Epilogue

Leandris C. Liburd, PhD1

Vincent A. Campbell, PhD2

Karen E. Bouye, PhD1

1Office of Minority Health and Health Equity, CDC

2National Center on Birth Defects and Developmental Disabilities, CDC

Corresponding author: Leandris C. Liburd, PhD, Office of Minority Health and Health Equity, CDC. Telephone: 770-488-8343; E-mail: lel1@cdc.gov.

As racial and ethnic minorities constitute ever larger percentages of the U.S. population, the overall health statistics of the nation increasingly reflect the health status of these groups (1). Overcoming persistent health and health-care disparities that affect racial/ethnic minorities benefits the entire society. For example, the economic well-being of a nation relies on the health of its populace. According to one report, "The nation's dependence on an increasingly minority workforce means that healthy communities of color are vital to the nation's economic fortunes" (2). Other U.S. population groups, such as persons with disabilities or special health-care needs, persons living in certain geographic locations, and persons with certain sexual identities or sexual orientations, also have higher rates of preventable morbidity and premature death, and efforts should be directed toward improving their health outcomes and eliminating health disparities.

Eliminating disparities in health and health care includes monitoring current disparities, identifying effective interventions, and promoting necessary change. As one example of how disparities affecting population groups other than racial/ethnic minorities are receiving increased attention, the health status of people with disabilities is presented more frequently in descriptive demographic tables in public health reports. Health indicators included in the 2011 and 2013 CDC Health Disparities and Health Inequalities Reports were stratified by disability status (3,4). Many of the descriptive demographic tables in Health, United States, 2012, included comparative data for persons with and without disabilities for a variety of health conditions, health behaviors, health-care access and coverage, and preventive service use (5). Presentation of health indicators by disability status should increase the awareness of public health practitioners and health-care providers of the serious preventable health disparities of this population.

Eliminating disparities and health inequities (i.e., disparities that are systematic, avoidable, and unfair) and improving the health of all groups are overarching goals included in the Healthy People 2020 national public health agenda (6) and a top priority for CDC and the public health community. Eliminating health disparities is also one of four strategic directions of the National Prevention Strategy (7), which was created through the Patient Protection and Affordable Care Act of 2010 (8). The Affordable Care Act and other national policy initiatives create unprecedented opportunities to overcome historical barriers to eliminating health disparities. For example, preventive screenings to test for high blood pressure, high cholesterol, and diabetes are now available at no cost to persons with health insurance. These persons also can be screened for obesity and receive free nutrition counseling and counseling on the use of daily aspirin to reduce their risk for stroke. These screening and education programs are particularly important for black adults, for whom death rates for coronary heart disease and stroke are substantially higher than for non-Hispanic white adults (3,4). Increased access to these preventive screening services might help reduce heart disease and stroke in communities at high risk for these preventable conditions.

CDC supports the implementation, evaluation, and dissemination of public health practices to reduce health disparities. This supplement provides a snapshot of five varied programs that showed evidence of having made a difference and documented similarities that contributed to lessons learned. Building a strong base of intervention science is critical to effectively reducing, and ultimately eliminating, health disparities. The intervention strategies presented here share common elements: targeting population groups with higher risk or poorer outcomes; increasing knowledge and consideration of social, environmental, and behavioral factors that increase risks for negative health outcomes; enhancing community support and engagement; promoting cultural sensitivity and appropriateness; and following principles of program evaluation.

Multiple and intersecting characteristics at the societal, regional, community, family, and individual levels contribute to a population burden of health disparities, including health inequities (9,10). As improvements in data collection enable better identification of health disparities that affect diverse populations, elaboration of conceptual frameworks that inform public health practice, and implementation of population-based strategies toward health equity, health disparities and inequities can be overcome.

References

1. LaVeist T. The ethnic demographic transition. In: LaVeist T, Isaac L, eds. Race, ethnicity, and health. San Francisco: Jossey-Bass;2013:5.
2. Blackwell AG, Kwoh S, Pastor M. Uncommon common ground: race and America's future. New York: WW Norton; 2010.
3. CDC. CDC health disparities and inequalities report—United States, 2011. MMWR 2011;60(Suppl, January 14, 2011).
4. CDC. CDC health disparities and inequalities report—United States, 2013. MMWR 2013;62(Suppl 3).
5. CDC, National Center for Health Statistics. Health, United States, 2012. With special feature on emergency care. Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2013. Available at www.cdc.gov/nchs/data/hus/hus12.pdf.
6. US Department of Health and Human Services. Healthy people 2020. Washington, DC: Available at http://healthypeople.gov/2020.
7. National Prevention Council. National prevention strategy. Washington, DC: US. Department of Health and Human Services, Office of the Surgeon General; 2011. Available at http://www.surgeongeneral.gov/initiatives.
8. Patient Protection and Affordable Care Act, Pub. L. No. 111-148 (March 23, 2010).
9. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health 2006;27:167–8.
10. Braveman P, Gruskin S. Defining equity in health. J. Epidemiol Comm Health 2003;57:254–8.