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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." Although these disparities have existed for more than two centuries, defining and characterizing disparities in health and health care are necessary beginnings to understanding the problem and seeking effective solutions to inequities in health status. 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 variety of factors including age, gender, nationality, family of origin, religiosity, education, income, geographic location, race or ethnicity, sexual orientation, and disability be considered.

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Health care disparities are defined by the Institute of Medicine (IOM) as "differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention." Causes of health care disparities most often relate to quality and include provider-patient relationships, provider bias and discrimination, and patient variables such as mistrust of the health care 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.

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One of the most significant efforts to address disparities has been the introduction of the Healthy People goals in the late 1990s. Foundational principles of the federal Healthy People initiatives are (1) that all people are valued equally, (2) health is valued for everyone, (3) everyone should be able to achieve the highest level of health possible, and (4) the resources needed for health should be distributed fairly (http://www.healthypeople.gov/hp2020/advisory/PhaseI/PhaseI.pd). The disparities evident in the health and/or health care of the US population reflect inconsistencies in implementing these principles.

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Concerns regarding health and health care disparities are amplified when the dramatic changes in the population served during the last two decades of the twentieth century are considered. Between 1980 and 2000 the white non-Hispanic population of the United States increased 7.9% compared with an 88% increase in the aggregated minority (people of races other than white or of Hispanic ethnicity) population. 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. By the year 2050, the US census estimates that 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 delivery of quality health care.

Smedley BD et al: ...

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