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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 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (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 (now called the National Academy of Medicine) 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 health care can be inextricably tied to one another, distinguishing between them increases our understanding of the complexity of the problem.

When considering health disparities from a population health perspective, the focus turns to an underrecognized determinant of health disparities described as the “Fundamental Causes” theory. This theory stipulates that when new health knowledge arises, those groups with higher socioeconomic status (SES) benefit more than groups with lower SES because of their greater material and nonmaterial resources. However, it is well known that various factors influence health. A helpful framework for understanding these factors is evident in the model described in the County Health Rankings where the percent contributions of a variety of factors can explain why there are disparities in health outcomes (Figure 65–1).

Figure 65–1.

County Health Rankings and Roadmaps. (Reproduced with permission from County Health Rankings & Roadmaps.

The Healthy People goals were initiated each decade beginning in the late 1990s as a way of setting goals to progressively address disparities. 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 health care of the US population reflect inconsistencies in implementing these principles.

Approximately one-third of Americans (slightly more than 100 million) self-identify as belonging to a racial or ethnic minority group, 51% of Americans (154 million) are women, 12% of Americans (36 million) not living in nursing homes or other residential care facilities have a disability, 70.5 million Americans (23%) live in rural areas ...

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