Health disparities

The term "health disparities" is used in two related but distinct senses. One is to describe differences in health outcomes or health status among different population groups—for instance, American Indians and Alaska Natives are twice as likely as White Americans to have hepatitis C, and the asthma rate for Puerto Rican Americans is almost twice as high as for other Hispanic Americans. Health disparities can also refer to differences in access and utilization of healthcare services and quality of services provided among population groups. For instance, African Americans and Hispanic Americans are less likely than White Americans to have a reliable source of healthcare, and low-income children are less likely than higher-income children to see a dentist annually. The two types of disparity are clearly related—lack of access can easily lead to poor outcomes—but the distinction between disparities is important when devising programs to address them.

Background

Interest in health disparities is largely a product of the increased availability and effectiveness of healthcare services and the growing belief that healthcare is a basic human right rather than a consumer good that should be available only to those who can afford it. However, health disparities linger even in countries where national health programs provide healthcare to all residents.

Not all differences in outcomes are considered disparities, and not all disparities are due to underlying inequities in treatment. For instance, women have a higher rate of breast cancer than do men, and light-skinned people have a higher rate of skin cancer than dark-skinned people; in both cases these results can be attributed to basic differences in biology. However, there is no known biological explanation for why Black women are more likely to die from breast cancer than White women, so this difference is considered a disparity. Identifying the reasons for such a disparity can be complex, however, because any human health outcome may be the result of numerous interactions among factors, including the individual’s access to care, the quality of care provided, health behaviors such as tobacco and alcohol consumption, the presence or absence of complicating conditions, and personal attitudes toward health and medicine.

A 2002 report by the Institute of Medicine of the National Academies (IOM), Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, found that members of minority groups in the United States tend to receive lower quality care than nonminorities. Because such disparities persist even when controlling for factors such as income and insurance status, the IOM suggested that they were rooted in social and cultural factors such as stereotypes, language and geographic barriers, and attitudes toward the healthcare system. Guidance for the National Healthcare Disparities Report, a second 2002 report by the IOM, identified another type of inequality, which it labeled hyperdisparities, i.e., disparities in which members of a particular group use less of an optimal type of health service, and more of a suboptimal type. For instance, African Americans, as compared to White Americans, use fewer scheduled physician visits (an optimal service), and more visits to a hospital emergency department (a suboptimal service, at least for routine care).

Health Disparities Today

Despite many efforts to address health disparities, they continue to exist, both in the United States and worldwide. In the United States, a report by the Centers for Disease Control and Prevention (CDC), CDC Health Disparities and Inequalities Report—United States, 2013, concluded that although most Americans want a society in which everyone lives a full and healthy life, that goal is far from being realized.

The CDC identified many existing health disparities in the country, including the fact that lower-income residents on average enjoy fewer healthy days than higher-income residents, and residents of states with large inequalities in income enjoy fewer healthy days than residents of states with lower-income inequalities. Hypertension (high blood pressure) is most common among non-Hispanic Black people, and uninsured individuals with hypertension are only half as likely as insured individuals to have their hypertension under control.

Men of all races and ethnicities are more likely than women to die in motor vehicle accidents, and they are also more likely to die by suicide. Alcohol consumption and binge drinking is also most common among men, while binge drinking is also more common in higher income groups. Tobacco consumption is most common among individuals with low levels of income and/or education and among people of color. Men are more likely to die from coronary heart disease (CHD) than women, and Black men and women are both more likely to die of CHD than White men and women, respectively.

African Americans are more than twice as likely as White Americans to experience preventable hospitalizations, and Hispanic and non-Hispanic Black females are about twice as likely as White females to become pregnant in adolescence. Children born to Black women are twice as likely to die in infancy as children born to White mothers. The rate of HIV infection is highest among African Americans (84.0 per 100,000 population in 2010, versus 9.1 for Whites and 30.9 for Hispanics), and among men, it is highest among African Americans (128.4 per 100,000 in 2010, versus 16.5 for White men and 49.9 for Hispanic men).

Health disparities are even greater on a global basis, and the relationship between unequal access to services and unequal health outcomes is often quite stark. According to a 2013 report from the World Conference on Social Determinants of Health, life expectancy at birth in Japan (83 years) was almost twice that of Mali (47 years). High-income countries had ten times as many physicians per capita as low-income countries, and children from the poorest quintile (lowest 20 percent) of households worldwide were almost twice as likely to die before age five as children born into households in the richest quintile (top 20 percent). Women in the richest 20 percent of the global population were up to twenty times more likely to be attended in birth by a skilled health worker, and almost all (99 percent) of maternal deaths occur in low-income countries. However, progress has been made on a global basis, as the gap in health services between low- and middle-income countries narrowed significantly in the early twenty-first century. For example, according to a 2023 report by the World Health Organization (WHO), the gap in health service coverage among women and children in low- and middle-income countries decreased by close to 50 percent over the preceding decade.

Despite such gains, the COVID-19 pandemic that broke out in 2020 continued to highlight global health disparities. Systemic inequities caused low-income people living in areas with less access to health facilities around the world to be more vulnerable to the negative impacts of COVID-19, and inequities also caused low- and middle-income countries to experience challenges in delivering COVID-19 vaccines to its populations.

New challenges related to health disparities became apparent with the advent of artificial intelligence (AI) technology, a field that experienced tremendous growth during the early 2020s. Researchers at the Stanford School of Medicine found in 2023 that AI chatbots like ChatGPT, which were increasingly used in hospitals to help analyze health records and provide other support to medical professionals, were guilty of perpetuating racist medical ideas, especially related to Black patients. The research found that AI models frequently reinforced false beliefs about biological differences between Black and White patients that the medical field has worked to debunk for decades. Such biases have historically led medical providers to misdiagnose the health concerns of Black patients and to fail to take complaints from Black patients seriously.

Bibliography

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