Module Components

• Overview
• Assignments

Topics

• Health Disparities Definitions
• Examples of Health Disparities
• Community Health Indicators
• Leading Reports on Health Disparities
• Federal and State Initiatives
• Cultural Competence

NRSG 780 - Health Promotion and Population Health

Module 5: Health Disparities / Cultural Competence

Leading Reports on Health Disparities

IOM Report on Unequal Treatment

A landmark report on health disparities is the Institute of Medicine (IOM) report published in 2002 titled: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

“Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable.”

- Alan Nelson, retired physician, former president of the American Medical Association and chair of the committee that wrote the IOM report. Martha Hill, former dean of the Johns Hopkins School of Nursing, co-chaired the committee.

The report described evidence of racial and ethnic disparities in healthcare:

• Found consistently across a wide range of disease areas and clinical services
• Present even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account
• Found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc.
• Associated with higher mortality among minorities

The report identified potential sources of disparities in care:

• Health systems-level factors – financing (e.g., lack of insurance), structure of care; cultural and linguistic barriers
• Patient-level factors – including patient preferences, refusal of treatment, poor adherence, biological differences
• Disparities arising from the clinical encounter

AHRQ Report on National Healthcare Disparities

Source: https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr.pdf

Since 2003, the Agency for Healthcare Research and Quality has produced the National Healthcare Quality Report and the National Healthcare Disparities Report. These reports to Congress are mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). Beginning with the 2014 reports, findings on health care quality and health care disparities are integrated into a single document that provides a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic and socioeconomic groups. Key findings of the 2021 report focus on:

• Overview of Disease Burden and the Healthcare System
• Access to Health Care
• Quality of Care
• Disparities in Healthcare
• Key Findings and Trends

If you are interested in further information, review the priorities available at: https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-final-es.pdf

CDC Health Disparities & Inequities Reports

Factors, environmental exposures, social determinants, and healthcare access by sex, race and ethnicity, income, education, disability status and other social characteristics.

CDC published its first report on Health Disparities and Inequities (CHDIR) in 2011.  These reports assess health disparities and inequalities for a broad range of diseases, behavioral risk factors, environmental exposures, social determinants, and healthcare access by sex, race and ethnicity, income, education, disability status and other social characteristics.  They also identify interventions that can reduce health disparities among high risk populations.

To review the CDC’s Health Disparities and Strategies Reports, please review the Minority Health website available at https://www.cdc.gov/minorityhealth/chdir/index.html