Why Health Equity Matters
Overview
Over the last decade, the issue of racial and ethnic health disparities has become one of the most pressing problems plaguing this nation's health care system. Myriad studies and reports, including the Institute of Medicine's Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, document that racial and ethnic minorities, compared to whites, often have less access to health care, receive lower-quality health care, and have higher rates of illness, injury, and premature death.
In fact, the problem of health disparities has led the U.S. Department of Health and Human Services (HHS) to establish the elimination of health disparities by 2010 as a national goal and has inspired members of Congress to introduce legislation to help achieve that goal. However, the recent threats to public health programs such as Medicaid and SCHIP (the State Children's Health Insurance Program), the increasing numbers of people without health insurance coverage, and the persistently disproportionate prevalence and incidence of chronic diseases and conditions among racial and ethnic minorities make reducing and ultimately eliminating these heath disparities very challenging.
Racial and Ethnic Health Disparities
The term "health disparities" is an umbrella term that includes disparities in health and disparities in health care. Although "disparities in health" and "disparities in health care" are often used interchangeably, they are two different concepts:
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Disparities in health:
Disparities in health refer to differences between two or more population groups in health outcomes and in the prevalence, incidence, or burden of disease, disability, injury, or death. (For specific research findings that document racial and ethnic disparities in health, see the Disparities in Health Quick Facts box to the right.)
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Disparities in health care:
Disparities in health care refer to the differences between two or more population groups in health care access, coverage, and quality of care, including differences in preventive, diagnostic, and treatment services. (For more findings that document racial and ethnic disparities in health care, see the Disparities in Health Care Quick Fact box below.)
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Distinguishing between the two concepts is important because different factors contribute to each. However, these factors are interrelated. For example, personal behavior and decisions about health, environmental factors, and genetics are factors that are known to contribute to disparities in health. Disparities in health care also contribute to disparities in health. Likewise, studies have found that factors such as discrimination, bias, language barriers, and preferences about health care practices contribute to disparities in health care. However, no single factor contributes more to disparities in health and health care than access to health care.
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Disparities in Access:
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When individuals have reliable, consistent access to health care, they have greater access to health monitoring and are more likely to receive screenings, timely diagnoses, and appropriate treatment of chronic diseases and conditions. However, racial and ethnic minorities are disproportionately more likely than whites to be underinsured or to lack health insurance coverage altogether. For example, although racial and ethnic minorities constitute one third of the total U.S. population, they comprise more than one half (52 percent) of the uninsured population. In fact, in 2003, 23 million of the 45 million uninsured were racial and ethnic minority Americans.
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Medicaid: Opening Doors to Health Care
Medicaid, the nation's health care program for more than 50 million low-income children, working families, seniors, and people with disabilities, provides crucial comprehensive health care to individuals who would otherwise likely be uninsured. Medicaid is a particularly important program to many racial and ethnic minorities, who are disproportionately more likely than whites to rely on the program to access the health care system. In fact, Medicaid affords coverage to roughly one in five nonelderly Latinos, African Americans, and American Indian/Alaska Natives and to about one in 10 non-elderly Asian Americans. Without this safety net, the numbers of uninsured individuals would undoubtedly be much higher. And because Medicaid serves such a critical function, it is important that minority health advocates and stakeholders support and launch efforts to protect and defend state Medicaid programs from the deep cuts that are already being made in states such as Tennessee. (For more information on Tennessee's Medicaid program, please click here.)
Employer-Sponsored Health Insurance: Staying Healthy on the Job and in Life
Two in three non-elderly Americans receive their health insurance through their jobs, making employer-based coverage a crucial source of health insurance for all Americans. However, racial and ethnic minority workers are disproportionately more likely than white workers to be uninsured. These differences in insurance status can be attributed to the fact that racial and ethnic minority individuals are more likely than whites to: 1) work in positions where health care benefits are not offered; 2) work for companies—typically small companies—that cannot afford to pay for employee health insurance; and 3) not be able to afford health insurance premiums when coverage is offered.
Medicare: Keeping the Elderly and People with Disabilities Healthy
Medicare is an important federal health insurance program that provides health coverage for more than 40 million adults aged 65 and older and for people with disabilities. Roughly one in five elderly Medicare beneficiaries is a member of a racial and ethnic minority group, and by 2030, that proportion is expected to increase to one in four. Anticipating and understanding this expected increase in the diversity of Medicare beneficiaries is important because elderly racial and ethnic minorities often are in poorer health than their white cohort and therefore may have special hospital, outpatient, and prescription drug needs that the new Medicare law does not adequately address.
Diversity in the United States
According to the latest estimates, roughly one in every three people in the United States belongs to a racial and ethnic minority group. Latinos (the largest racial and ethnic minority group) and African Americans together account for 25 percent of the total U.S. population. In the next 50 years, the proportions of both Asian Americans/Pacific Islanders and Latinos are expected to double.
Racial and ethnic minority communities are extremely diverse, embrace distinct cultural traditions, and speak many different languages. Despite this diversity, there are other characteristics that many racial and ethnic minorities share that directly affect their access to quality health care. For example:
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- Racial and ethnic minorities are more likely than non-Hispanic whites to have family incomes that are less than 200 percent of the federal poverty level ($33,200 per year for a family of three in 2006). Consequently, racial and ethnic minorities are more likely than whites to be enrolled in Medicaid and to be uninsured.
- On average, racial and ethnic minorities are more likely than whites to have higher rates of illness and premature death, to have lower rates of access to affordable, quality health care, and to suffer worse health outcomes.
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As the United States population continues to become more diverse, and if the numbers of uninsured and underinsured individuals continue to rise, racial and ethnic health disparities will remain a challenging public health and health policy issue that should be addressed by health care advocacy groups and by all levels of government.
Dare to Get Involved: How to Take Action
What can you do to help raise awareness about minority health policy issues, such as health disparities and the uninsured? Click here to find out!
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