently exist.
Disparities with COVID-19
The SARS-CoV-2 (COVID-19) pandemic of 2020 has highlighted disparities in health care as it pertains to ethnic minorities. According to a report published in JAMA, geographic data by race/ethnicity suggest that African Americans and Latinos bear a disproportionate burden of COVID-19-related outcomes. Although the true impact may not be understood until the pandemic has concluded, what is apparent now is that preliminary data show a consistent pattern of racial/ethnic disparities. For example, in Chicago, cases per 100,000 are greatest among Blacks and Latinos, and these two groups also suffer higher mortality rates juxtaposed to white counterparts. Similar findings were observed in New York City back at the height of the city’s outbreak in May when a greater age-adjusted COVID-19 mortality rate was observed among Latinos (187 per 100,000) and African Americans (184 per 100,000) compared to white (93 per 100,000) residents.
These reports, as the authors note, are a sign that prevention efforts, such as shelter-in-place and social distancing, might have less benefit among African American and Latino populations. As the authors of the report wrote, “Understanding the reasons for the initial reports of excess mortality and economic disruption related to COVID-19 among health disparity populations may allow the scientific, public health, and clinical community to efficiently implement interventions to mitigate these outcomes, particularly if substantial disease emerges in the fall of 2020 or beyond.”
Health Insurance Disparities
Research shows health insurance coverage significantly varies between racial and ethnic groups in the US, which is salient because uninsured people face major barriers in accessing the best health care. African Americans and Hispanics are more likely to be uninsured in adulthood than whites. According to researchers, low-income employment and the propensity to work in jobs with no health benefits greatly contributes to high uninsured rates among black people. Studies suggest that these low-paying positions pay too much to qualify for public assistance, but too little to take on private insurance. Research also shows a lack of job-based insurance as a big reason for high uninsured rates among Hispanics. Moreover, access to health insurance is linked to not only employment, but marriage, and African American and Hispanic people are less likely to get marry compared to non-Hispanic whites, and for those who do, divorce rates are higher. As noted by a paper published in Population Research and Policy Review, “Patients who have unstable insurance may make their medical decisions with the expectation of losing insurance coverage. They may have a preference for shorter-term solutions or treatments plans that requires fewer follow-ups. Greater expectation of insurance loss by either the patient or the physician may contribute to biases in referrals to specialists and in receiving surgical procedures.”
Disparities in Disease Outcomes
Health disparities also impact disease outcomes. For example, one recent study found that stroke patients living in rural areas have less access to advanced treatments than people living in urban areas, and are therefore more likely to die. Also, as noted by the National Cancer Institute (NCI), people with lower socioeconomic status (SES) have disproportionately higher cancer death rates than higher-income individuals. The NCI says that, “SES appears to play a major role in influencing the prevalence of behavioral risk factors for cancer (for example, tobacco smoking, physical inactivity, obesity, excessive alcohol intake, and health status), as well as in following cancer screening recommendations.” Furthermore, the NCI notes that people who reside in medically undeserved areas are more likely to be diagnosed with late-stage diseases, such as cancer, diabetes, and heart disease, which augments their chances of dying.
A healthy diet comprised of fruits and vegetables and low in sugar and processed foods is essential to maintaining one’s health. However, the ability to adhere to such a diet is largely dependent on food access. According to a report published in The New England Journal of Medicine, a previous study of dietary trends among US adults between 1999 and 2012 showed overall improvements in the American diet, with the percentage of people reporting poor-quality diets falling from almost 60% to 45.6%. However, an additional analysis revealed worsening disparities in nutrition based on ethnicity, socioeconomic status, and education level.
The authors of the NJEM report wrote that, “People experiencing food insecurity and living in food deserts may predominantly have access to low-cost, energy-dense processed foods. Barriers to accessing high-quality, nutritious food, in turn, are major factors in people’s body-mass index. The overall prevalence of obesity among U.S. adults is 42.4%, but Black (49.6%), Native American (48.1%), and Latinx (44.8%) adults are disproportionately affected, according to the Centers for Disease Control and Prevention. Obesity, in turn, is linked to numerous chronic diseases, including cardiovascular disease and diabetes — conditions that significantly contribute to mortality and disability-adjusted life-years in the United States and that also disproportionately affect underserved racial and ethnic populations.”
What Can Be Done?
Unfortunately, there is little consensus on what can be done to rectify US health disparities. However, Congress created the National Center of Minority Health Disparities and requires the Department of Health and Human Services (DHHS) to provide the National Health Disparities Report. According to a Kaiser Family Foundation report, here are four broad policy areas that should be addressed in the fight against health disparities:
- Raising public and provider awareness of racial/ethnic disparities in care.
- Expanding health insurance coverage.
- Improving the capacity and number of providers in underserved communities.
- Increasing the knowledge base on causes and interventions to reduce disparities.