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Definitions & Data |
PROLOGUE
Health Disparities: Definitions And Data
How do you define disparity? Is it one of those concepts best described as, "I know it when I see it" (Jacobellis v. Ohio, 1964), but deliberately left vague? Most observers of U.S. health care today acknowledge that there are disparities in health status and outcomes. African Americans, American Indians, and other racial and ethnic groups live shorter lives with a greater burden of ill health than white Americans. But why is this a disparity? Is disparity merely a difference between two groups, or is it a difference with negative and even malignant connotations? Researchers struggle with this concept, because most of medicine is about identifying or defining a problem and measuring its dimensions—how far has a disease progressed, how high are the cholesterol or blood pressure numbers—before one can prescribe a treatment. Defining and measuring a disparity is a prerequisite for solving or at least ameliorating the problem. But unlike identifying a disease process, defining and measuring disparities in health means that health policymakers, government officials, and others have to navigate the messy intersection where the history and sociology of racism and poverty meet the science of medicine. This is a place where definitions are not fixed; nor are the parameters of what to measure easily apparent.
Two papers in this volume take on these twin dilemmas of definition and data. Paul Hebert, of the Department of Health Policy at the Mt. Sinai School of Medicine, and colleagues Jane Sisk (who is on leave from Mt. Sinai) and Elizabeth Howell grapple with the varying definitions of disparity formulated by government and research organizations. The definitions seem to move like the gradient in health status, up and down a ladder of ethnic, racial, and economic considerations. The next paper, by Linda Bilheimer and Sisk, both of whom are affiliated with the National Center for Health Statistics, notes the current shortcomings in state and federal data collection and the challenges ahead to meet the goals set for eliminating health disparities in Healthy People 2010.
These papers portray the challenges ahead, but several other papers in the DataWatch section of this issue note that the calls for better data and definitions have not gone unheeded. Robert Blendon and colleagues from Harvard and the Robert Wood Johnson Foundation have surveyed subpopulations to draw out perceptions of U.S. health care. Also, Ernest Moy and colleagues from the Agency for Healthcare Research and Quality promote techniques for gathering data on disparities in care for Asian American Medicare beneficiaries. Their work suggests that progress is being made in the measurement realm. If we can measure, perhaps we then can define the problem, which should put us on the path toward solutions.
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