Health Disparities

This social work research web page focus on Health Disparities provides references to access additional information on health disparities research agendas as well as selected publication references in which research findings are presented and/or research agendas are identified. Included is information related to federal legislation mandating attention to disparities in the public's health, the National Institutes of Health's efforts to support research in this area, and some examples of the social work profession's research endeavors in this area.

Health disparities are defined in the NIH Strategic Research Plan to Reduce and Ultimately Eliminate Health Disparities Fiscal Years 2002-2006 as: “…differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. Research on health disparities related to socio-economic status is also encompassed in the definition.” (p.4)

Social workers have long been engaged in research related to health disparities and the particular attributes and needs of various populations defined by culture or socio-economic status. Indeed, the interplay between health and economic status and access to health care has been the subject of social work research and special issues in social work-related journals in recent years.

PUBLIC CALL FOR RESEARCH ON HEALTH DISPARITIES

The Minority Health and Health Disparities Research and Education Act of 2000 (PL-106-525) amended the Public Health Service Act "to improve the health of minority individuals." The act directed the National Academies of Science (NAS) to "conduct a comprehensive study of the Department of Health and Human Services´ data collection systems and practices, and any data collection or reporting systems required under any of the programs or activities of the Department, relating to the collection of data on race or ethnicity, including other Federal data collection systems (such as the Social Security Administration) with which the Department interacts to collect relevant data on race and ethnicity.. [and] prepare and submit ..a report that (1) identifies the data needed to support efforts to evaluate the effects of socioeconomic status, race and ethnicity on access to health care and other services and on disparity in health and other social outcomes and the data needed to enforce existing protections for equal access to health care; and (2) examines the effectiveness of the systems and practices of the Department of Health and Human Services described in subsection (a), including pilot and demonstration projects of the Department, and the effectiveness of selected systems and practices of other Federal, State, and tribal agencies and the private sector, in collecting and analyzing such data. Two reports pursuant to that directive can be found through the NAS website:

• Eliminating Health Disparities: Measurement and Data Needs. 2004.
  Michele Ver Ploeg and Edward Perrin, Editors, Panel on DHHS Collection of Race and Ethnic Data, National Research Council. http://books.nap.edu/catalog/10979.html
• Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. 2003.
  Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, Editors, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care.
  http://books.nap.edu/catalog/10260.html

back to top

NATIONAL INSTITUTES OF HEALTH FOCUS ON HEALTH DISPARITIES RESEARCH

The National Institutes of Health's National Center for Minority Health and Health Disparities was created as a result of P.L.106-525. Also, NIH has embarked upon the development of health disparities strategies within each Institute or Center (IC) in recognition of the importance of tending to this particular dynamic in the public's health. A number of related NIH web pages include:

NIH HEALTH DISPARITIES STRATEGIC PLANS

NIH Strategic Plan for Health Disparities Research
www.obssr.od.nih.gov/Activities/HealthDisp.htm

National Center for Minority Health and Health Disparities
http://ncmhd.nih.gov/

National Cancer Institute Strategic Plan and Budget to Reduce and Ultimately Eliminate Health Disparities
www.crchd.nci.nih.gov/pdf/Strategic_Plan_and_Budget.pdf

National Institute on Aging Strategic Plan to Address Health Disparities
www.nia.nih.gov/strat-planhd/2000-2005/6.htm

National Institute on Drug Abuse Strategic Plan on Reducing Health Disparities
www.drugabuse.gov/StrategicPlan/HealthStratPlan.html

National Human Genome Research Institute's Strategic Plan for Reducing Health Disparities.
www.nhgri.nih.gov/10001493

Office of Research on Women's Health
http://www4.od.nih.gov/orwh/disparities.pdf

NIH Funding Opportunities Related to Health Disparities

Advanced Centers for Mental Health Disparities Research (Acmhdr)
http://grants2.nih.gov/grants/guide/pa-files/PAR-04-060.html

Community-Partnered Interventions to Reduce Health Disparities
http://grants2.nih.gov/grants/guide/pa-files/PA-02-134.html

Related NIH Resources

NIH Plan for Social Work Research
www.obssr.od.nih.gov/Publications/SWR_Report.pdf

NIH Health Disparities Research Abstracts - DERT
Health Disparity Research Programs in the Division of Extramural Research and Training at the National Institute of Environmental Health Sciences (NIEHS).
www.niehs.nih.gov/translat/hd/awardees.htm

back to top

SOCIAL WORK RESEARCH RELATED TO HEALTH DISPARITIES

The following references are examples of research or research agenda setting related to health disparities. Most of the authors are social workers or have affiliation with social work programs. The references were gathered via Social Work Abstracts online webspirs search.

