The Imperative of Reducing Health Disparities through Prevention:
Challenges, Implications, and Opportunities
Reprinted with permission from the Prevention Institute
The following is the introduction to the first in a series
of articles focusing on the importance of prevention in reducing
“Despite steady improvement in the overall health of the
U.S. population, racial and ethnic minorities, with few exceptions,
experience higher rates of morbidity and mortality than non-minorities.”
– Institute of Medicine
What are Health Disparities?
Our nation spends nearly one trillion dollars a year on diagnosing
and treating disease. Nevertheless, each year hundreds of thousands
of deaths due to preventable causes occur—including nearly
400,000 deaths due to poor diet and inactivity; 85,000 deaths
as a result of alcohol misuse; 55,000 attributable to toxic agents;
and 29,000 attributable to firearms.13 These deaths and other associated health problems occur disproportionately
among poor and minority populations.
The National Institutes of Health defines health disparities
as “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.”14 Racial and ethnic health disparities are “large, persistent,
and even increasing in the United States.”15 When elements of racism, poverty, and problematic community environments
converge, greater overall threats to health and safety develop.
When efforts are designed to address this convergence, disparities
can be reduced.
The Imperative of Reducing Health Disparities
According to the Institute of Medicine, “All members of
a community are affected by the poor health status of its least
healthy members.”16 Therefore, poor
health is not only a burden to those affected but also to others.
Conversely, by reducing disparities, the health care system would
be enhanced for all.
An excess of people with poor health overburdens the health care
infrastructure, increases the spread of infectious diseases, and
uses up public health and health care resources. Good health for
all is precious; it enables us to be productive, learn, and build
on opportunities. Poor health jeopardizes our independence, responsibility,
dignity, and self-determination. The success of our communities,
society, and economy also depends on good health. Healthy workers
and a healthy emerging workforce are critical for social and economic
progress. As a nation we are spending one out of every seven dollars
of our Gross Domestic Product on health care, and it is anticipated
that the proportion will soon rise to one out of every six dollars.17,18 Our health expenditures double those of any other nation.19 The strain is also taking a toll on government resources and consequently
on taxpayers. When public money is used for medical care, less
money is available for other vital services that enable us to
thrive, such as education and transportation. But by spending
primarily on the medical end—after people get injured or
sick—we are not using our money wisely.
The prevalence of disparities may increase in the U.S. as the
population becomes even more diverse. In coming years, achieving
a healthy and productive nation will increasingly rely on our
ability to keep all Americans healthy and reduce racial and ethnic
disparities by improving the health of communities of color. A
significant health gap exists in the U.S. We know the strategies
that will be effective in closing it; many of them are described
in this report.
We have a social and moral responsibility to act.
For the full article, please visit the Prevention Institute online
13. Mokdad,A.H., Marks, J.S., Stroup,D.F., Gerberding, J.L., Actual
causes of death in the United States, 2000. JAMA 2004: 291:1238
14. National Institutes of Health, Addressing Health Disparities:The
NIH Program of Action.What are health disparities.Available at:
nih.gov/whatare.html. Accessed January 14, 2002.
15. House, J.S.,Williams,D.R. Understanding and reducing socioeconomic
and racial/ethnic disparities in health. In: Smedley, B.D. Syme,
Eds. Promoting Health: Intervention Strategies from Social and
Behavioral Research.Washington,D.C.: National Academy Press; 2000:
16. Smedley, B., Stith, A., Nelson,A. Eds., Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care.Washington,D.C.:The
National Academies Press; 2003: 37.
17. California HealthCare Foundation., Health Care Costs 101.
2005.Available at http://www.chcf.org. Accessed February 2006.
18. California HealthCare Foundation., Health Care Costs 101:
California Addendum. 2005.Available at http://www.chcf.org. Accessed
19. Farley, 2005:XI