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Overview of Health Disparities: Maryland Considerations.

Despite improvements in health and life expectancy over the past 100 years, advances in medicine and public health have not benefitted all communities. Lack of translation of advances in prevention and disease management for some communities contributes to lags in health status and life expectancy. Differences, compared to a reference population, in disease rates and burden of illness are referred to as “health disparities.”1 The focus on population and individual disparities in health status and health care demonstrates the need to ensure equity and equality in access to quality health care, health care delivery and health outcomes. 
 
The term “health disparities,” which is widely used in the United States, is defined as follows: “…..differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”2 Although the United States has increased the use of additional terminology, the terms “health inequity” and “health inequality” are more commonly used outside the United States. Health inequity (lack of fairness) and health inequality (not being equal) are “…differences in health which are not only unnecessary and avoidable, but are considered unfair and unjust.”1 These two terms incorporate the concept of “social justice,” whereas the term “health disparities” emphasizes differences in disease rates, health-related data and other measures. 
 
Health disparity populations are defined as populations where there are significant differences in disease prevalence, incidence, mortality and survival when compared to the general population.2 This includes African Americans, American Indian and Alaska Natives, Asians, Hispanics, Native Hawaiian and other Pacific Islander, low socioeconomic groups and rural communities. 
 
As research on the causes of health disparities and inequities has progressed, a national and global focus has defined associated factors, called “social determinants of health,” which emphasize the social, economic, and other characteristics related to health disparities. The World Health Organization Commission on Social Determinants of Health states that health inequities are “…the unfair and avoidable differences in health status….”3 
 
Socioeconomic status influences insurance status, tobacco and alcohol use, whether individuals have a usual source of care and other factors associated with health disparities. Determinants include transportation; housing or place of residence; access and availability of services; educational level; income and material goods, such as home ownership; diet; discrimination by social grouping (e.g., race, gender, and class); and social and environmental stressors.4 Less-educated and poorer communities are at the highest risk of being uninsured, not having a usual source of health care and delays in seeking diagnosis or treatment. 
 
Descriptions of disparity populations have historically focused on health indicator differences between racial/ethnic groups; thus, these data are the most readily available. Disparities are also associated with geography, such as rural versus urban communities, age, gender, and a host of other factors. The changing demographics in the United States and in Maryland show an increase in racial/ethnic minority populations. The estimated population for 2009 was, over 40% of Maryland’s population was minorities.5 These demographics emphasize the need for clinical care delivery that incorporates cultural influences on health behaviors and compliance with treatment and cultural competence in health care delivery to meet the needs of an increasingly diverse population.