Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.

ABSTRACT:The United States has made progress in decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health inequalities persist. We examined trends in black-white standardized mortality ratios (SMRs) for each age-sex group from 1960 to 2000. The black-white gap measured by SMR changed very little between 1960 and 2000 and actually worsened for infants and for African American men age thirty-five and older. In contrast, SMR improved in African American women. Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated.

Objective To evaluate a brief, clinic-based, safer sex program administered by a lay health advisor for young, heterosexual, African American men newly diagnosed with an STD. Methods Subsequent to STD diagnosis, eligible men (N=266) between the ages of 18–29 years, were randomized to either a personalized, single session intervention (delivered by a lay health advisor) or standard-of-care. Behavioral assessments were conduced at baseline and 3 months post-intervention (retention was 74.1%). A 6-month clinic record review was also conducted. Results Intervention men were significantly less likely to acquire subsequent STDs (50.4% vs. 31.9%, P=.002) and more likely to report using condoms during last sex (72.4% vs. 53.9%, P=.008). Intervention men reported fewer sex partners (mean of 2.06 vs. 4.15, P=.0003) and fewer acts of unprotected sex (mean of 12.3 vs. 29.4, P=.045). Based on a 9-point rating scale, intervention men had higher proficiency scores for condom application skills (mean difference = 3.17, P<.0001). Conclusion A brief, clinic-based intervention, delivered by a lay health advisor, may be an efficacious strategy to reduce incident STDs among young, heterosexual, African American men.

The purpose of the current investigation was to contextualize the sexual relationships and risk behaviors of heterosexually active African Americans. A total of 38 participants (20 females and 18 males) aged 18–44 years were recruited in a large city in the southeastern U.S. to participate in focus group discussions exploring sexual partnerships, general condom perceptions, and condom negotiation. Results indicated that participants distinguished among at least three partner types–one-night stand, “regular” casual partner, and main partner. Partner types were found to shape and influence types of sexual behaviors, perceptions of risk and condom use, and condom negotiation. Participants also shared general perceptions about condoms and elucidated situations in which intentions to use condoms were not realized. Gender differences emerged in many of these areas. Implications of these findings are discussed and directions for future research on sexual partnerships and risk behavior are offered.