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Factors underlying health and healthcare disparities

Health professional students and health practitioners must understand the reasons underlying disparities in health and health care and what they can do to address them. Disparities in health care may rise from (1) differences in access to health care and (2) differences in the quality of health care received. Timely use of personal health services to achieve the best health outcomes or health care access can be assessed using measures of (a) entry into the health care system, (b) structural barriers (e.g., transportation, ability to schedule appointments, specialist referrals), (c) patient perceptions (e.g., patient-provider communication and relationships, cultural competency, health literacy, and health information), and d) health care utilization (i.e., routine, acute, and chronic care, and avoidable hospital admissions).
Aspects of quality of care that could result in health disparities include the following:

  • Effectiveness: care based on scientific knowledge, as provided to all patients who could benefit and not provided to patients unlikely to benefit.
  • Safety: care that avoids injuring patients through care intended to benefit them.
  • Timeliness: care that reduces delays in the use of care.
  • Patient Centeredness: care that is respectful and responsive to the individual needs, preferences and values of patients.
  • Equity: care that encompasses the need for health care systems to provide care that does not vary in quality because of personal characteristics (such as gender, ethnicity, geographic location and socioeconomic status). Racial and ethnic bias and stereotyping by health care providers are thought to make significant contributions to health care disparities (Physicians for Human Rights, 2003). Cultural competency training at all levels of curriculum and training programs can play an important role in eliminating racial and ethnic bias and stereotyping by health care providers.

Here are some articles and resources on factors underlying health and healthcare disparities:

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Demographic patterns of disparities

Extensive literature reviews have summarized evidence showing that African-Americans and Hispanic Americans (and to a less well-documented extent, American Indians, Alaska Natives, Asian Americans, Native Hawaiians and Other Pacific Islanders) receive less medical care in general, as well as less intensive care, than comparable white patients (Physicians for Human Rights, 2003; Institute of Medicine Unequal Treatment report; National Health Care Disparities Report). This pattern has been found in the use of high-technology interventions such as angioplasty and coronary artery bypass surgery and for more general medical and surgical procedures and treatment of chronic conditions such as diabetes. These differences are often termed 'disparities' (Carter-Pokras and Baquet 2002).

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Collaborating with communities

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