Health equity

Health equity (related, slightly more neutral terms include healthcare inequality and healthcare disparities) refers to the study of differences in the quality of health and health care across different populations.^[1]. This may include differences in the "presence of disease, health outcomes, or access to health care"^[2] across racial, ethnic, sexual orientation and socioeconomic groups.^[3] The term "disparities" generally refers to differences of which the writer disapproves; thus, for instance, some definitions of "disparities" do not include differences due to differing access (e.g., due to socioeconomic class).^[4]

Differences between populations in the presence of disease and health outcomes are well-documented in many areas. In the United States, disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos, with these groups having higher incidence of chronic diseases, higher mortality, and poorer overall health outcomes.^[5] For example, the cancer incidence rate among African Americans is 10% higher than among whites,^[6] and adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes.^[7] Similarly, differences in the overall level of health in individuals also exist between differing socioeconomic groups, with lower-status socioeconomic groups generally having poorer health and higher rates of chronic illness including obesity, diabetes, and hypertension;^[8] whether these are considered disparities to be eliminated depends on the author.^[4]

Health equity by some definitions^[4] also includes differences in access to health care between populations. For example, those in lower-status socioeconomic groups receive less consistent primary care, which is positively correlated to overall level of health in the recipient.^[9]. Similarly, in England, "people living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements."^[10]

A lack of health equity is also evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals.^[11]

Ethnic and racial disparities

See Ethnicity and health and Race and health.

The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these racially-centered disparities continue to exist and are a significant social health issue.^[12] The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race. The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.^[13]

There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory care.^[12].

A 2002 study on racial and ethnic disparities in health done by the Institute of Medicine showed that these differences cannot be accounted for in terms of certain demographic characteristic like insurance status, household income, education, age, geographic location and severity of conditions is comparable. Even when the researchers corrected for these factors, the disparities persist. ^[14]

It is pretty widely recognized that minority groups generally have higher death rates from cancer, heart disease and diabetes than whites. Gerard Boe’s article ^[15] cites studies that show major disparities in health care as it relates to specific diseases:

• Heart Disease: African Americans are 13% less likely to be recommended for and undergo coronary angioplasty and 1/3 less likely to undergo bypass surgery than whites. Death rates from heart attack and stroke are 29% and 40% higher, respectively, among African Americans than whites^[16]
• Asthma: Of preschool aged children who were hospitalized for Asthma related conditions, only 7% of African American children, 2% of Hispanic children compared to over 20% of White children are prescribed medications to prevent future Asthma related hospitalizations.
• Breast Cancer: Studies have found that the length of time between and abnormal mammogram and further diagnostic testing to determine if a patient has cancer is more than twice as long in Asian-American, African American and Hispanic women than it is in White women. African American women are more than twice as likely as white women to die of cervical cancer and have the highest rate of breast cancer death of any racial or ethnic group ^[16]
• Compared with rates in whites, the rates of diabetes are 1.9 times higher among Hispanics, two times higher among African Americans, and 2.6 times higher among Native Americans
• Some of these disparities are actually worsening. For example, the African American–to-white ratio of infant mortality has steadily increased during the past 2 decades and now is at 2.5:1

His article also discusses the increased incidence of receiving little or no routine and usual care and therefore, reduced chance of receiving preventative care and other health services.

• Hispanic children are almost three times as likely to receive no routine and usual source of health care as White children.
• Only 16% of White patients have a lack of routine and usual sources of health care compared to about 20% of African Americans and 30% of Hispanic patients.

Racial and Ethnic disparities in children: ^[17] 31.4 million Children in the United States are of non-white race or ethnicity (March 2010), this compromises 43% of American children and shows an increase over 11% since 2000. Mortality rates are substantially higher in minority children for all-cause mortality. Overall mortality rates are consistently found to be significantly higher in African American and other minority children. Specifically, disparities are found in specific mortality rates for certain diseases, acute-lymphoblastic leukemia and congenital heart defect among others. Asthma has also been a topic of many studies.

Race is considered to be more strongly associated with higher rates of African American children with unmet health care needs and lower access to primary health care providers than income is. ^[17]

One of the most important ways to help reduce health disparities is to work to reduce language barriers between patients and physicians. Language barriers are a major problem because of five main difficulties: ^[16]

• First, arriving at an accurate diagnosis is difficult, because an adequate history cannot be obtained.
• Second, treatment options cannot be adequately explained and discussed.
• Third, it is impossible to obtain truly informed consent for diagnostic and therapeutic procedures.
• Fourth, any attempts to provide health education are severely compromised.
• Finally, it is very difficult for physicians to act as effective advocates for patients we do not really know.