Selected Research Abstracts

Research Agenda Setting

Promoting minority health research at the National Institutes of Health.
Ruffin-J. Office of Research on Minority Health, National Institutes of Health, Bethesda , MD
Journal-of-Mental-Health-and-Aging. 6 (1): 19-20, Spring 2000.

This commentary reviews efforts of the Office of Research on Minority Health (ORMH) at the National Institutes of Health (NIH) in partnership with the National Institute on Aging, to redress disparities in health among minority populations. The ORMH works in partnership with the

scientists and program administrators in the NIH institutes, centers, and other federal agencies in support of its Minority Health Initiative (MHI).The MHI was launched in 1992 and is the rubric under which a series of multiyear biomedical and behavioral research studies and a set of training programs is being funded. (This is one of three commentaries and seven articles on recruiting and retaining minority groups in research on health promotion.).

Research based articles, organized in descending order by year and then by first author name.

The effect of partner characteristics on HIV infection among African American men who have sex with men in the Young Men's Survey, Los Angeles, 1999-2000.
Bingham-T.A; Harawa-N.T; Johnson-D.F; Secura-G.M; MacKellar-D.A; Valleroy - L.A.
AIDS-Education-and-Prevention. 15 (1): 39-52, Supplement A, 2003.

In this analysis of data collected for the 1999 -2000 Los Angeles Young Men's Survey, a cross-sectional venue-based survey of MSM aged 23-29, the authors investigated whether information on male sex-partner characteristics accounts for some of the racial/ethnic differences in HIV prevalence. In this sample of survey participants, it was observed that African American MSM reported similar or lower levels of HIV risk behaviors compared with white MSM but much higher HIV prevalence (26% vs. 7.4%, respectively). In an unadjusted logistic regression model, African American participants had 4.4 times higher odds of HIV infection compared with white participants. Study findings suggest that differences in male partner types, namely older and African American partners, may account for some of the observed racial disparity in HIV infection, especially for African American MSM compared with white MSM in Los Angeles . (This is one of 11 articles in this special issue on HIV prevention for men of color who have sex with men and with women.).

The effects of socioeconomic status, perceived discrimination and mastery on health status in a youth cohort.
Caputo-R.K. Social-Work-in-Health-Care. 37 (2): 17-42, 2003.

This study examined the influence of socioeconomic status (SES), perceived discrimination, and sense of mastery over one's life on the health status of a sub-sample of a US cohort of youth (N = 969). When controlling for a variety of social characteristics and personal attributes, only sense of mastery over one's life, measured by the Pearlin Mastery Scale, affected physical and mental health statuses. Perceived discrimination affected only mental health status, while SES over the life course affected only physical health. Findings affirmed the efforts of professions like social work that stress self-determination and empowerment enabling individuals to enhance their own social functioning and improve conditions in their communities and in society at large. They also suggested that in regard to mental health advocacy, efforts to decrease health disparities can find social justice related grounds based on gender.

Disparities in women's health and health care experiences in the United States and Israel : findings from 1998 national women's health surveys.
Schoen-C; Simantov-E; Gross-R; Brammli-S; Leiman-J. Women-and-Health. 37 (1): 49-70, 2003.

Using data from bi-national 1998 surveys of adult women in the U.S. and in Israel , this article examines health, access, and care experiences among women in two countries with very different health care systems. The authors examine how well each country's system serves those vulnerable due to lower socioeconomic status. The Israeli health care system---characterized by universal coverage for all its residents--relies on a system of competing health funds that employ many features typical of U.S. managed care plans. The findings indicated that achieving more equitable access to health care requires attention to non-financial as well as financial barriers to care. The finding that disparities in health persist in a country with universal coverage indicated that improving women's health will require attention to broader social influences on health as well as improving access to health care.

Methodological issues in conducting community-based health and social services research among urban Black and African American LGBT populations.
Wheeler-D.P. Journal-of-Gay-and-Lesbian-Social-Services. 15 (1/2): 65-78, 2003.

