The term health disparity is used to refer to the gaps in the quality of health and health care services across ethnic, racial and socio-economic groups (Healthy People 2010: National Health Promotion and Disease Prevention Objectives 2000).
During the second half of the 20th century, people’s health has improved enormously. According to United Nation Human Development report 2003, average life expectancy at birth now exceeds 70 years in almost half of the world’s countries.
Though health has improved enormously, this positive trend has not been shared equally among or within the countries and there is a huge difference in the health status of people across the world. Disparities in the occurrence of the medical errors and the quality of health care are prominent issues in the contemporary health policy.
Health disparities are well documented in United States. Minority groups such as Native Americans, African American, Latinos, and Asian Americans have higher mortality, higher occurrence of chronic diseases and poor health outcomes than the white population (Goldberg, Hayes, and Huntley). For instance, cancer occurrence rate among African American is 10 per cent higher than whites (Eliminating Health Disparities).
Latinos and African Americans, when compared to whites, are at approximately twice the risk of developing diabetes. It is also observed that the ethnic groups also have higher incidence rates of AIDS, cardiovascular diseases and infant mortality.
Causes of health disparities
Health disparities in United States between regions, racial and ethnic groups are due to several reasons. Some of the reasons are:
The socio-economic, personal and environmental characteristics of different racial and ethnic groups. Barriers which ethnic and racial groups face when they try to enter main health care delivery system.
The difference in the quality of health care which different racial and ethnic groups receive. Health care disparities in United States:
There are several reasons for disparities among different peoples in accessing health care. Some of the reasons are lack of financial resources and regular sources of care, inadequate insurance coverage and diversity in health care work force.
Some other important reasons are health literacy, scarcity of providers, the health care financing system, linguistic, structural and legal barriers. Inadequate insurance coverage or the lack of it is one of the important reasons for health care disparities in United States.
People without insurance coverage tend to postpone medical care and likely to go without the required medical care. Ethnic and racial groups lack insurance coverage at higher rates than whites. Asch and his colleagues studied health care disparities in people belong to different racial and ethnic groups in United States (Asch et al. 2006).
Their research found a big gap between actual and received quality of health care. Their study proved that uninsured people, members of ethnic and racial minorities, women, less educated, older and poorer are less likely to receive the needed care than others.
Patricia Hewitt, Secretary of State for Health in UK, who hosted an EU summit in London called “Tackling health inequalities—governing for health” says “Almost all important health problems, and major causes of premature death across Europe such as heart disease and cancer, are more common among people with lower levels of education and income.”
(Narayan et al 2000) At the conference, which was attendant by health experts and delegates from 25 European countries, Marko Kyprianou, the European Union Commissioner for health and consumer protection stressed the need for reducing gap between rich and poor.
The widening of the gap between rich and poor creates inequalities in health among the people from same country. Inequalities in health contribute to increasing disparities in health.
According to some papers presented in the conference, health disparities increased drastically across Europe in recent decades, in spite of overall improvements in health. Globalization which has widened income gap between rich and poor, and changing cultural habits are the important reasons of widening health disparities across Europe.
According to John Mackenback, a professor at the Erasmus university Medical centre, Rotterdam, health disparities have increased drastically in several eastern European countries in the past decade. For instance, the Estonia in 1989 life expectance at birth in the upper echelons of society is 7 years higher than people from disadvantaged groups.
The gap has increased to 13 years in 2000. It is observed everywhere in Europe that people from higher socio economic groups live longer. Fitness and healthy eating habits are said to be two important reasons for this. Generally, people from disadvantaged groups eat badly, some and take less exercise. Some other factors such as environment, housing and work condition are also important reasons for causing health disparities among people in Europe.
In industrialized countries women enjoy a life expectancy much higher than that of men and they are more likely to survive than boys in the first five years of their life (Sophie, Arie 2005).
In South Asia, gender plays a crucial role in health disparities and women in South Asia are much less privileged than their counterparts in the developed countries and almost all walks of life they are dependent on men. Boys are considered to have social, economic, or religious utility; girls are perceived to be an economic liability due to dowry system.
Women in South Asia are in an extremely disadvantageous position with regard to health and health care system due to societal and individual attitudes and beliefs with regard to gender specific roles. Factors such as neglect of girl children, sex selective abortions, poor access to health care facilities for girls and women and gender discrimination contribute greatly to health disparity between men and women.
In direct contrast to western countries, female life expectancy is shorter or equal to men in South Asia. Gender related disparities in healthcare have created an unfavorable sex ratio in South Asia which is declining further. For instance, sex ratio is as low as 770 women per 1000 men in some parts of the Indian continent.
Some of the reasons for these differences are neglect of girl children, reproductive mortality, sex selective abortions and poor access to health care for girls. Neglect of girls is common in some parts of south Asia.
This has created gender based disparities among the population aged less than five years. Girls belong to this age group has much higher mortality rate than the boys of the same age group.
The neglect may take the form of lack of preventive care, poor nutrition, and unusual delays in seeking medical assistance for disease. Health disparities in adolescents are due to anemia, poor educational opportunities, early marriage and sexual violence. Another cause for health disparities between men and women is that the latter is less likely to seek early and appropriate care for illness.
In England, health disparities between rich and poor are widening. In 1997-1999, the infant mortality rates among the families of routine and manual workers were 13% higher than the national average. In 1999-2001 it rose to 17% and in 2001-03, it was 19% higher than the national average. Life expectancy difference between the most deprived sections of the population and the national average also widened in these years.
Income and Aboriginal status are the important factors of health disparities in Canada. People from lower income groups are associated with higher infant mortality, reduced life expectancy, increased incidence of infectious disease, low birth weight, injury and suicide.
Aboriginal people have higher rates of death from accident, chronic disease infections disease and shorter life span. Regarding gender, women in Canada live longer but more prone to suffer from chronic diseases, but income related health gaps are larger for men. In order to tackle these problems new thinking across all sections of government is required.
Healthy People 2010: National Health Promotion and Disease Prevention Objectives, conference ed. in two vols. (Jan 2000). U.S. Department of Health and Human Services (HHS), Washington: D.C. Goldberg, J., Hayes, W., and Huntley, J. (Nov 2004). Understanding Health Disparities. Health Policy Institute of Ohio. pp. 4-5.
Eliminating Health Disparities. (2004). American Public Health Association (APHA). Toolkit. Asch, S M, et al. Who is at greatest risk for receiving poor-quality health care? N Engl J Med 2006. 354. pp. 1147-56.
Narayan D, et al. (2000). Changing gender relations in the household. In: Voices of the poor: can anyone hear us? New York: Oxford University Press. Sophie Arie. (22 Oct 2005). UK pushes EU to tackle health gap between rich and poor.
(No. 331:923 doi:10.1136/bmj.331.7522.923).