If physicians and other clinicians are able to reduce language barriers the resulting improved communication can improve compliance, reduce the number of emergency room visits, and enhance patient understanding. ^[16] Gunderman suggests that there are a few ways for physicians and the health care system in general to reduce language barriers like using nonverbal communication through gestures, the use of visual aids, and printed materials and videos in patients' native languages. They can also improve their fluency in the non-English equivalents of basic medical terms. The use of trained interpreters can also prove extremely valuable.

There is debate about what causes health disparities between ethnic and racial groups.^[18] However, it is generally accepted that disparities can result from three main areas:

• From the personal, socioeconomic, and environmental characteristics of different ethnic and racial groups (such as how certain racial groups, on average, live in poorer areas with high incidence of lead-based paint, which can harm children). A great deal of research on social determinants of health and the socio-ecological model have also surfaced, which connect economic and social conditions in determining a community's or a population's health.
• From the barriers certain racial and ethnic groups encounter when trying to enter into the health care delivery system; and
• From the quality of health care different ethnic and racial groups receive.^[19]

Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive. Additionally, attention on health care disparities is largely focused on race and ethnicity; data on racial and ethnic disparities are relatively widely available. In contrast, data on socioeconomic health care disparities are collected less often, often using education as the indicator of socioeconomic status.^[20]

The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data.^[21]

The Institute of Medicine report, Race, Ethnicity, and Language Data[1] identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement.

A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast cancer, prostate cancer and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.^[22]

Transplantation rates differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplant present themselves even before patients are on the transplant list.^[23] For example, different groups express definite interest and complete the pre-transplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.

The National Partnership for Action to End Health Disparities (NPA) was established to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. http://minorityhealth.hhs.gov/npa/

The National Stakeholder Strategy (NSS)for Achieving Health Equity is a product of the NPA. This document provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential. The strategy incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. Local groups can use the National Stakeholder Strategy to identify which goals are most important for their communities and adopt the most effective strategies and action steps to help reach them. http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286

The NSS defines health equity as the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. According to the NSS, a health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion

LGBT minority group health disparities

See also LGBT issues in medicine.

Often under emphasized are the minority groups that are heavily affected by health disparities in America, UK and all the same worldwide. Health disparities are not just based on race, ethnic, and cultural differences. Such disparities are seen as affecting the sexuality minority groups and observations and surveys show that one’s sexual minority status may limit access to health care, with especially bad impact on lesbians,^[24] which are being discriminated both as females and as homosexual.^[25]

“Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism.” ^[26] This known interference with health care access is a prime example of heterosexual privilege and homosexual prejudice prevalence in Western societies. Just as this lack of health care affects minority races, ethnic groups, and less represented cultural beliefs; lesbian and bisexual women are deteriorating their health by either not seeing (being feared of) or not be attended to by health care professionals.

It is important that health care professionals consider the nine cultural competency techniques suggested by the Agency for Healthcare Research and Quality and make an effort to break the barriers put into place through society’s homophobia and heterosexism.^[27]

"We don't have a good understanding of the developmental processes that affect LGBT persons. I would love to see something that pulls together what we have attempted to piece together: the LGBT life cycle," -Brian de Vries, gerontologist at San Francisco State University.

Most of the current research that exists focuses on homosexual male adults in regards to HIV. There is very little research regarding the entire group of individuals who are categorized under the LGBT umbrella. ^[28] A ground breaking report sponsored by the University of Minnesota’s Program in Human Sexuality looked into existing literature regarding findings on health issues for LGBT individuals. The report focused on HIV as well as other health issues, including lesbian, bisexual, and transgender individuals. The report listed many key findings:

• HIV is found disproportionately in young men, particularly young black men
• LGB youth and adults have a higher risk for depression, suicidal thoughts or actions, mood and anxiety disorders; some small studies suggest the same elevated risk may be true in transgender youth
• Smoking, alcohol consumption and drug abuse may be have a higher incidence in LGB youth
• Very little research has been done on this topic among transgender youth
• Lesbian and bisexual women may be at a greater risk of obesity and breast cancer than heterosexual women
• Some very limited research may suggest that older transgender individuals will experience some negative health problems as a result of long-term hormone use. ^[29]

Gay, Lesbian, Bisexual, and Transgender Health Access Project:

The Gay, Lesbian, Bisexual, and Transgender Health Access Project was established in 1997 and first funded by Massachusetts Department of public health. The program developed standards of practice for quality health care services. It also developed a training curriculum for health care providers.

Mission: "To strengthen the Massachusetts Department of Public Health's ability to foster the development of comprehensive, culturally appropriate health promotion policies and health care services for GLBT people through a variety of venues including community awareness, policy development, advocacy, and prevention strategies."