In this article the author examines factors affecting research with urban black and African American LGBT populations. A brief case study is included that demonstrates the viability of the recommended research methods and discusses the possible negative consequences of deviating from these methodological suggestions.

Motivated but fearful: welfare reform, disability, and race.
Crewe-S.E. Journal-of-Health-and-Social-Policy. 16 (1/2): 55-68, 2002.

This article uses findings from a research study to discuss barriers faced by individuals with physical disabilities who are forced to find work under welfare reform. It highlights the experiences of African Americans who have the added burden of health disparities because of discriminatory and differential practices in diagnoses, treatment, access, and utilization. It also presents practice implications. (This is one of 16 articles in this special issue on disability and the black community.)

100% access, zero health disparities, and GIS: an improved methodology for designating health professions shortage areas.
Juarez-P.D; Robinson-P.L; Matthews-Juarez-P. Journal-of-Health-and-Social-Policy. 16 (1/2): 155-167, 2002.

The purpose of this paper was to explore the utility of Geographic Information Systems (GIS) technology as an improved methodology for obtaining HPSA designation status for geographic areas. Results showed that GIS identified 24 Medical Services Study Areas (rational planning areas) in Los Angeles County that met the minimum 3,500:1 population-to-primary-care physician ratio for geographic area HPSA designation compared to only three that currently are identified. Authors concluded that restructuring of the state/county responsibilities for HPSA designation is long overdue and that use of GIS as a required methodology would help ensure that all areas in any state that meet the intent of federal legislation are included.

Low birthweight: do unwed fathers help?
Padilla-Y.C; Reichman-N.E. Children-and-Youth-Services-Review. 23 (4/5): 427-452, Apr./May 2001.

Previous studies have revealed that marital status is an important predictor of birth outcomes, with unmarried mothers having a higher probability than married mothers of delivering low birth weight babies. In this study, the authors used the sample of unwed parents in the seven-cities baseline Fragile Families and Child Wellbeing Study data to examine the effects of parents' relationship status and support provided by the baby's father during pregnancy on the likelihood of delivering a low birth-weight baby, and to examine whether father involvement explains racial and ethnic disparities in low birth weight. A major contribution of the study is that it used rich new data to examine birth outcomes in a population at high risk-unmarried mothers-and incorporates measures such a parents' relationship status and father's financial support, along with an extensive set of demographic, social, and behavioral risk factors. (This is one of six articles in this special issue on fragile families and welfare reform.)

Disparities in hormone replacement therapy use by socioeconomic status in a primary care population.
Finley-C; Gregg-E.W; Solomon-L.J; Gay-E. Journal-of-Community-Health. 26 (1): 39-50, Feb. 2001.

The use of hormone replacement therapy (HRT) is a controversial decision for many women, yet few studies have evaluated the sociodemographic, psychological, and behavioral correlates of HRT use. This cross-sectional, mailed survey evaluated the associations of socioeconomic status, preventive health behaviors, knowledge and perceptions about HRT-related risks and benefits with HRT use among 428 women 50-70 years old in Vermont . Women of moderate to high income were three times more likely than those of low income to use HRT. A recommendation by a health care provider is a powerful predictor of HRT use, but disparities in use exist by socioeconomic status. Future research should examine why lower income women are less likely to use HRT and whether the discrepancy is due to inconsistent recommendations by health care providers.

AIDS: the development of a gender appropriate research intervention.
Goicoechea-Balbona-A; Barnaby-C; Ellis-I; Foxworth-V. Social-Work-in-Health-Care. 30 (3): 19-37, 2000.

This study is part of an AIDS research-service project, implemented by a faculty member and graduate students from the University of Maryland , School of Social Work . It focuses on the last of the completed studies between 1993 and 1998. This study explores demographic factors, method of contraction, symptoms, initial reactions, support systems, level of satisfaction and frustration with services, physical health-care needs, social service needs, including legal, housing, financial and mental health needs of women living with HIV/AIDS. The literature search reaffirmed the gender related disparities of services offered found by the team in the field.

Leadership/citizen participation: perceived impact of advocacy activities by people with physical disabilities on access to health care, attendant care and social services.
Jurkowski-E., Jovanovic-B.,& Rowitz-L. Journal-of-Health-and-Social-Policy, 14 ,(4): 49-60, 2000.

