Healthcare disparities refer to the differences in health experienced by people who belong to traditionally underserved social groups. Although the experience of disparities in care is intersectional, persons are most likely prone to disparity due to their race/ethnicity, religion, socioeconomic status, age, location, gender, able-bodiedness, and sexual orientation. (Kaiser Family Foundation, 2018)
In order for practitioners and scholars to best serve healthcare needs, it's important to recognize healthcare disparities, how and why they happen, why they matter, and how they can be addressed.
A complex and interrelated set of individual, provider, health system, societal, and environmental factors contribute to disparities in health and health care. Factors include (but are not limited to):
Federal efforts to reduce disparities include a focus on designated priority populations who are particularly vulnerable to health and health care disparities. These priority populations include people of color, low-income groups, women, children, older adults, individuals with special health care needs, and individuals living in rural and inner-city areas. Again, these disparities do not occur in isolation; rather, they are intersectional, and prone to overlap.
Patient + Research + Provider
Even though healthcare disparities are far-reaching, the American Medical Association insists that all providers should address disparities such that they ensure equitable, appropriate, effective, safe and high quality care for all, with no gaps in services based on any medically irrelevant factor (2007, p. 3). In short, providers should seek to end disparities rather than striving primarily to reduce them. The AMA has developed 10 guiding principles to assist providers in making evidence-based decisions to battle healthcare. Policies and actions should be:
relationship centered |supportive of the delivery of patient-centered, family-focused, community-oriented care to individuals throughout the life span
culturally and linguistically appropriate | strategies tailored to the unique needs of diverse patient populations
targeted | with a focus on recognized and demonstrated gaps in access to health prevention, health care, safety, and quality
data-driven | making use of both quantitative and qualitative information to inform
transparent, participatory and collaborative | designed in open processes with the input of all key stakeholders and interested constituency groups
both long and short-term | quick fixes are important, but solutions should also aim to resolve underlying causes of disparities and should create permanent structural and financial incentives to prevent the reemergence of disparities
comprehensive | because health care disparities are intersectional, a set of policies to eliminate disparities must be broad-based
judicious in the use of incentives and requirements | both incentives and mandates might have a role in ending disparities, but policy-makers should recognize a preference for incentives, since mandates often risk backlash and long-term failure
fiscally responsible and bi-partisan | eliminating health care disparities is a non-partisan goal that can be accomplished in fiscally responsible ways
monitor and revise | policies to end disparities should be tracked closely over time for both intended and unintended effects so that they can be revised in the future
Inherent in these guidelines are the core principles of evidence-based practice, in which providers should concern themselves with patient interactions by asking, aligning, acquiring, and appraising information while balancing their expertise with the level of knowledge conveyed in research, and the patients' values and circumstances. Arguably, providers should take particular care to their patients' values and circumstances, as these are both complexly associated with the disparities attributed to a patient's social grouping.
Finding the best available research
The NLM has dedicated resources to helping researchers and providers find information that can help them make informed decisions that best suit patients prone to inequity in treatment and health. The following search terms are recommended by NLM to assist in accessing information relevant to healthcare disparities research:
"health status disparities"
"social determinants of health"
Collapsed into a search string, they appear as such: "Health disparities" OR "healthcare Disparities" OR "health Status disparities" OR inequalit* OR inequit* OR "socioeconomic factors" OR "Minority groups" OR "Social Determinants of Health" OR racism OR sexism OR ageism OR "Ethnic groups"
The NLM has also created a much more cohesive search strategy that includes MeSH, filters for title and abstract([TIAB]), major topics with no explosions (ie: [MAJR:noEXP]), and a more diverse array of search terms. The complete search strategy can be accessed here. Search results can be accessed by clicking here.
The following online resources can help providers make evidence-based decisions that fall within the guidelines set by the AMA and NIH:
The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. AHRQ priorities are described.
A review that takes the position that the “action” in community approaches to addressing health disparities lies in better understanding, design, and implementation of “hybrid” approaches to community development and health disparities.
The Guide to Community Preventive Services (The Community Guide) is a collection of evidence-based findings of the Community Preventive Services Task Force (CPSTF). It is a resource to help you select interventions to improve health and prevent disease in your state, community, community organization, business, healthcare organization, or school.
One of the most well-known policy groups advocating and lobbying for healthcare equality. Has a robust and informative well of resources, including infographics, multimedia, and updates concerning the American Healthcare Act.
The Health Inequality Project is a non-profit research organization that has collected massive amounts of non-identifiable healthcare information and made it available for academic and citizen researchers interested in community health and health disparities.
provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to: 1) Encourage collaborations across communities and sectors. 2) Empower individuals toward making informed health decisions. 3) Measure the impact of prevention activities.
"The Institute for Diversity and Health Equity, a 501(c)(3) nonprofit organization, works closely with health services organizations to advance health equity for all and to expand leadership opportunities for ethnic minorities in health management. The Institute’s mission is to advance diversity, inclusion and health equity. It is our vision to empower all health organizations to ensure equitable care for all persons."
MedlinePlus is THE primary consumer health information resource available today. It is sustained by the NLM, and contains information for a vast number of populations, including those who often experience inequities in health and healthcare.
features summaries of programs and practices that are proven to improve outcomes for children. All programs have been reviewed for quality and to ensure that they have evidence of positive effects. Programs are assigned to one of three evidence level categories (Proven, Promising, or Other Reviewed Programs) according to a number of evidence criteria.
In 2004, the Commission to End Health Care Disparities was established by the AMA and the National Medical Association to address gaps in health care. The National Hispanic Medical Association joined shortly after. In June of 2016, the commission was retired, but the resources and materials produced by the commission are available on this page for physicians.
The World Conference on Social Determinants of Health brought together Member States and stakeholders to share experiences on policies and strategies aimed at reducing health inequities. The event provided a global platform for dialogue on how the recommendations of the WHO Commission on Social Determinants of Health (2008) could be taken forward.
Implicit biases involve associations outside conscious awareness that lead to a negative evaluation of a person on the basis of irrelevant characteristics such as race or gender. This review examines the evidence that healthcare professionals display implicit biases towards patients.
This white paper provides guidance on how health care organizations can reduce health disparities related to racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
There is ample evidence that unconscious bias in medicine can have life-altering consequences. It can affect the type and quality of care certain patients receive, as well as the training and career opportunities available to people identified with certain ethnic, cultural, and other underrepresented groups.
Leveraging empathy and humanities to combat bias
Current and emerging research supports the use of empathy and empathic thinking as an intervention to reduce bias in patient-provider interactions (Stewart, 1995; Stewart, et al., 2000; Reiss, 2015; Ariso, 2018). This is a fairly unsurprising idea, in general, but even as empathy is regarded as necessary to care, it is increasingly less likely to be taught in biomedical education. As a result, students are actually less empathetic after leaving medical school than entering it.
This course offers an array of interventions that health professionals committed to addressing their own biases can try out and hopefully adopt. The suggested approaches focus on both conscious and unconscious biases. However, a greater emphasis has been placed on those interventions that address implicit bias, because it is virtually impossible to act on feelings, attitudes, and behaviors that are outside of one’s conscious awareness until they are brought into awareness.
emphasizes respect for patient values in individual care decisions as well as the role of patients and families as advisors and essential partners in improving care practices. It is characterized by a two-way partnership, the importance of which is growing with the movement from payment for volume to payment for value.
on-profit organization and international collaboration between researchers who are interested in implicit social cognition - thoughts and feelings outside of conscious awareness and control. The goal of the organization is to educate the public about hidden biases and to provide a “virtual laboratory” for collecting data on the Internet.