Vision: "To create a partnership between the Massachusetts Department of Public Health, community-based health and human services agencies, and the GLBT communities and their straight allies to develop an awareness of health issues; reduce barriers to health care and prevention services; and promote, enhance, and sustain health norms for GLBT people throughout the Commonwealth of Massachusetts."

One of their major goals is the identify, quantify and close gaps in services as well as barriers to care for GLBT people. www.glbhealth.org/about.html

Healthcare equity and sex

The results in comparing inequiies in access to adequate healthcare and gender are somewhat surprising, with women in the United States generally having higher levels of access to care. These disparities can be explained in part by looking at rates of overall insurance coverage (privatized and publicly assisted) between men and women, the effects of certain socioeconomic factors on levels of coverage between men and women, and overall gender-based differences in perceptions of health and health care.

In the United States, women have better access to healthcare, in part, because they have higher rates of health insurance. In one study of a population group in Harlem, 86% of women reported having health insurance (privatized or publicly assisted), while only 74% of men reported having any health insurance. This trend in women reporting higher rates of insurance coverage is not unique to this population and is representative of the general population of the US^[9].

Gender-based perceptions of health and healthcare may help explain some of the lag of men behind women in levels of insurance coverage. Women report higher rates of illness than men, which barring the idea that women are sicker than men, indicates women are more likely to seek medical care out and are therefore more likely to possess medical insurance^[9].

Gender-related disparities in access to healthcare are also related to socioeconomic factors including geographic job-market differences and differing levels of government assistance available to men and women. There are fewer job opportunities with insurance coverage available to men and women living in poorer communities, and of these opportunities, women tend to occupy more of the jobs with these benefits. Government assistance available to these individuals without job-related coverage varies between men and women, with women, especially women with children, receiving a higher percentage of available public assistance than men.^[9] Ultimately, for both men and women discrepancies in access to adequate healthcare is largely based on socioeconomic issues including income and full-time work status, with both groups of men and women with higher levels of income and full-time work receiving greater access to adequate healthcare^[9].

Healthcare Inequality and Socioeconomic Status

While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual's level of access to healthcare. Not surprisingly, individuals of lower socioeconomic status in the United States have lower levels of overall health, insurance coverage, and less access to adequate healthcare. Furthermore, individuals of lower socioeconomic status have less education and often perform jobs without significant health and benefits plans, whereas individuals of higher standing are more likely to have jobs that provide medical insurance^[9].

It is also important to note the almost caste-like conditions created by the U.S. healthcare system. The permanent effect that delayed, patchy, and second-rate health care has on an individual's body affects their chances of being healthy enough to rejoin the stratum of the labor market that provides health benefits. Actions such as smoking also affect health.^[30]

A study conducted in 2010 characterized the association between neighborhood poverty, racial composition and deceased kidney donor waitlist. Blacks in poor, predominantly Black neighborhoods were less likely to appear on transplant waitlist than those in wealthy, predominantly Black neighborhoods and poor, predominantly White neighborhoods. All were all less likely to be waitlisted than their Black counterparts in wealthy, predominantly White or mixed neighborhoods. These findings, using national data from the USRDS, support work indicating that neighborhood poverty and racial admixture affect the likelihood of being listed on the deceased donor kidney waitlist.^[31]

Disparities in access to health care

Reasons for disparities in access to health care are many, but can include the following:

• Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites.^[32]
• Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.^[33]
• Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.^[34]
• Legal barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.^[35]
• Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.^[36]
• The health care financing system. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.^[37]
• Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.^[38]
• Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.^[39]
• Health literacy. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.^[40]
• Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.^[41]
• Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.^[42] This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it. On the other hand, older individuals in the US (65 or above) are provided with medical care via Medicare.

Disparities in quality of health care

Health disparities in the quality of care different ethnic and racial groups receive can include:

• Problems with patient-provider communication. This communication is critical for the delivery of appropriate and effective treatment and care and, regardless of a patient’s race, miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. Among non-English-speaking populations in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during health care visits report having one. Additional communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. For example, patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.^[43] Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.^[44]

• Provider discrimination. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than other patients. Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.^[45]

• Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care.^[46] For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people.

Ending health disparities

The National Stakeholder Strategy for Achieving Health Equity (NSS) provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential.

Additionally, the Office of Minority Health has released the NPA Toolkit for Community Action. Community members can use the toolkit to engage fellow citizens and local media as they spread the word about health disparities and educate others about the impact disparities have in the lives of individuals and the greater impact on society.

The Commonwealth Fund, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:^[47]

• Consistent racial and ethnic data collection by health care providers.
• Effective evaluation of disparities-reduction programs.
• Minimum standards for culturally and linguistically competent health services.
• Greater minority representation within the health care workforce.
• Establishment or enhancement of government offices of minority health.
• Expanded access to services for all ethnic and racial groups.
• Involvement of all health system representatives in minority health improvement efforts.