This study looked at the perceive impact of leadership and participation by people with physical disabilities and at their ability to gain increased access to health care, attendant care, and social services. Findings suggest that those who participated in advocacy activities were significantly more likely to feel that their action improved access to health care resources, attendant care resources, and social services. This study highlights the value of consumer/citizen participation and the vital role this action can play in collaboration with social work professionals for system changes, health resource planning and policy development,

Disparities in health indicators for Latinas in California.
Baezconde-Garbanati-L; Portillo-C.J; Garbanati-J.A. Hispanic-Journal-of-Behavioral-Sciences. 21 (3): 302-329, Aug. 1999.

This study analyzes disparities in selected health indicators for Latinas when compared to non-Latina whites, and other population groups in the United States , and as available in Mexico . A review and secondary analyses of government and other data were conducted as an extension of previous research. Data revealed that the population of Latinas, although youthful on average, are composed of an increasingly large group of poor women who in their middle years (45-64), and in rural communities, display high cardiac risk, high rates of diabetes, and cervical cancer. Further research, policies that protect women's health, and culturally competent prevention services are needed to address these health disparities and the complexities of Latina health in California .

Health care needs of medically underserved women of color: the role of the bureau of primary health care.
Gaston-M.H; Barrett-S.E; Johnson-T.L; Epstein-L.G. Health-and-Social-Work. 23 (2): 86-95, May 1998.

The Bureau of Primary Health Care (BPHC) was developed to increase access to comprehensive primary and preventive health care and to improve the health status of medically underserved populations. One of the newest initiatives of BPHC is the Office of Minority and Women's Health, developed with a mission to help reduce the disparities in the health status of women of racial and ethnic minority populations. This study outlines these disparities and discusses proposals for reducing them.

Patterns of hospital and physician utilization among the uninsured.
Hafner-Eaton-C. Journal-of-Health-Care-for-the-Poor-and-Underserved. 5 (4): 297-315, 1994.

Despite numerous studies of access to care by the uninsured, few researchers have examined whether access to hospitals among the uninsured differs from access to physicians. This study employed a correlational, two-group design (n = 102,055) to analyze cross-sectional data from the 1989 National Health Interview Survey. Multiple logistic regression was used to compare the likelihood of hospitalization for the uninsured and insured in chronically ill, acutely ill, and well nonelderly subpopulations. When compared to data from a previous study on physician visits, disparities in hospitalization among the three subgroups differed in both magnitude and relative order from disparities in physician visits. These findings suggest that the uninsured face even greater access barriers for hospitalization than they do for physician care.

Racial differences in AIDS knowledge among adults.
Peruga-A; Rivo-M.. AIDS-Education-and-Prevention. 4 (1): 52-60, Spring 1992.

Adults 18 to 65 years of age (N = 1,237) were interviewed by telephone to explore differences in AIDS knowledge between black and white Americans. Adjusted odds ratios were calculated to determine the association between race and AIDS knowledge. Results show no discrepancies between black and white respondents in the level of knowledge about proved HIV transmission

modes. Racial differences in the level of knowledge of preventive measures are due primarily to differences in educational attainment and not to race. However, lack of awareness of the difference between asymptomatic individuals infected with HIV and persons with AIDS remained significantly higher for black than for white respondents after adjustment for educational attainment.

At risk: health needs of Hispanic children.
Guendelman-S. Health-and-Social-Work. 10 (3): 183-90, 1985.

Cultural, psychological, and economic factors interact to jeopardize the health and educational development of Hispanic children. Eight risk factors that contribute to health problems are large family size, inadequate prenatal visits, a high rate of births to unmarried women, low educational attainment of mothers and heads of families, low family income, inadequate insurance coverage, language and cultural barriers, and low value placed on preventive care. Knowledge of these risk factors helps social workers make more accurate psychosocial assessments of Hispanic families and points to programs that must be developed to keep pace with the needs of the growing Hispanic population and to reduce disparities in health status and use of services with other ethnic groups. A high priority is the implementation of primary care services that monitor children's health from the prenatal state through adolescence. Particularly warranted by the high fertility rates are primary care programs that address perinatal problems with a host of bicultural and bilingual ancillary services.

back to top