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Braveman (ARPH, 2006: Health disparities and health equity: Concepts and measurement) suggests that U.S. public health and government officials have approached the health disparities issue primarily from the perspective of assessing and understanding racial and ethnic differences in health care access, utilization, and health outcomes. This is in contrast to other nations that have focused on disparity issues primarily from a socio-economic differences perspective. What drawbacks (in terms of understanding and

addressing health disparities) result from focusing on ethnicity/race rather than SES? (These can

be drawbacks Braveman suggests and others that you may identify.) What drawbacks might there

be in shifting the focus away from racial/ethnic disparities, and toward a SES-based analysis?

There is abundant literature (Prevention Institute, ND; World Health Organization, ND; Graham, 2004; Braveman, 2006) on health disparities. However, there is little consensus on what is meant by health disparities. The general view is that health disparities are systematic, potentially avoidable, unfair and unjust differences in health between groups of people who have different relative positions in social hierarchies according to wealth, power, or prestige (Whitehead, 1992; National Institutes of Health, 2005; Braveman, 2006). In contrast to other nations that have focused on disparity issues primarily from a socio-economic differences perspective, in the U.S. the term health disparities is generally assumed to refer to racial/ethnic disparities (Braveman, 2006). This perspective is not without its critics.

By focusing typically on racial and ethnic differences in health care access, utilization, and health outcomes through comparing other racial/ethnic groups to Whites or non Hispanic/Latino Whites this approach ignores the fact that even within certain racial/ethnic groups there are huge health disparities that should be investigated and addressed. As pointed out in the WHO’s World Report 2000, it is important to go beyond aggregate measures to examine how health is distributed within populations. Health disparities are caused by many other variables which vary within racial groupings. For example, gender, income, accumulated wealth, education, residential location and occupational characteristics are all factors that influence health care access, utilization, and health outcomes. Also, comparing groups basing on the “most” and “least” advantaged has a problem in that at times the “a prior most advantaged group will not have the highest level of health on every indicator” (Braveman, 2006 p 187). Rather health disparities should be viewed as a continuum where factors at each level can potentially impact the health of the community and that of individuals. Thus, tackling health disparities requires widening our lens to bring into view the ways in which all confounding factors (jobs, gender, race, working conditions, education, housing, social inclusion, political power) influence individual and community health (Treuhaft, 2009). This way, focus is on the unequal community environments that shape life opportunities and health outcomes of residents rather than racial differences alone.

However, using the most privileged group as the reference for comparison has its strengths. Allocation of societal resources is influenced by many factors including politics, power and social position. Because of this, there is a “possibility that resources earmarked for health equity may be directed to groups who are more privileged overall but happen to do worse on a particular outcome” (Braveman, 2006 p. 179). When societal resources are distributed unequally by class and by race, population health will be distributed unequally along those lines as well (Treuhaft, 2009). Focusing on socio-economic solutions without comparing health disparities between the “most” and “least” advantaged racial groups could fail to highlight the unequal distribution of resources among groups. This may result in failure to influence policy to promote an equitable allocation and utilization of resources between/among different racial/ethnic groups. Also, comparisons have an added benefit in that highest health indicators from the privileged group(s) can be used to set/represent the “minimum level that should be biologically possible for everyone” (Braveman, 2006 p. 187), without which there will be no yardstick to work with in efforts to change the environment and policies that affect health disparities.

Although there is burgeoning research on health disparities, adopting only one approach to measure and address them equates to ignoring the depth of the diverse factors that shape health disparities. There is no one pill that can cure this cancer. Deep and wide approaches to that understand the gender, cultural, social, economic, environmental and political factors shaping health disparities, should be used together, each drawing from the strength of the other(s) to improve the health of individuals and groups in society.

References

Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual

Review of Public Health, 27, 167-194.

National Institute of Health (NIH). 2005. Addressing disparities: the NIH program of action.

What are health disparities? Retrieved from http://healthdisparities.nih.gov/whatare.html

Prevention Institute, ND. Retrieved from http://www.preventioninstitute.org/

Treuhaft, S. (2009). Community Mapping for Health Equity Advocacy. Retrieved from

http://www.opportunityagenda.org/mapping.

“What is Health Equity?” Retrieved April 18, 2010 from

http://www.unnaturalcauses.org/assets/uploads/file/What_Is_Health_Equity.pdf

World Health Organ. (2000). World Health Report. Geneva:WHO.