Vulnerable Populations: Data And Measurement Issues

As the twenty-first century dawned, hopes swelled that decadesof data collection on health disparities would catalyze previouslyelusive reductions. The data, budget surpluses, and other factorshad brought the nation and its policymakers to a tipping point.Federal health disparity reduction initiatives rolled out inrapid succession. Healthy People 2010, released in 2000, didn’tjust call for disparity reduction; it also made eliminationof specific disparities one of the nation’s two highesthealth priorities and provided minority-specific baseline data.The 2002 Institute of Medicine report, Unequal Treatment, galvanizedthe growing sense of purpose to level the health playing fieldfor minorities; a surge in health disparities research ensued.

Subsequent fiscal reversals and strains on the health care systemdampened hopes of realizing major reductions in health disparitiesby mid-decade. Even so, trends recently revealed in the 2006National Healthcare Disparities Report and the Midcourse Reviewof Healthy People 2010 were jarring. Both documents reportedno major reductions in the majority of racial and ethnic healthdisparities tracked, with some gaps growing. And the bad newscouldn’t be written off to difficult times: Simultaneoushealth improvements were reported for the overall population,even in some spheres where disparities went undiminished.

In this section, Kenneth Keppel and colleagues identify onelikely reason for those outcomes: decisionmakers’ preferentiallyinvesting limited local health resources in overall health improvement,thereby underpowering programs to help the most burdened minoritiescatch up. The Midcourse Review reveals that such an approach,although tempting when resources are strained, typically leavesthe minorities hardest hit by disparities trailing behind; theauthors elucidate why. Racial and ethnic health disparitieswill persist, they conclude, unless policymakers specificallycommit to reduction. To facilitate locally appropriate resourceallocation decisions, policymakers should also arm themselveswith current, local data.

Indeed, a firm commitment to reducing racial and ethnic healthdisparities is the driving force behind two unprecedented initiativesto obtain highly detailed, local disparity data. In 2006 theCommonwealth of Massachusetts and the City of Boston issuedoverlapping mandates to collect race and ethnicity data forall acute care hospital patients. The interventions that willfollow have yet to be solidified—in part, Robin Weinickand colleagues explain, because data will inform design. Craftinga flexible system to collect the data needed to support programmaticand resource allocation decisions involved everyone from patientsto legislators. The lessons learned along the way, recountedby the authors, should prove illuminating for leaders in otherjurisdictions contemplating similar undertakings.

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Vulnerable Populations: Data And Measurement Issues