Eliminating health disparities: What have we done and what do we do next?

Abstract

Keywords health disparities; asthma; workforce diversityThe United States, one of the richest countries in the world, spends more than any other on health care, but does not provide the best nor does it provide healthcare equally. Much of this inequity stems from vast socioeconomic inequalities. 1 Conversely, improving the overall health of our citizens depends in large part on eliminating health disparities. 2 Although we face a battered economy, there is new attention to this problem and to diversifying the workforce; there is new hope that these disparities can be addressed.As detailed in our Journal, asthma, a treatable condition and the most common chronic disease of childhood, is one in which disparities in care and outcome are prominent. [3][4][5] This issue of the Journal is devoted to describing health disparities, particularly as they apply to the management of asthma, along with a discussion of proposals for enhancing the care that we can deliver as a community. Three commentaries emphasize the multiple factors and levels of complexity that converge to form the disparity in health care that we have witnessed. 6-8 Bryant-Stephens points out that although the prevalence of asthma is greater for Blacks than non-Latino Whites, the disparity in morbidity is far greater. Most disturbing is her reference to the Six City Study that found that even after controlling for factors anticipated to explain disparities such as environmental exposures, parental history, and demographic factors; Black children still had 1.6 times the odds of asthma diagnosis when compared to non-Latino White children. 9 What are these other factors? Arguably, some are combinations of those multi-level factors presented by Canino et al. 7 They could include other neighborhood exposures or effects of poverty not characterized in the study, problems with access to medications and health care, or health practice factors to name only a few of the possibilities. Both Bryant-Stephens and Valet et al comment on the burden of asthma for rural minority populations. Valet et al conducted an interesting analysis showing that differences in outcomes for rural versus urban dwellers is not well-established; however, in both rural and urban areas of the United States, poverty is associated with poorer health outcomes. Impoverished rural African Americans may have increased risk for poor asthma outcomes, but this requires further study. Together these three articles emphasize that health disparities operate through direct and indirect effects of unrelenting poverty on health.

Improving asthma outcomes in large populations

“…This is especially relevant regarding racial, ethnic, and socioeconomic status because these disparities have well-documented effects on asthma care and outcomes at Kaiser Permanente 24 and elsewhere. 25,26 Our patients are demographically similar to the overall southern California community (Steve Derose, MD, unpublished data, October 2005), and administrative data not depending on survey responses should reflect this generalizability. However, survey data might reflect a more select population.…”

Review of Family Relational Stress and Pediatric Asthma: The Value of Biopsychosocial Systemic Models

“…Health disparities are defined as differences between demographic groups in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival (McQuaid, 2008). The underlying causes of these disparities are complex and not well understood (Apter & Casillas, 2009;Canino, McQuaid, & Rand, 2009;Valet, Perry, & Hartert, 2009). The underlying causes of these disparities are complex and not well understood (Apter & Casillas, 2009;Canino, McQuaid, & Rand, 2009;Valet, Perry, & Hartert, 2009).…”

“…Low socioeconomic minority children experience differentially high morbidity and mortality from asthma (Bender, Milgrom, Rand, & Ackerson, 1998;Celano et al, 2010;McQuaid, Walders, Kopel, Fritz, & Klinnert, 2005). The underlying causes of these disparities are complex and not well understood (Apter & Casillas, 2009;Canino, McQuaid, & Rand, 2009;Valet, Perry, & Hartert, 2009). Koinis-Mitchell et al (2007) propose the use of a multidimensional cumulative risk index to conceptualize the variety of factors.…”

Mathematical Performance of American Youth: Diminished Returns of Educational Attainment of Asian-American Parents

“…The MDR framework provides a paradigm shift for understanding developmental outcomes in youth from middle-class ethnic minorities [1,2]. A major contribution of the MDR framework is that it provides an explanation for the persistence of ethnic disparities over decades despite decades of investment made to eliminate inequalities [18][19][20]. MDR also provides an answer to the question of why programs such as Head Start have had disappointing results in closing the achievement gaps across ethnic groups [1,2].…”