Pillars of health disparities Science


December 21, 2023

NIMHD leaders discuss the pillars of health disparities science in a viewpoint published in JAMA Health Forum

Research on health disparities is critical to achieving optimal health for all communities and should continue to focus on the two major determinants of health: race and ethnicity and socioeconomic status (SES). That’s according to a new perspective from Eliseo J. Pérez-Stable, MD, director of the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health, and Monica Webb Hooper, Ph.D. Deputy Director of NIMHD. They emphasize that these pillars of health disparities science are fundamental to addressing the root causes of health disparities and implementing evidence-based interventions to promote health equity. Their point of view appeared today in JAMA Health Forum.

Drs. Pérez-Stable and Webb Hooper note that recent studies supported by NIMHD highlight the importance of both pillars. County-level analyzes of life expectancy in the United States found that while life expectancy had improved in the 20 years preceding the COVID-19 pandemic, there were widespread gaps among racial and ethnic populations with geographic disparities. Another study, providing national and state-level estimates of the economic burden of health care disparities, found that the societal cost of health care disparities, as measured by excess medical care costs, lost labor productivity, and premature death, cost the U.S. economy states $978 billion for people without college in 2018*

Given this staggering economic cost—and the significant role these pillars play in exposure to discrimination, the quality of health care, and overall living conditions—the authors point to an urgent need to identify and address the mechanisms through which disparities exist. health. They also indicate the range of cross-sectoral factors that influence health disparities. Intersectionality recognizes that individuals have multiple interrelated social identities (eg, gender, race and ethnicity, SES, and sexual orientation) that intersect with other demographic factors and all clinical settings to shape their unique experiences and positions in society.

“Integrating intersectorism into the science of health disparities provides a meaningful framework upon which to deepen understanding of these issues,” the researchers wrote in their commentary. “Recognizing the importance of the interrelationship with race and ethnicity and/or SES is essential to understanding the unique challenges faced by other populations identified as experiencing health disparities and all individuals with a diagnosed condition.”

In the view Drs. Pérez-Stable and Webb Hooper describe the founding of NIMHD and its predecessors as an outgrowth of the 1985 report of the Secretary’s Task Force on Black and Minority Health and the congressional mandate to the institute to improve the health of all racial and ethnic minority groups and SES disadvantaged individuals. NIMHD strongly recommends measuring race and ethnicity and SES using standardized questions to facilitate analyzes of these two pillars in all studies involving humans.

Focusing the science of health disparities on race and ethnicity and SES, anchored in principles of equity and inclusion, can help achieve health equity for all, the authors conclude.

*In 2018, the total burden of racial and ethnic health disparities was $451 billion, about 2% of United States gross domestic product (GDP). When measured by education-related health disparities, the economic burden is $978 billion and $2,988 per person. At about 5% of US GDP, this is 2 times the annual growth rate of the economy in 2018.

The page was published on December 21, 2023

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