Health and Health Care Disparities in Minority Populations

by Charles E. Taylor, MPH, MT (ASCP)

The term “health disparities” is an umbrella term that refers to the gaps in the quality of health and health care that crosses racial and ethnic groups. These disparities originate in the overall health status of the people and the health care system that renders services to the specific groups of people.

Health Disparities versus Health Care Disparities:

Distinguishing between the two concepts is important because different factors contribute to each. For example, personal behaviors and decisions about ones health, environmental factors, and genetics are factors that are known to contribute to disparities in health. On the other end of the spectrum factors such as discrimination, bias, language barriers, and preferences about health care practices contribute to disparities in health care delivery systems.



Disparities in Health:


As defined by
the Human Resources and Services Administration, refers to the
“population specific differences in the presence of disease, health
outcomes, or access to adequate health care”. Assessing health outcomes
as well as the prevalence, incidence, burden of diseases, disability,
injury, and death rates of a specific minority group, warrants the
opportunity to launch “disparities-reduction” efforts to reduce or
eliminate the specific causes of these disparities.


Three main areas have been generally accepted as being responsible for these disparities:


    – Personal, Socioeconomic, and environmental characteristics of ethnic and racial groups

    – Barriers encountered by certain ethnic and racial groups in attempts to enter a health care system

    – Overall quality of care that these various ethnic and racial groups receive


Health Care Disparities:


Health care
disparities, refer to the differences between two or more population
groups (ethnic and minority based) in health care access, health care
coverage, and the quality of health care provided or received. These
differences include preventive, diagnostic, and treatment services that
may not be adequate due in part to cultural, religious and ethical
barriers.


A major health
care disparity for minorities is accessibility. Documented contributing
factors to disparities in access to health care are multiple, and may
not be limited to the following:


    – Lack of Insurance coverage

    – Scarcity of providers

    – Continuity of care

    – Linguistics barriers

    – Inadequate financial resources

    – Literacy

    – Legal Barriers

    – Diversity in Health Care workforce

    – Structural Barriers

    – Health Care Financing


Disparities in the Quality of Health Care:


Quality of care
within in ethnic and minority groups is a major consideration when
assessing the impact of health disparities created by the quality of
care rendered by the health care system, and the adequacy of care
received by these specific groups. Two identified contributing factors
have been:


    – Inadequate patient-provider interaction and dialogue

    – Provider Discrimination


Inadequate
patient-provider interaction and dialogue is a critical element that
enables appropriate, effective treatment, and care regardless of a
patient’s race. Implications for not establishing this specific type of
dialogue can lead to a misdiagnosis, improper use of medications, and
failure to receive follow up care. Identified causes that impede
effective interaction and dialogue may include a lack of cultural
understanding by a non-minority provider, illiteracy of English
language, religious beliefs, mistrust of Western medical practices, and
familial and hierarchical roles.


Provider
discrimination may occur as a result of a provider either consciously
or unconsciously treat certain racial or ethnic patients differently
from other non-minority patients. Many ethnic and minority tend to feel
alienated if they are seemingly coerced to answer specific questions
regarding health habits or overall behavioral practices that affect
their health status. These people are also reluctant to question a
diagnosis, plan of treatment, prognosis, and plans of treatment, thus
further extenuating the disparity for personal health and the access to
adequate and appropriate care.


Eliminating Health Disparities for Minorities


Consideration must be given to the following areas when developing policies to eliminate racial and ethnic health disparities:


•    Continuity of care by culture competent health care providers

•    Evaluation of disparities-reduction programs

•    Culturally and linguistic competent health care services

•    Minority representation within in the health care workforce

•    Establishment an enhancement of government offices for minority health

•    Expanded access to services for all ethnic and racial groups

•    Involvement of all health system representatives in minority health improvement endeavors


Reference: American Public Health Association. “Eliminating Heath Disparities”: Toolkit (2004)


Charles E. Taylor is the Assistant Professor of Health/Clinical Laboratory Sciences, Western Carolina University.