Journal of Health Politics Policy and Law Health Disparities Special Issue
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In the Literature JOURNAL OF HEALTH POLITICS, POLICY AND LAW SPECIAL ISSUE: COMPARATIVE PERSPECTIVES ON HEALTH DISPARITIES Vanessa Northington Gamble, Racial and ethnic disparities in health care Health Care, as an objective, scientific M.D., Ph.D. were the theme of a special issue of the inquiry into multiple causes of disparity. Deborah Stone, Ph.D. Kala Ladenheim, Ph.D. Journal of Health Politics, Policy and Law The report made general recommendations Brian K. Gibbs, Ph.D. (Feb. 2006), which includes four articles about restructuring health care delivery et al. supported by The Commonwealth Fund. without assigning responsibility to specific Journal of Health Politics, Rather than simply describing the problem actors or agencies. Yet, the report carries Policy and Law of racial disparities in health care, the au- the imprimatur of scientific evidence and February 2006 thors attempt to refocus policy discussion may inspire action within the care delivery 31(1) on finding solutions, including efforts now system. under way at the state and local level. Abstracts are available at: The authors conclude that, to maximize http://jhppl.yale.edu/current/ abstracts311.html From Research to Action impact, researchers should focus on inter- Writer and civil rights activist W. E. B. vention strategies; investigate the control- For more information about Dubois documented racial inequalities in lable causes of disparities, such as institu- this study, contact: health as early as 1906. A century later, such tional rules; target political actors who have Mary Mahon disparities still persist. In “U.S. Policy on the authority to make changes; and be Public Information Officer Health Inequities: The Interplay of Politics willing to use moral language to fuel po- The Commonwealth Fund and Research,” Vanessa Northington TEL 212-606-3853 litical will. E-MAIL [email protected] Gamble, M.D., Ph.D., of Tuskegee Uni- versity, and Deborah Stone, Ph.D., of State Policy Framework Dartmouth College, argue that social prob- In an additional article in the issue— lems do not become policy priorities just “Reframing the Racial Disparities Issue because research demonstrates they exist. for State Governments”—Stone proposes a way for state policymakers to catalyze Whether research catalyzes political action political action. depends to some extent on how it is pre- sented. The U.S. Commission on Civil The “story” of racial and ethnic health dis- This summary was prepared Rights’ 1999 report, The Health Care Chal- parities is complex, she contends. There are by Martha Hostetter and lenge: Acknowledging Disparity, Confronting disparities in terms of health status, insur- Deborah Lorber. Discrimination and Ensuring Equality, framed ance, and medical care, with evidence Commonwealth Fund Pub. #921 disparities in terms of discrimination and pointing to complex, interlocking causes. April 2006 recommended addressing them through Stone argues that the most compelling way In the Literature presents brief stronger enforcement of existing legislation. for policymakers to frame the issue is in summaries of Commonwealth Fund–supported research recently The authors note that, while potent, this terms of distributive justice, in which medi- pub-lished in professional journals. approach depends on the will of the execu- cal care should be distributed according to THE COMMONWEALTH FUND tive branch. need. Although health care is often dis- ONE EAST 75TH STREET cussed and provided as a market good, NEW YORK, NY 10021-2692 TEL 212.606.3800 By comparison, the Institute of Medicine many Americans believe that medical FAX 212.606.3500 framed its 2002 report, Unequal Treatment: treatment is essential to well-being, rather E-MAIL [email protected] http://www.cmwf.org Confronting Racial and Ethnic Disparities in than an optional consumer good. Framing the issue of racial disparities in this way—that share lessons across the nation. In “Reducing Racial is, as a deviation from medical need, rather than a result and Ethnic Health Disparities: Exploring an Outcome- of racial and ethnic bias—could defuse some of the ex- Oriented Agenda for Research and Policy,” Brian K. plosive energy associated with racial politics, Stone says. Gibbs, Ph.D., of the Harvard School of Public Health, and colleagues argue that standard variables are needed Under the framework of distributive justice, state poli- to measure the efficacy of disparities reduction initiatives. cymakers could use their power over public health in- formation to reveal patterns of injustice or examine Specifically, the authors propose the use of a disparity how health care financing policies cause inappropriate reduction profile (DRP) and a disparity index (DI). distribution of medical services. They suggest modeling the DRP, intended to measure state efforts to reduce disparities, on the AIDS Program State Legislative Actions Effort Index. The DRP could take into account organ- In “State Legislative Activities Related to Elimination izational structure, policy and planning, the legal and of Health Disparities,” Kala Ladenheim, Ph.D., and regulatory environment, and monitoring and research. Rachel Groman, M.P.H., of the National Conference of State Legislatures, examine the trends in state legisla- The DI, a set of 18 health status indicators developed by tion related to disparities in care and access and find the Centers for Disease Control and Prevention, could that the mix of strategies reflects the differing ways that be used to track changes in racial and ethnic health dis- states understand gaps in minority health. parities. In pilot tests in California, Massachusetts, Michi- gan, and Mississippi, use of the index in this way showed Disease- and population-specific legislation was the ear- considerable promise as well as some limitations. liest type of activity, and continues to be an important approach. Prior to 2001, the creation of an Office of Such an outcome-oriented approach to addressing ra- Minority Health was the most common type of legisla- cial and ethnic health disparities, the authors argue, tion aimed at reducing disparities. Other laws in the would move “beyond ‘doing something’ to ensuring 1990s focused on making care available and affordable, that proposed efforts have an impact on improved as well as recruiting minority health care personnel. health status.” During the 2001–02 legislative session, many bills called for studies of disparities and appropriations for specific Facts and Figures minority health initiatives. Measures related to cultural competence also were common. • Racial and ethnic disparities exist in numerous areas of diagnosis, treatment, and preventive In addition to allocating resources and setting policy, care, even when income, insurance status, and policymakers use state legislatures to educate their other socioeconomic factors are held constant. peers, health care providers, and the public about racial and ethnic health disparities. • Historically, California, Florida, and Louisiana— all states with substantial minority populations— Measuring Success have been the most active in dealing with mi- The variation among states’ efforts to reduce health dispari- nority health issues through statutes. ties makes it difficult to compare their effectiveness and .