3.5 Health Disparities
Open Resources for Nursing (Open RN)
Despite decades of promoting culturally competent care and the Patient’s Bill of Rights, disparities in health care continue. Vulnerable populations continue to experience increased prevalence and burden of diseases, as well as problems accessing quality health care. In 2003 the Institute of Medicine (IOM) published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, sharing evidence that “bias, prejudice, and stereotyping on the part of health care providers may contribute to differences in care.”[1] The health care system in the United States was shaped by the values and beliefs of mainstream white culture and originally designed to primarily serve English-speaking clients with financial resources.[2] In addition, most health care professionals in the United States are members of the white culture and medical treatments tend to arise from that perspective.[3],[4]
The term health disparities describes the differences in health outcomes resulting from entrenched economic, sociopolitical, or environmental factors, referred to as social determinants of health. Social determinants of health are conditions in the environment where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.[5]
Vulnerable populations experience increased prevalence and burden of diseases, as well as problems accessing quality health care because of social determinants of health. A related term is health care disparity that refers to differences in access to health care and insurance coverage. Health disparities and health care disparities can lead to decreased quality of life, increased personal costs, and lower life expectancy. More broadly, these disparities also translate to greater societal costs, such as the financial burden of uncontrolled chronic illnesses.
The Agency for Healthcare Research and Quality (AHRQ) releases an annual National Healthcare Quality and Disparities Report that provides a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. Quality is described in terms of client safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Although access to health care and quality have improved since 2000 in the wake of the Affordable Care Act (ACA), the 2022 report shows continued disparities, especially for poor and uninsured populations[7]:
- There was a decline in overall health expectancy in 2022 due to COVID, with a