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PROLOGUEAddressing Specific DisparitiesThe realization on the economic front that the "rising tide" does not necessarily lift all boats has been borne out by U.S. income data showing that the chasm between rich and poor has only widened over the past several years. An analogue in the health care context can be found in the discourse surrounding efforts to eliminate health care disparities. As we learned from Kenneth Keppel and colleagues in their Sep/Oct 2007 paper, although improving quality of care and eliminating disparities "both focus on improving health, progress toward one goal does not necessarily ensure progress toward the other." A growing awareness has emerged among health care decisionmakers that eliminating disparities requires a unique commitment beyond generalized quality improvement efforts. A corollary to this, particularly in tight public budgetary times, is that policymakers must often confront difficult trade-offs in allocating scarce resources in a way that ensures progress in improving health while attempting to minimize disparities. Two federal initiatives designed to track progress toward achieving population health improvement goals contribute to the evidence base that informs such policy-making calculations. Healthy People 2010, a Health and Human Services initiative, explicitly states as its twin goals (1) improving overall quality of life and life expectancy; and (2) eliminating health disparities based on race, ethnicity, sex, or education. In addition, the Agency for Healthcare Research and Quality (AHRQ)–sponsored National Healthcare Disparities Report, the companion to the National Healthcare Quality Report, has as its unique mission tracking disparities in access to high-quality care. The papers that follow build on this knowledge base by considering three oft-neglected subsets of the disparities conversation that should be considered by policymakers. First, Thomas McGuire and Jeanne Miranda attempt to divine what the evidence reveals in answer to two questions affecting the intersection between disparities and mental health: Can general health care policies also reduce mental health disparities, and to what extent do mental health care quality improvement efforts reduce disparities writ large? Next, Susan Fisher-Owens and colleagues document the disparities in oral health status and access to dental health services that emerge over the course of the life span, and highlight the need for a remedial policy prescription embracing better integration of oral health and general health care. Finally, Kevin Grumbach and Rosalia Mendoza make the case for greater diversity in the health care workforce, particularly with respect to African Americans, Latinos, and American Indians, and propose strategies for increasing the ranks of "underrepresented" minorities within the health care professions.
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