Disparities in Health and Health Care: Five Key Questions and Answers

Issue Brief
  1. Definitions of health disparity differ. For example, the Department of Health and Human Services describes health disparities as “differences in health outcomes that are closely linked with social, economic, and environmental disadvantage” while the National Institutes of Health defines a health disparity as a “difference in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States.” United States Department of Health and Human Services, HHS Action Plan to Reduce Racial and Ethnic Health Disparities, (Washington, DC: Department of Health and Human Services, April 2011), http://minorityhealth.hhs.gov/npa/files/plans/hhs/hhs_plan_complete.pdf. “NIH Announces Institute on Minority Health and Health Disparities,” National Institutes of Health, published September 2010, https://www.nih.gov/news-events/news-releases/nih-announces-institute-minority-health-health-disparities.

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  2. However, they may have nuanced distinctions. For example, a health disparity, which typically refers to differences caused by social, environmental attributes, is sometimes distinguished from a health inequality, used more often in scientific literature to describe differences associated with specific attributes such as income or race. A health inequity implies that a difference is unfair or unethical. Centers for Disease Control and Prevention, “CDC Health Disparities and Inequalities Report – United States 2011,” Morbidity and Mortality Weekly Report 60 (Jan 2011):55-114. Olivia Carter-Pokras and Claudia Baquet. "What is a Health Disparity?" Public Health Reports 117 (Sep-Oct 2002): 426-434.

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  3. “NCHHSTP Social Determinants of Health: Frequently Asked Questions,” Centers for Disease Control and Prevention, accessed December 2019, https://www.cdc.gov/nchhstp/socialdeterminants/faq.html.

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  4. Samantha Artiga and Elizabeth Hinton, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, (Washington, DC: KFF, May 2018), https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.

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  5. Priority Populations. Content last reviewed March 2019. Agency for Healthcare Research and Quality, Rockville, MD, https://www.ahrq.gov/topics/priority-populations/index.html.

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  6. “Chapter Eight: Focusing on Vulnerable Populations,” Agency for Healthcare Research and Quality, published March 1998, http://archive.ahrq.gov/hcqual/meetings/mar12/chap08.html.

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  7. Agency for Healthcare Research and Quality, Agency for Healthcare Research and Quality: Division of Priority Populations, (Rockville, MD: Agency for Healthcare Research and Quality, April 2016), http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/factsheets/priority-populations/prioritypopulations_factsheet.pdf.

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  8. Health Coverage of Immigrants, (Washington, DC: KFF, February 2019), https://www.kff.org/disparities-policy/fact-sheet/health-coverage-of-immigrants/.

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  9. Samantha Artiga, Katherine Young, Elizabeth Cornachione, and Rachel Garfield, The Role of Language in Health Care Access and Utilization for Insured Hispanic Adults, (Washington, DC: KFF, November 2015), https://www.kff.org/disparities-policy/issue-brief/the-role-of-language-in-health-care-access-and-utilization-for-insured-hispanic-adults/.

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  10. Ibid.

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  11. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States; Baciu A, Negussie Y, Geller A, et al., editors. Communities in Action: Pathways to Health Equity. Washington (DC): National Academies Press (US); 2017 Jan 11. 2, The State of Health Disparities in the United States. Available from: https://www.ncbi.nlm.nih.gov/books/NBK425844/.

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  12. Ani Turner, The Business Case for Racial Equity, A Strategy for Growth, (W.K. Kellogg Foundation and Altarum, April 2018), https://altarum.org/publications/the-business-case-for-racial-equity-a-strategy-for-growth.

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  13. Jessica Semega et al., Income and Poverty in the United States: 2018 Current Population Reports, (Washington, DC: US Census Bureau, September 2019), https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-266.pdf.

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  14. Institute of Medicine (US). How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary. Washington (DC): National Academies Press (US); 2012. 2, What Progress in Reducing Health Disparities Has Been Made?: A Historical Perspective. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114236/.

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  15. 2018 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Pub. No. 19-0070-EF. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-final.pdf.

