AD-Perspective
Health and Health Care Disparities
Based on the NLM Long Range Plan, the National Library of Medicine has developed its Strategic Plan for Addressing Health Disparities 2004-2008. The Plan consists of 25 objectives under 3 broad categories or areas of emphasis: 1) Promote the use of health information by health professionals and the public, 2) Strengthen the information infrastructure for health through training, and 3) Support informatics research.
The objective contains an action plan, performance measures and outcomes measures. Three objectives are related to Regional and National Networking (3.1.17 - 3.1.19)
- Ensure coordination of NNLM services in providing equal access to health information
- Expand partnerships among libraries and community-based organizations in order to form coalitions to improve health information for underserved populations
- Provide community based organizations the opportunities to seek health information funding opportunities.
Disparities Defined
The Center for Health Equity Research and Promotion (CHERP) defines health disparities as The differences in the prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups. Health disparities studies examine the higher rates of disease occurrences in a population, the resulting death rates or complications of disease, and the disease's impact upon that community. CHERP's example of a health disparity is taken from NCHS's Socioeconomic Status and Health Chartbook: US citizens who have not completed high school are four times more likely to die from a contagious disease than those who have gone to college.
Somewhat related to health disparities is the term health care disparities. This is where differences in access, process, and structure of healthcare among specific population groups occur. An example of a health care disparity may be that urban residents have easier access to certain types of healthcare than rural residents. CHERP notes that health disparities and health care disparities are not always related.
Factors
Health and health care disparities can result from the following factors:
Individual factors: genetic or biological differences among ethnic groups or genders; related to individual factors are cultural factors affecting decisions and behaviors
Environmental factors: where people live and exposure to disease and substances
Social factors: health care availability, education, income…
System and policy factors: location, organization, and staffing of health care facilities as well as decisions made in health care financing that affect insurance and payer coverage
Provider factors: are the knowledge, attitude, and clinical and cultural competence of health care providers
Health equity research examines and identifies health and health care disparities in order to discover relationships between health and health care disparities. Three areas or health equity research (CHERP calls these first, second, and third generations) are documenting occurrences of health and health care disparities, explaining the reasons for disparities, and providing solutions for correcting disparities.
The Literature
A recent review of health disparities literature was published in the Annals of Internal Medicine (Long JA, Chang VW, Ibrahim SA, Asch DA. Update on the health disparities literature. Annals Intern Medicine, 2004 Nov 16;141(10):805-12). The authors reviewed 20 articles in the area of health equity research published between 2002 and 2003. The articles fell into the first two areas of health equity research: documenting disparities and studies explaining disparities. Research in the latter area was divided into patient factors, provider factors, and system factors.
Here is a thumbnail of four articles along with links to their PubMed citations.
Long JA et al. Update on the health disparities...[PMID: 15545681]
Schneider EC, et al. Racial Disparities in the quality of care…[PMID: 11886320]
This study examined quality of care in managed care settings for African-American and white populations in four measures: Mammographies, retinal examinations, acute myocardial infarctions, and mental health. The study is "consistent with other studies showing that black patients receive fewer appropriate medical services than white patients." (Long et al., p.805)
Ibrahim, SA et al. Understanding ethnic difference in the utilization of joint replacement…"[PMID 11789631]
600 male patients in a VA setting were asked about their knowledge of joint replacement procedures and expectations of postsurgical outcomes. The authors identify patient beliefs and understanding that might contribute to observed racial disparities in the receipt of joint replacement." (Long, p.808)
Cooper LA, et al., "Patient centered-communication, ratings of care…"
[PMID 14644893]
This study examined patient perceptions of care with African-American patients under the care of African-American physicians (referred to as race concordance) as compared to the care of white physicians. Using pre and post interviews for patient and provider and audiotapes of the care visits, data on duration of visit, speech, verbal dominance, and patient centered interviewing were gathered. The study found that despite differences in length of visit and higher ratings of satisfaction for race concordant visits, "audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits." (Cooper, et al. p.907)
Wong MD, et al., "Contribution of major diseases to disparities in mortality" [PMID 12432046]
Race specific data from the National Health Interview Survey were matched with the National Death Index to determine the potential years a person would have lived had they not died of a disease or condition (life-years lost). African-American patients have a higher rate of life-year lost at a difference of 35% as compared to white patients with similar age, sex, and education. The diseases or conditions contributing to the disparities in life-years lost were hypertension, HIV infection, diabetes, and homicide. Long et al. point out that this study can be used to "help guide policy and resources aimed at reducing mortality disparities" (p. 811).
The review by Long et al. identified 20 articles appearing in ten health journals. While not exhaustive, the review shows that health equity research has made contributions to identifying and explaining health and health care disparities. Little research is available on the possible solutions or interventions for reducing or eliminating health and health care disparities.
As stated in NLM's Plan to Reduce Health Disparities, National Network Office will prepare the RFP for the 2006-2011 NN/LM contracts. Based on the Plan's objectives, member libraries will have opportunities to collaborate with community organizations (Objective 3.1.18). The upcoming contract proposal will also have to outline efforts to expand outreach opportunities to community agencies in order to address health disparities that may be remedied by broadening health information access (Objective 3.1.19)
Javier Crespo, Associate Director
