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2 Health Disparities: Concepts, Measurements, and Understanding
Pages 21-33

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From page 21...
... Strategic Plan presents data on health among several selected populations that show marked differences in such diverse health indicators as infant mortality, cancer mortality, coronary heart disease mortality, and the prevalence of diabetes, end-stage renal disease, and stroke (see Table D-4, Appendix D)
From page 22...
... . These data document continuing racial and ethnic differences in death rates from heart disease, malignant neoplasms, cerebrovascular disease, chronic respiratory diseases, diabetes, HIV, and homicide.
From page 23...
... The National Center for Health Statistics found that death rates for American Indians/Native Alaskans were underestimated by nearly 21 percent, compared with an overestimation of 1 percent among white populations (Rosenberg et al., 1999)
From page 24...
... Creating scientific knowledge to reduce and ultimately eliminate health disparities involves significant definitional and methodological challenges. Proper review of the NIH Strategic Plan requires consideration of the current scientific context within which the goals and objectives are being established and pursued.
From page 25...
... Although previous research demonstrates the feasibility and importance of studying health disparities, further research is needed to maximize our ability to identify, measure, reduce, and eliminate disparities. There is not complete agreement on how to define or measure health disparities because observed differences vary depending on which groups are observed and what is measured.
From page 26...
... Understanding and addressing racial/ethnic health disparities will clearly require looking at subgroups within large ethnic categories, despite the difficulty in obtaining adequate data. Data on Socioeconomic Health Disparities Many health outcomes vary with socioeconomic status -- though again, the patterns of disparity vary depending on the measures of health used and socioeconomic variables studied.
From page 27...
... Both African Americans and Hispanics are overrepresented in lower categories of socioeconomic status. For some health outcomes, the differences between racial/ethnic minorities and whites become nonsignificant, once income is controlled.
From page 28...
... Regarding health care disparities, the Agency for Healthcare Research and Quality has, since 2003, issued an annual National Healthcare Disparities Report. This report summarizes disparities in health care access and quality for racial and ethnic minorities.
From page 29...
... The report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare provides extensive documentation of the differences in the appropriateness and quality of care received by members of racial and ethnic minority groups (Smedley et al., 2003)
From page 30...
... Stress Exposure to stress and the resulting behavioral and biological responses put individuals at risk for a range of diseases. Studies documenting greater stress exposure for groups disadvantaged by race, ethnicity, or socioeconomic status suggest that differential stress exposure, which can include perceived discrimination, may be an important mechanism by which social disadvantage gets "into the body" to affect health.
From page 31...
... , several conceptual models have been developed to explain the complex pathways by which biological, medical, behavioral, and environmental determinants of health differentially affect individuals and groups (Baum et al., 1999; Brunner and Marmot, 1999; Hertzman, 1999; House, 2002; House and Williams, 2000; Kaplan, 1999; Kuh and Ben-Shlomo, 1997; Kuh et al., 1997)
From page 32...
... Lack of consensus regarding conceptual and operational defini tions of disparities and the complexity of measuring health and health determinants pose challenges for the identification, under standing, monitoring and elimination of health disparities.
From page 33...
... · Disparities research embedded into large studies (molecular, clinical, and epidemiological) , national data sets, and public health monitoring measures through the greater inclusion of appropriate measures of race, ethnicity, socioeconomic status, and residential characteristics, and of the psychosocial and environmental factors that are likely to shape health disparities in the population being studied at each time point of data collection.


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