Persons belonging to racial or ethnic minority populations are likelier to be poor and to have lower educational levels and, in addition, they are at increased risk of ill health. The health care and social factors associated with these disparities are directly related to access to health care. Differential access is a key part of disparities in health care. For instance, only 13% of whites lack health insurance, compared to 34% of Hispanics and 21% of blacks. Disparities in health care are increasingly being viewed as a quality issue. There is some evidence that differences in health care are narrowing. The fundamental causes of disparities in health care are more complex than either insurance or socioeconomic status. Important considerations when addressing these disparities include, in addition to insurance coverage, quality of care, public health measures, and community resources.
Encouragingly, some countries have achieved universal access to care and have better health outcomes—including fewer health disparities. Some social conditions that contribute to poor health would seem to be amenable to such policy changes as increasing the minimum wage and expanding the earned income tax credit. Another example is improving air quality. Not only federal policy, but state and local policies as well have the potential to improve access and focus on conditions that promote health. Too few physicians in the United States are engaged in community programs, political action, or collective advocacy. Progress in diminishing health disparities will come only when both the medical and nonmedical determinants of health are addressed.
RAND Center for Population Health and Health Disparities, Arlington, Virginia