Although the health of most Americans has improved
significantly over time, not all racial and ethnic groups have benefited
equally. African-Americans and Hispanics, for example, are more likely
than whites to suffer from poor health and to die prematurely. Minority
and low-income families are more likely to live in substandard housing
and polluted communities, increasing their risk of childhood lead poisoning,
asthma, cancer, and other environmentally related diseases. In addition
to being disproportionately affected by disease, minorities often lack
adequate insurance and access to health care due to financial and cultural
To a large extent, disparities in health and access
to care among minorities reflect disparities in socioeconomic
status. In fact, according to the Health Resources and
Services Administration, the connection between socioeconomic
status and health disparities is so strong that income
and education levels often serve as proxies for health
status. The fact that minority populations on average
are poorer than whites underlies many health disparities.
Health insurance coverage and access to preventive care play a major
role in determining health outcomes. Uninsured persons are less likely
to seek routine care and may postpone or decline to seek treatment for
health problems. According to a report by the Henry J. Kaiser Family Foundation,
minority Americans are at least twice as likely to be uninsured than whites,
due to disparities in private insurance coverage. At the same time, minorities
are more likely than whites to be insured under Medicaid, which provides
health coverage for low-income Americans.
Although insurance coverage improves access to health care, minority
children have less access to primary medical care than white children,
even after accounting for differences in insurance coverage, according
to the Kaiser Family Foundation Report. Minority children are less likely
to have a usual source of medical care or a specific doctor and are less
likely than white children to seek care for symptoms warranting medical
attention. Inadequate routine and preventive care increases a child’s
incidence and burden of disease.
Over the past 20 years, childhood lead poisoning has declined dramatically
in the United States due to bans on lead in gasoline, paint, food cans,
and other consumer products. However, lead poisoning is still an important
health problem, affecting an estimated 310,000 (1.6 percent) children
ages 1-5, according to analysis
of data from the National Health and Nutrition Examination Surveys (NHANES),
released by the Centers for Disease Control and Prevention. As the numbers
of lead-poisoned children have declined, the disparities of the disease
have become more pronounced.
While lead poisoning crosses all socioeconomic, geographic, and racial
boundaries, the burden of this disease falls disproportionately on low-income
families and families of color living in older, poorly maintained housing.
For example, in the U.S., African-American children are at two times greater
risk than whites, according to the most recent data available on the disparities
of the disease.
For a fact sheet explaining this prevalence and disparity data, click
The prevalence of asthma in the United States has increased dramatically
over recent decades, affecting all racial, ethnic, and age groups. The
risk for asthma appears to be more closely correlated with socioeconomic
status than race. However, even after accounting for socioeconomic differences,
African-American children are twice as likely to have asthma and six times
more likely to die from it than white children, according to a Kaiser
Family Foundation Report.
In a continuing study, researchers at the Harlem Hospital Center, Harlem
Children’s Zone, and the Mailman School of Public Health have found
that 25 percent of Harlem children tested have asthma, the highest rate
ever documented in this country. For Hispanics, prevalence rates are mixed.
For example, the Institute of Medicine reports that Mexican-American children
living in the Southwest have some of the lowest rates of asthma in the
country, while Puerto Rican children living on the East Coast have some
of the highest asthma rates.
Hospitalization for asthma generally is avoidable if the disease is well
managed. In urban, low-income, and minority areas, increases in asthma
hospitalization and mortality rates are especially pronounced. Poverty,
substandard housing, inadequate access to health care, lack of education,
and failure to adequately control asthma with medication all contribute
to asthma episodes and deaths.
