Health disparities and disparities reduction in Healthy People 2020

HP2020 ('Healthy People 2020') initiative is reducing health gaps in America. Much controversy exists with regard to what the term 'health disparities' actually refers to. Disparities are largely witnessed on the basis of socioeconomic status (SES), and racial/ethnic identity. A number of health indicator-related differences exist among different racial and ethnic groups in America. This paper will endeavor to explain what health disparities implies, the health indicator-related differences among different racial/ethnic populations, causes for such differences, and potential ways to bring about health improvements for underserved populations.

"Health Disparities" Defined

There is considerable debate regarding the precise meaning of "health disparities." One key facet of a majority of accepted meanings is that every health status difference between different population groups is not a disparity; disparities are only differences that systematically and adversely affect socially and economically less-advantaged people. On the American scene, disparities-related discourse has chiefly concentrated on ethnic/racial disparities. American and global literature addresses disparities based on sexual identity, gender, social class, economic capacity, and disability (Dehlendorf, Bryant, Huddleston, Jacoby, & Fujimoto, 2011).

A study of health disparities between less- and more- advantaged individuals necessitates their proper identification and classification into 'groups'. Socioeconomic status, race, and ethnicity definitions give rise to measurement issues that should be taken into account by researchers on health gaps. Ethnicity/race related measurement strategies include self-identification, genetic markers and third-party assignment. Although the former is often regarded as the reference point of comparison in case of non-genetic research, a fresh analysis discovered that several research scholars fail to show how to identify subjects' race/ethnicity in their works; in very few cases, investigators assign ethnicity/race to subjects (Dehlendorf, Bryant, Huddleston, Jacoby, & Fujimoto, 2011).

Another consideration in socioeconomic status, race, and ethnicity measurement in health disparity analysis deals with explaining the complex interactions between these constructs. For instance, poor African-Americans' socioeconomic standing might affect their health differently, as compared to their White counterparts. Such nuances should be considered in health disparity studies and conceptualization (Dehlendorf, Bryant, Huddleston, Jacoby, & Fujimoto, 2011).

Differences in Health Indicators of Various Ethnic and Racial Groups in the U.S.

American socioeconomic stratification and quality-of-life differences in key ethnic/racial populations are deemed as the source of health indicator differences. The lives of individuals from different social groups differ with regard to most aspects including upbringing, education, career, marriage/family life, housing locality, healthcare, and leisure. SES indirectly impacts health outcomes via various SES-linked life experiences, choices, or opportunities, starting from childhood and accruing or changing for the good in later life. Health differences surface throughout people's lifecycle. However, it is widely assumed that they diminish with age (Crimmins, Hayward, & Seeman, 2004).

Socioeconomic and ethnic/racial differences aren't equal in all health areas. For instance, Black males exhibit higher mortality rates from cardiovascular ailments compared to White males; however, no significant difference is observed in reported heart ailment prevalence. Disparities vary even within disease groups; e.g., fatalities linked to some cancers seem less strongly associated with SES as compared to mortalities from other reasons (Angel & Guarnaccia, 1989). A few sources of disease and death will more likely be impacted by assumed SES mechanisms. Health variances between adult Whites and Blacks, and between different social classes, are perceived to be greatest among late-middle-aged persons. But analyses of observed socioeconomic gaps' impact in short-term prevalence at middle age might not be fully indicative of overall health difference age patterns due to compounding of the effect with time (Crimmins, Hayward, & Seeman, 2004).

Potential Causes for Observed Differences

Survey data can help examine health-related ethnic/racial and socioeconomic differences. An analysis of a few major ailments' onset and prevalence differences helps researchers see if linkages among disease, SES, and ethnicity/race are identical in different data sets: their different by age as well as when incidence, not prevalence, is studied. Introduction of income and education reveals that some educational categories are linked significantly to individual health outcomes. Lower educational attainment is nearly always linked to increased illness. But with regard to cancer, better-educated sufferers will more likely remain alive and report their problem. Income impacts are significant -- increased income improves health -- in nearly 66% of equations. Impacts are largely consistent among younger samples as compared to older samples of the Retirement and Health Study (Crimmins, Hayward, & Seeman, 2004). SES is a better predictor of most health aspects among Whites as compared to other ethnic/racial groups. A comparison of differences among Hispanics and African-Americans reveals limited SES ability to explain these groups' differences. The relationships for every ethnic group seem greater for disability and functioning loss, as compared to mortality and disease (Crimmins, Hayward, & Seeman, 2004).

Possible Ways to Improve the Health of Underserved Populations

A great gap exists between achievable care quality in the U.S. and current care quality. Quality gaps are not because of inadequacies of practitioners, or their actions, but because of healthcare institutions' failure to include proven improvement measures in the care process (Maybery, Robert, Nicewander, Qin, & Ballard, 2006).

• Equity: provision of care of equal quality to all irrespective of their SES, geography, sex, and race/ethnicity.

• Patient-centeredness: provision of care that respects and responds to patients' unique needs, values and preferences, and making sure patient values form the guideline for clinical decision-making. Considerable improvements can be achieved in each healthcare quality dimension. Equity and patient-centeredness aim at ensuring quality care to all, depending on patients' unique needs, and ensuring care quality neither varies on grounds of personal patient traits (e.g., race, ethnicity, etc.) nor links to the person's health problem.

• Ethnicity/race data collection for determining disparities and planning interventions: Precise ethnicity/race data collection is imperative to an inclusive strategy for tackling healthcare inequity. Hospitals, care plans and integrated healthcare frameworks across America are moving to ascertain inequities by using ethnicity/race information as the basis for interventions aimed at improving care quality for ethnic/racial groups (Maybery, Robert, Nicewander, Qin, & Ballard, 2006).

Conclusion

A study of health disparities between less- and more- advantaged individuals necessitates their proper identification and classification into 'groups'. On the American scene, disparities-related discourse has chiefly concentrated on ethnic/racial disparities. American socioeconomic stratification and quality-of-life differences in key ethnic/racial populations are deemed as the source of health indicator differences. Socioeconomic and ethnic/racial differences aren't equal in all health areas. Introduction of income and education reveals that some educational categories are linked significantly to individual health outcomes. Lower educational attainment is nearly always linked to increased illness. Patient-centeredness, equity, and collection of race/ethnicity data to identify inequities and plan interventions can help improve the health of underserved population groups.

Bibliography

Angel, R., & Guarnaccia, P. (1989). Mind, body, and culture: Somatization among Hispanics. Social Science and Medicine, 1229 -- 1238.

Crimmins, E., Hayward, M., & Seeman, T. (2004). Race/Ethnicity, Socioeconomic Status, and Health. Critical Perspectives on Racial and Ethnic Differences in Health in Late Life.

Dehlendorf, C., Bryant, A., Huddleston, H., Jacoby, V., & Fujimoto, V. (2011). Health Disparities: Definitions and Measurements. Am J. Obstet Gynecol, 212 -- 213.

Maybery, Robert, Nicewander, D., Qin, H., & Ballard, D. (2006). Improving quality and reducing inequities: a challenge in achieving best care. Proc (Bayl Univ Med Cent)., 103 -- 118.