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Health Disparities and Culture-Moving Beyond the Beginning

Health disparities between majority and racial ethnic minority populations have long been documented in the literature. In 1986, the landmark Report of the Secretary’s Task Force on Black and Minority Health (Department of Health and Human Services [DHHS], 1986) was released, spotlighting the disparities in health status and health outcomes among minority populations. In an effort to improve the health and well-being of minority populations, the report called for more research on risk factor identification and prevalence, sociocultural health-seeking factors, preventive services, health education and interventions, treatment of services, and health outcomes. Since this original report, other major initiatives have followed. Healthy People 2000 (DHHS, 1993) and, most recently, Healthy People 2010 (DHHS, 2001) address specific health conditions disproportionately affecting racial and ethnic minority communities, such as infant mortality, health disease, stroke, and oral health. In response to these, numerous agencies, foundations, and most of the institutes within the National Institutes of Health have outlined strategic plans to reduce racial and ethnic health disparities. Each plan usually addresses the concept of culture, such as developing strategies to improve cultural competency among health care providers, developing culturally specific interventions, or creating culturally and linguistically appropriate services. Although a beginning, these strategies alone will not resolve the issue. Health disparities will not be truly eliminated until we demonstrate and understand social and economic inequalities, whether by race or ethnicity. Although the concepts of race and ethnicity have been controversial in the academic literature that serves political, public policy, health planning, and other purposes, both have a role to play depending on the context and purpose. The emphasis is to have a wider understanding and shared vocabulary of the concepts of race and ethnicity in nursing, health care, and research. To exemplify the point, in a study question on the genetic causes of diseases, or the impact of racism based on skin color or facial features, the concept of race may be most useful. If the study question is on the consequences of health care delivery issues, encapsulating culture, the broader concept of ethnicity may be more of value. A study of Jamaicans that does not differentiate between Jamaicans of Indian descent and Jamaicans of African descent is likely to mislead. Within broadly defined racial or ethnic groups, the heterogeneity in health patterns and risk is immense. Those who analyze data categorized by inappropriate racial/ethnic labels, most often capture data of convenience, have too readily ignored such heterogeneity. Moreover, at the heart of perpetuating inequalities lurk social and economic factors that are inextricably entwined with ethnicity and race. Nursing has led the way in addressing disparities in health and health care. However, our leadership efforts will have to move beyond the beginning to reduce health disparities. A better understanding of the strengths and limitations of the concepts of race and ethnicity is a priority for nursing. Too often we ignore or abandon these conversations because they are perceived as too risky. If we are to continue to remain champion leaders in addressing health disparities, it will require us to regularly engage in such discussions and questions.