WASHINGTON – The definition of “health disparities” should be broadened to include the conditions that caused the affected groups to have poor health in the first place, according to Dr. Camara Jones of the Centers for Disease Control and Prevention.
The usual definition of health disparities refers to differences in the quality of care patients receive within the health care system, as well as differences in access to care, including preventive and curative services, Dr. Jones said at a meeting of the federal Advisory Committee on Minority Health.
However, “differences in life opportunities, exposures, and stresses that result in differences in underlying health status” also must be taken into account. So although health is partly determined by medical care and public health conditions, “it clearly extends beyond these [factors],” she said.
Dr. Jones said the social determinants of health include individual behaviors, such as what people choose to eat; individual resources, such as education, occupation, income, and wealth; neighborhood resources, such as housing, available grocery and dining choices, public safety, transportation, parks and recreation, and political clout; hazards and toxic exposures; and opportunity structures.
Therefore, reducing health disparities requires intervention in societal structures and attention to systems of power, said Dr. Jones, who is the CDC's research director on social determinants of health and equity. “We must address the social determinants of health, including poverty but also social determinants of equity, [such as] racism, in order to achieve social justice and eliminate health disparities,” she said.
Progress in eliminating health disparities has been slow because the country has been “pruning [the problem] instead of getting to the root,” she said. For example, it could be hypothesized that racism is a fundamental cause of disparities in health. (See box.)
Dr. Jones cited a U.N. treaty–the International Convention on the Elimination of All Forms of Racial Discrimination–that the United States signed in 1966 and ratified in 1994.
The U.N. has recommended that the United States establish a mechanism to ensure compliance with the treaty against racism at the federal, state, and local levels.
Responding to this directive might focus more attention on the ramifications of racism, Dr. Jones said.
Impact of Race, Ethnicity on Health
When people think about how racism affects health, the stress of being discriminated against often comes to mind, but there's another dimension as well, according to Dr. Jones.
A 2004 survey by the federal government found that the way people are perceived racially by others affects their perceived health status. Researchers asked more than 30,000 people to list both their actual race and the race others perceived them to be. They were also asked for perceptions of their own health status.
The results showed that, for example, Hispanics who were perceived by others as Hispanic responded less often that their health was “excellent” or “very good” (40%), compared with Hispanics who were perceived as white (54%). And the latter group had a lower percentage of “excellent” or “very good” responses, compared with whites who were perceived as white (59%).
The differences were similar among American Indians/Alaska Natives (AIANs), who comprised a small subgroup of respondents (321 people). Among those who both perceived themselves to be AIANs and were perceived that way by others, 32% reported themselves in “excellent” or “very good” health, compared with 53% of AIANs who were perceived to be white.
People who are usually classified by others as being white are significantly more likely to report that they are in excellent or very good health. “We live in a society that structures opportunities and assigns value based on how you look,” she said.