Disparities in Health and Health Care: The Distinction and Why It Matters Erika Blacksher, PhD Bioethics & Humanities University of Washington October 16, 2013

Objectives Health care disparities vs. health disparities Definitions Causal pathways ... social determinants of health Why the distinction matters

Health Care Disparities Differences in the quality of health care across racial, ethnic, and socioeconomic groups

Health Care Disparities Racial or ethnic differences in the healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention... Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2003.

Health Disparities Differences in the incidence, prevalence, mortality, and burden of disease, illness, and injury that exist among specific population groups in the United States. National Institute on Minority Health and Health Disparities

Health Disparities “A population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates in the population as compared to the health status of the general population.” Minority Health and Health Disparities Research and Education Act United States Public Law 106-525 (2000).

Determinants of Health

Social Determinants of Health ‘the circumstances in which people grow, live, work, and age and the systems put in place to deal with illness ... shaped by political, social and economic forces’ Commission on the Social Determinants of Health (2008) Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report.

Social Determinants of Health Web of personal resources and nested environments: Income, poverty, unemployment Education Wealth Built environment Food environment School/learning environment Housing stock Toxin exposure Health care (geographic proximity, quality, insurance/access) Social support, social capital, social security Racism and discrimination Sexism, misogyny Political environment (vote, voice)

The job of justice has just begun... Why It Matters The job of justice has just begun...

Thank You eb2010@uw.edu