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Ethnic and racial minorities manifest significantly poorer health status than their white counterparts. Health disparities are defined by the National Institutes of Health as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” Cardiovascular disease, cancer, and diabetes mellitus are the most commonly reported health disparities, followed by cerebrovascular diseases, unintentional injuries, and HIV/AIDS. Assessing these differences requires that a wide variety of factors, including age, gender, nationality, family of origin, religiosity, education, income, geographic location, race or ethnicity, sexual orientation, and disability, be considered.

Healthcare disparities are defined by the Institute of Medicine (IOM) as “differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.” Causes of healthcare disparities most often relate to quality and include provider-patient relationships, provider bias and discrimination, and patient variables such as mistrust of the healthcare system and refusal of treatment. Although disparities in health and healthcare can be inextricably tied to one another, distinguishing between them increases our understanding of the complexity of the problem.

One of the most significant efforts to address disparities has been the introduction of the Healthy People goals every decade beginning in the late 1990s. The changes in the demographics of the US population are reflected in changes in Healthy People goals. Healthy People 2000 goals were to reduce health disparities. Healthy People 2010 goals were to eliminate those disparities. Healthy People 2020 expands these goals further to focus on achieving health equity, eliminating disparities, and improving the health of all groups. The disparities evident in the health and/or healthcare of the US population reflect inconsistencies in implementing these principles.

Approximately one-third of Americans, or >100 million persons, self-identify as belonging to a racial or ethnic minority group, 51% (154 million) are women, 12% (36 million) not living in nursing homes or other residential care facilities, had a disability, 70.5 million live in rural areas (23% of the population), while 233.5 million (77%) live in urban areas, and 4% identified themselves as lesbian, gay, bisexual, or transgender. Each of these groups experiences certain disparities in health or healthcare. (See Chapter 66 for a comprehensive discussion on the health disparities experienced by the GLBT community.) An estimated 1 in 4 Americans (almost 70 million persons) is classified as a member of one of the four major racial or ethnic minority groups: African American, Latino/Hispanic, Native American, and Asian/Pacific Islander. The US Census Bureau estimates that by the year 2050, people of color will represent 1 in 3 Americans. These populations bear a disproportionate burden of illness and disease relative to their percentage distribution in the population. Understanding the factors that contribute to inequities in health among these populations and the strategies that have resulted in improved health can inform and promote the ...

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