Other methods for ending health disparities or reducing health disparities have been suggested based on research that observes cultural differences within health care systems. According to the Agency for Healthcare Research and Quality and the assisting authors Cindy Brach and Irene Fraserirector, in an effort to reduce disparities between racial and ethnic groups, the health care system should consider the following nine cultural competency techniques:

• Interpreter services. If agencies take an active approach in hiring professional interpreters, for both foreign languages and for the speaking and hearing impaired, communication barriers will begin to decrease.
• Recruitment and Retention. Healthcare systems need to become more conscious of the staff within their facilities. It is essential to the reduction of disparities that most minority groups be represented within the various health care offices and clinics.
• Training. The Agency for Healthcare Research and Quality and its assisting authors emphasized the importance of health care professionals being trained to work with interpreters and minority groups.
• Coordinating with traditional healers. Health care workers should be supportive and able to adjust health care plans according to the patient’s cultural beliefs and traditional health practices.
• Use of Community Health Workers. These individuals could be responsible for bringing in the population of people who rarely seek out health care.
• Culturally competent health promotion. This information can be available through community health workshops, or simply by health care workers taking the necessary measures to promote early detection and treatment and outlining the good and risky health behaviors to all patients.
• Including family and/or community members. The Agency for Healthcare Research and Quality states that this particular cultural competency may be vital to obtaining consent and adherence to treatments.
• Immersion into another culture. Allowing yourself to step outside of your comfort zone will increase your tolerance for another culture as well as raise your awareness to new ideals and beliefs.
• Administrative and Organizational accommodations. These are some aspects of the health care offices that should be considered; they include the location of the healthcare offices, public transportation availability, clinic hours, the physical environment of the clinic, and the rapport built with the patients.^[48]

Health inequalities

Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services. Such examples include higher rates of morbidity and mortality for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada, the issue was brought to public attention by the LaLonde report.

In UK, the Black Report report was produced in 1980 to highlight inequalities. On 11 February 2010 Sir Michael Marmot, an epidemiologist at University College London, published the Fair Society, Healthy Lives report on the relationship between health and poverty. Marmot described his findings as illustrating a "social gradient in health": the life expectancy of the poorest is seven years shorter than the most wealthy, and the poor are more likely to have a disability. In its report on the study, The Economist argued that the causes of this health inequality include lifestyles - smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain.^[49]

See also

• Center for Minority Health
• Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries
• Hopkins Center for Health Disparities Solutions
• Population health
• Public health
• Unnatural Causes: Is Inequality Making Us Sick?
• Health Disparities Center
• The Cultural Competency Organizational Assessment-360 (COA360)
• Drift Hypothesis

References

Further Notes

• Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Health Policy Institute of Ohio (November 2004).
• McDonough, J., Gibbs, B., Scott-Harris, J., Kronebusch, K., Navarro, A., and Taylor, K. A. "State Policy Agenda to Eliminate Racial and Ethnic Health Disparities," Commonwealth Fund (June 2004).
• Smedley, B., Stith, A., and Nelson, A. "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." Institute of Medicine (2002).

External links

• Progress in Community Health Partnerships: Research, Education, and Action (PCHP)
• Institute of Medicine Roundtable on Health Disparities was created to enable diaologue and discussion of issues related to the visibility of racial and ethnic disparities in health and health care as a national problem, the development of programs and strategies to reduce disparities and the emergence of new leadership.
• Center for Managing Chronic Disease
• Cultural Diversity in Health Care Speaker Series videos presentations from expert lecturers, University of Wisconsin School of Medicine and Public Health
• Cultural Diversity in Health Care Research Symposium video presentations from expert lecturers, University of Wisconsin School of Medicine and Public Health
• National Center on Minority Health and Health Disparities
• Journal of Health Care for the Poor and Underserved
• Understanding Health Disparities
• Initiative to Eliminate Racial and Ethnic Disparities in Health United States government minority health initiative
• Health Disparities Collaborative
• Massachusetts General Hospital seeks to bridge healthcare's racial gap
• Diversity Health Institute Clearinghouse
• Case Center for Reducing Health Disparities
• FIU Health Disparity Research Group
• "Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health", News summary report from kaisernetwork.org
• Health inequality in New Zealand
• BBC News article regarding health inequalities
• EXPORT Project webpage atTuskegee University
• VIDEO: Health Status Disparities in the US, April 4, 2007, featuring Paula Braveman, Gregg Bloche, George Kaplan, Thomas Ricketts, Mary Lou deLeon Siantz, and David Williams
• UK National Health Service Specialist Library for Ethnicity & Health [2]
• National Rural Health Association
• The National Partnership for Action to End Health Disparities
• The National Partnership for Action Toolkit for Community Action