The Disparities Thing

Believe it or not, it is an official national goal of the United States to eliminate racial and ethnic disparities in health by the Year 2010. Of course, that goal was established under the Clinton Administration, but it has not been repudiated. We have less than five years left, so we need to get cracking.

Hmm. Maybe we aren't going to make it after all. That would require, you know, actually doing something. Most disparities in health -- by which we mean life expectancy, disability-free life years, self-assessed good health, freedom from pain, any number of measures -- result from disparities in life circumstances, including wealth, income, amount of education (somehow it makes us healthier), quality of work (i.e., having control, authority, and intrinsic rewards), quality of community (as measured through various concepts of "social capital"), quality of the physical environment (not living next door to a lead smelter, for example). The present administration, aided and abetted by the Republican-controlled Congress, is on a concerted campaign to increase social inequality in the United States, on every one of these dimensions, and the result will, inevitably, be an increase in health disparities.

A part of the disparities story, however, is health care. Medical intervention is not the most important factor in determining health, but it does matter -- considerably more now than it did when Ivan Illich wrote Medical Nemesis. Too much and the wrong medical intervention are still bad, and they still happen. But the right amount of the right stuff is of major value -- and it's also a public good, i.e. when one person is healthier, the rest of society benefits. (See January archived post "Consumer Driven Health Care and other fantasies.")

Unfortunately, not being an Anglophone European-American -- or a White non-Hispanic as the Census Bureau would have it -- is an independent risk factor for getting inferior medical care, even after we correct for having insurance. We know less about this than we should, but the existence of such disparities is proven. Don't take it from me, take it from the Institute of Medicine.

I'll have more to say about this soon.