Health Disparities

I couldn't blog yesterday because I was attending a conference, sponsored by the New England Coalition for Health Equity, on state policy to eliminate health disparities. "Health disparities" is a term which refers specifically to the substantial differences in life expectancy and health status among segments of the population. Most people know that rich people live longer than poor people, and are healthier, but it is also true that after you control for wealth, income and education, Black people in the U.S. are substantially less healthy, and don't live as long, as White non-Hispanic people. ("Black" is actually a heterogeneous category that includes African Americans and other ethnic groups such as Haitian and Cape Verdean people, but African Americans constitute most of the group and drive the statistics. If we could disagreggate, which we usually can't, we would probably see differences within the group as well.)

For Latinos, the picture is more complex. Immigrants from Mexico tend to be healthier than their low average socio-economic status would predict, but they lose that advantage in the second and third generations. Puerto Ricans tend to be less healthy than the average in the U.S. We don't know very much about other immigrant groups from Latin America, many of which are growing fast such as Colombians and Central Americans. We don't even count Brazilians or recognize their existence in our standard system of racial and ethnic classification.

The reasons for these disparities are only partly understood. Health care probably doesn't explain most of it, but it has been shown by a lot of good research that minority group members, even when they have insurance and can get in the door of the clinic, often receive inferior care. This could have to do with racism or other kinds of prejudices on the part of providers, poor provider-patient communication, non-financial barriers to receiving good care -- we don't completely know. But methods of raising quality overall tend to reduce disparities, because they make medical decision making less arbitrary and better based in evidence.

So, this is another major topic for this blog. More on this later. Soon, I want to respond to some of the interesting comments I've recieved in a top-level post. And I will also talk about citizen organizing and activism for public health and better health care, which I believe are a very promising approach to democratizing social policy in the U.S. Thanks to everyone who has visited and contributed!