In an inner-city asthma study supported by the National Institute of
Allergy and Infectious Diseases (NIAID), researchers found that asthma
was more severe in children who experienced significant barriers to accessing
medical care. The NIAID study also found that when a nurse practitioner
assisted high-risk children and their families in managing the child's
condition and instituting environmental controls, such as the removal
of cockroach allergen from their homes, children experienced a 30 percent
decrease in asthma-related hospitalizations and unscheduled doctor and
emergency room visits. This study indicates that by addressing asthma
triggers in the home and taking aggressive action to ensure that inner-city
children adequately manage the disease, the disparities in hospitalizations
and deaths caused by asthma can be reduced.
Minority populations are both more likely to develop cancer and more
likely to die from the disease than whites. African-American men, for
example, are 20 percent more likely to get cancer than white men, according
to the American Cancer Society. Some specific forms of cancer affect minorities
at rates several times higher than the national average.
Ethnic minorities also experience poorer cancer survival rates than whites.
Like most diseases, cancer treatment is more effective if begun early
in the course of the disease. If preventive medical care is inadequate,
cancer is more likely to be diagnosed at a later stage, when options for
treatment are more limited and the odds for survival reduced. According
to the American Cancer Society, cancer mortality rates are 40 percent
higher for African-American men than white men.
Many of the differences in cancer incidence and mortality
rates likely are due to socioeconomic factors rather
than race or ethnicity. Socioeconomic status bears upon
education, occupation, health insurance, income level,
and living conditions to a greater extent than race.
Each of these factors in turn impacts a person’s
risk of developing and surviving cancer.
Efforts to eliminate health disparities are underway both nationally
and locally. The nation’s Healthy People 2010 agenda seeks to identify
the most significant preventable threats to health and establish national
goals to reduce them. The second of the program’s two overarching
goals is to eliminate health disparities that occur by gender, race or
ethnicity, education or income, disability, geographic location, or sexual
The National Institute of Environmental Health Sciences (NIEHS), part
of the National Institutes of Health, has developed a number of grant
programs to document health disparities and arm policy makers with the
information needed to reduce them. NIEHS and the National Institute of
Allergy and Infectious Diseases have supported several urban asthma studies.
The U.S. Department of Health and Human Services created an Office of
Minority Health in 1985, and the Centers for Disease Control and Prevention
created a similar office in 1988. Many states also have created offices
addressing minority health. The HHS OMH funds health projects conducted
by minority community and national organizations, maintains minority health
consultants in HHS Regional Offices, and operates a Resource Center on
minority health issues. This Office also overseas the Healthy Community
Innovation Initiative, a program designed to prevent asthma and other
diseases through community services, with special attention to eliminating
health disparities. The National Institutes of Health also has a National
Center on Minority Health and Health Disparities to coordinate research,
training, and outreach programs surrounding health disparities. Due to
the strong link between socioeconomic status and health disparities, programs
designed to improve the socioeconomic status of minorities also could
help to reduce health disparities.
Addressing health disparities related to hazards in housing requires
directing attention and resources to the communities at highest risk.
Focusing on properties that pose the greatest health risks, which are
overwhelmingly older, low-income, and in substandard condition, will yield
the greatest improvement in health outcomes and address the striking health
disparities borne by low-income and minority families.
Agency for Healthcare Research and Quality - www.ahrq.gov
American Cancer Society, Cancer Facts & Figures
for African Americans, 2003-2004 - www.cancer.org/downloads/STT/861403.pdf
National Cancer Institute, Center to Reduce Cancer
Health Disparities - http://crchd.nci.nih.gov/
Centers for Disease Control and Prevention, Office
of Minority Health - www.cdc.gov/omh/default.htm
Centers for Disease Control and Prevention, Third
National Report on Human Exposure to Environmental Chemicals
Health Resources and Services Administration - www.hrsa.gov
Henry J. Kaiser Family Foundation, Key Facts: Race,
Ethnicity & Medical Care (1999)
Institute of Medicine, Clearing the Air: Asthma
and Indoor Exposures (2000)
National Institute of Allergy and Infectious Diseases - www.niaid.nih.gov/default.htm
Office of Minority Health, U.S. Department of Health and Human Services