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  16. Institute of Medicine (US). How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary. Washington (DC): National Academies Press (US); 2012. 2, What Progress in Reducing Health Disparities Has Been Made?: A Historical Perspective. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114236/.

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  17. KFF analysis of 2018 American Community Survey.

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  18. KFF analysis of 2018 American Community Survey.

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  19. KFF analysis of 2018 American Community Survey.

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  20. Jennifer Tolbert, Kendal Orgera, Natalie Singer, and Anthony Damico, Key Facts about the Uninsured Population, (Washington, DC: KFF, December 2019), https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.

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  21. Samantha Artiga and Kendal Orgera, Key Facts on Health and Health Care by Race and Ethnicity, (Washington, DC: KFF, November 2019), https://www.kff.org/disparities-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/.

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  22. Ibid.

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  23. National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Publication No. 19-0070-EF. https://www.ahrq.gov/research/findings/nhqrdr/nhqdr18/index.html.

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  24. Julia Foutz, Samantha Artiga, and Rachel Garfield, The Role of Medicaid in Rural America, (Washington, DC: KFF, April 2017), https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/.

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  25. Samantha Artiga and Kendal Orgera, Key Facts on Health and Health Care by Race and Ethnicity, (Washington, DC: KFF, November 2019), https://www.kff.org/disparities-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/.

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  26. Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. 2018. https://www.cdc.gov/nchhstp/atlas/index.htm.

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  27. United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics (DVS). Linked Birth / Infant Death Records 2007-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program, on CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/lbd-current.html.

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  28. Elizabeth Arias et al., “United States Life Tables, 2017,” National Vital Statistics Reports 68(7) (June 2019), https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf.

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  29. Paula Braveman et al., “Socioeconomic Disparities in Health in the United States: What the Patterns Tell Us,” American Journal of Public Health 100(1) (April 2010):186-196, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837459/.

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  30. Jennifer Kates, Usha Ranji, Adara Beamesderfer, Alina Salganicoff, and Lindsey Dawson, Health And Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S., (Washington, DC: KFF, May 2018), https://www.kff.org/disparities-policy/issue-brief/health-and-access-to-care-and-coverage-for-lesbian-gay-bisexual-and-transgender-individuals-in-the-u-s/.

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  31. U.S. Department of Health and Human Services, Reducing Tobacco Use: A Report of the Surgeon General, (Atlanta, Georgia: Centers for Disease Control and Prevention, 2000), http://www.cdc.gov/tobacco/data_statistics/sgr/2000/index.htm.

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  32. U.S. Department of Health and Human Services, Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General, (Rockville, MD: National Institute of Mental Health, August 2001), http://www.ncbi.nlm.nih.gov/books/NBK44243/.

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  33. Pub. L. 106–525, Nov. 22, 2000, 114 Stat. 2495.

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  34. U.S. Department of Health and Human Services, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, (Washington, DC: Institute of Medicine, March 2002), http://www.nationalacademies.org/hmd/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx.

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  35. U.S. Department of Health and Human Services, Unequal Treatment: What Healthcare Providers Need to Know about Racial and Ethnic Disparities in Healthcare, (Washington, DC: Institute of Medicine, March 2002), http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf.

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  36. Dennis Andrulis et al., Patient Protection and Affordable Care Act of 2010: Advancing Health Equity for Racially and Ethnically Diverse Populations, (Washington, DC: Joint Center for Political and Economic Studies, July 2010), https://nashp.org/wp-content/uploads/sites/default/files/files/webinars/joint.center.ppaca_.health.equity.report.pdf for a comprehensive and detailed overview of these provisions.

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  37. “About Healthy People”, Office of Disease Prevention and Health Promotion, accessed January 21, 2020, https://www.healthypeople.gov/2020/About-Healthy-People.

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  38. U.S. Department of Health and Human Services, HHS Action Plan to Reduce Racial and Ethnic Health Disparities, (Washington, DC, September 2011) https://www.minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285.

