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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Case 1. Health Disparities Research Case (Page 2 of 37)

Case Background

Disparities in access and quality of care affect people's lives. The Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care released in March, 2002 documents continued disparities in access, treatment and to some extent quality of care across racial and ethnic groups. From the press release for the report:

"Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable," said committee chair Alan Nelson, a retired physician, former president of the American Medical Association, and current special adviser to the chief executive officer of the American College of Physicians-American Society of Internal Medicine, Washington, D.C. "The real challenge lies not in debating whether disparities exist, because the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them."
(IOM, 2002)

Health Services Research and the Study of Health Disparities

Health Services Research is an interdisciplinary, scientific, population-based and applied field of research focusing on questions of access, cost and quality of health services (Shi, 1997).

Health disparities is a focus of study within health services research that touches many of the core questions of the field. Disparities based on race, ethnicity, socioeconomic status, gender, and age, have been documented in access to health services and in the quality of care received by peoples of various sub-groups in the population.

Health disparities is a broad term that has come to mean different things in different contexts. Attention has been focused on the area by both the Health People 2000 goal to "decrease health disparities among Americans" (Lee & Estes, 2001 p. 30) and the decision to make one of the two goals of Healthy People 2010 to eliminate. In order to address this goal work has been done to identify the areas in which research is still necessary.

In the separate 1998 Initiative to Eliminate Racial and Ethnic Disparities in Health, President Clinton committed to the elimination of disparities in six major areas of health and health services by 2010, i.e. infant mortality, cancer screening and management, cardiovascular disease, diabetes, HIV/AIDS, and childhood and adult immunizations.

A major focus of study in health disparities is differences between African American and Whites in rates of illness and access to health care services. Many existing data sources, if they track race at all, track differences between these groups. However, the definition of health disparities is often broadened to include:

  • Socio-economic status (SES)
  • Other ethnic and racial groups such as: Hispanic (English speaking), Hispanic (non-English speaking), First Nation peoples, Asian and Pacific Islanders
  • Gender
  • Age: Elderly, Children
  • Geography (rural vs. urban)

For example, the second goal of Healthy People 2010 reads:

  • to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. (link to Healthy People 2010 goals)

There are current and intense debates about the relationship between factors such as SES and race.

Disparities in health and health care do not exist in a vacuum. The social and cultural history of the United States dating back to the country's founding, including our history of slavery, segregation, patterns of immigration and the treatment of women and minorities provides the context for any discussion of disparities in health. The complexity of context and issues helps explain the breadth and variety of methods and approaches to researching and addressing health disparities in the United States.

For more information on the history of health Services Research in the United States visit the History Module or view a video presentation of the National Library of Medicine's Health Services Research: A Historical Video

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