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  39. U.S. Department of Health and Human Services, Putting America’s Health First, FY2021 Budget in Brief, (Washington, DC, February 2020), https://www.hhs.gov/sites/default/files/fy-2021-budget-in-brief.pdf.

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  40. U.S. Department of Health and Human Services, HHS Action Plan to Reduce Racial and Ethnic Disparities: Implementation Progress Report 2011-2014, (Washington, DC: U.S. Department of Health and Human Services, November 2015), https://minorityhealth.hhs.gov/assets/pdf/FINAL_HHS_Action_Plan_Progress_Report_11_2_2015.pdf.

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  41. “National CLAS Standards”, U.S. Department of Health & Human Services, accessed February 12, 2020, https://thinkculturalhealth.hhs.gov/clas.

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  42. “Rural Health”, Centers for Medicare & Medicaid Services, accessed February 12, 2020, https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/index.

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  43. “CMS Office of Minority Health”, Centers for Medicare & Medicaid Services, accessed February 12, 2020, https://www.cms.gov/About-CMS/Agency-Information/OMH.

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  44. Kathleen Gifford, Eileen Ellis, Aimee Lashbrook, Mike Nardone, Elizabeth Hinton, Robin Rudowitz, Maria Diaz, and Marina Tian, A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020, (Washington, DC: KFF, October 2019), https://www.kff.org/medicaid/report/a-view-from-the-states-key-medicaid-policy-changes-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2019-and-2020/.

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  45. Office of Minority Health, State and Territorial Efforts to Reduce Health Disparities, (Washington, DC: U.S. Department of Health and Human Services, July 29, 2018), https://minorityhealth.hhs.gov/assets/PDF/OMH-Health-Disparities-Report-State-and-Territorial-Efforts-October-2018.pdf.

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  46. Ibid.

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  47. Ibid.

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  48. See for example, the Cultural-Quality-Collaborative https://www.jhsph.edu/faculty/research/map/US/1470/8309, which is a network of leading healthcare organizations that is working to share ideas, experiences, and solutions to real world problems that arise as a result of cross-cultural interactions that hinder the elimination of disparities in healthcare settings.; P. Braveman, L. Gottlieb, D. Francis, E. Arkin, and J. Acker, What Can the Health Care Sector Do to Advance Health Equity?, (Princeton, NJ: Robert Wood Johnson Foundation, November 12, 2019) https://www.rwjf.org/en/library/research/2019/11/what-can-the-health-care-sector-do-to-advance-health-equity.html; Centers for Disease Control and Prevention, “Strategies for Reducing Health Disparities – Selected CDC-Sponsored Interventions, United States, 2016” Morbidity and Mortality Weekly Report 65(1) (February 12, 2016), https://www.cdc.gov/mmwr/volumes/65/su/pdfs/su6501.pdf.

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  49. Tricia Brooks, Lauren Roygardner, and Samantha Artiga, Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey, (Washington, DC: KFF, March 2019), https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey/.

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  50. Samantha Artiga and Elizabeth Hinton, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity, (Washington, DC: KFF, May 2018), https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.

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  51. Matt McKillop and Vinu Ilakkuvan, The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2019, (Washington, DC: Trust for America’s Health, April 2019), https://www.tfah.org/wp-content/uploads/2019/04/TFAH-2019-PublicHealthFunding-06.pdf.

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  52. Prevention and Public Health Fund, (Washington, DC: American Public Health Association), https://www.apha.org/-/media/files/pdf/factsheets/200129_pphf_factsheet.ashx?la=en&hash=FF100DA73DBD3AF6327ABF88C3DD42B1959FE445.

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  53. Taryn Morrissey, The Affordable Care Act’s Public Health Workforce Provisions: Opportunities and Challenges, (Washington, DC: American Public Health Association, June 2011), https://www.apha.org/~/media/files/pdf/topics/aca/apha_workforce.ashx.

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  54. Samantha Artiga and Kendal Orgera, Key Facts on Health and Health Care by Race and Ethnicity, (Washington, DC: KFF, November 2019), https://www.kff.org/disparities-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/.

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