health disparities thesis

Reducing Racial Disparities in Health Services Use: Exploring the Role of Racial Equity Training for Nurse Navigators and Improved Measurement of Trust in Health Care

Add to collection, downloadable content.

Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Background. Black patients are less likely than White patients to receive treatment for lung cancer, the leading cause of cancer death in the U.S. Mistrust of health care providers and systems contributes to disparities in several health services use outcomes, including receipt of lung cancer treatment. Little is known about effective trust-related interventions, in part, because trust is hard to measure. This dissertation explored two areas for reducing health services use disparities: 1) evaluating an intervention to increase equitable receipt of lung cancer treatment and 2) improving trust measurement. Study 1. Nurse navigators trained to help patients overcome barriers to receiving lung cancer surgery may reduce treatment disparities, especially if they receive racial equity training (RET). RET offers a foundation for understanding barriers like medical mistrust that may be affected by patient experiences with racism. Yet, little is known about whether navigator RET increases lung cancer surgery receipt. Study 1 explored this gap using data from a trial where patients with early stage lung cancer were randomized to groups paired with navigators who did or did not receive RET (n=229). Results suggest that RET was not associated with the primary outcome. Study 2. Systematic reviews suggest the need to develop updated trust measures that are multidimensional and pilot tested using qualitative methods. In Study 2, I developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care System (T-HCS) scales. After obtaining expert feedback and conducting cognitive interviews (n=21), I used an online survey (n=801) to assess scale reliability and validity. Confirmatory factor analysis suggested acceptable model fit for second order latent factor models for each scale. Each scale required an 8th grade reading level or less, was significantly correlated with existing trust measures and perceived racism in health care, and was associated with health services use. Conclusions. Future studies should explore how RET is associated with other outcomes that affect health services use (e.g., trust in doctors). In such studies where trust is the main outcome, the T-MD, T-DiG, and T-HCS are measurement options with sound psychometric properties.
Lung Cancer
Public health
Health Services Use
Racial disparities
Trust in Health Care
Medical Mistrust
Health Equity
https://doi.org/10.17615/jwwv-zt91
Dissertation
Ribisl, Kurt M
Boynton, Marcella
Muessig, Kathryn E
Cykert, Samuel
Ozawa, Sachiko
Doctor of Philosophy
University of North Carolina at Chapel Hill Graduate School

This work has no parents.

Thumbnail	Title	Date Uploaded	Visibility	Actions
		2020-08-17	Public
		2020-08-17	Public

Select type of work

Master's papers.

Deposit your masters paper, project or other capstone work. Theses will be sent to the CDR automatically via ProQuest and do not need to be deposited.

Scholarly Articles and Book Chapters

Deposit a peer-reviewed article or book chapter. If you would like to deposit a poster, presentation, conference paper or white paper, use the “Scholarly Works” deposit form.

Undergraduate Honors Theses

Deposit your senior honors thesis.

Scholarly Journal, Newsletter or Book

Deposit a complete issue of a scholarly journal, newsletter or book. If you would like to deposit an article or book chapter, use the “Scholarly Articles and Book Chapters” deposit option.

Deposit your dataset. Datasets may be associated with an article or deposited separately.

Deposit your 3D objects, audio, images or video.

Poster, Presentation, Protocol or Paper

Deposit scholarly works such as posters, presentations, research protocols, conference papers or white papers. If you would like to deposit a peer-reviewed article or book chapter, use the “Scholarly Articles and Book Chapters” deposit option.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
My Bibliography
Collections
Citation manager

Save citation to file

Email citation, add to collections.

Create a new collection
Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

Search in PubMed
Search in NLM Catalog
Add to Search

Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity

Affiliations.

1 Center for Social Justice and Health Equity, Department of Emergency Medicine, Boston, Massachusetts.
2 Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
3 Tampa General Hospital, Tampa, Florida.
4 University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California.
5 University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington.
6 Washington State Department of Health, Tumwater, Washington.
7 Samford University, Moffett & Sanders School of Nursing, Birmingham, Alabama.
8 Trinity Health Ann Arbor Hospital, Department of Emergency Medicine, Ypsilanti, Michigan.
9 Yale University, Yale School of Public Health, New Haven, Connecticut.
10 University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas.
11 Ronald Reagan-UCLA Medical Center and David Geffen School of Medicine at University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California.
PMID: 37788031
PMCID: PMC10527840
DOI: 10.5811/westjem.58408

An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b) through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Publication types

Search in MeSH

Related information

Linkout - more resources, full text sources.

Europe PubMed Central
PubMed Central

Research Materials

NCI CPTC Antibody Characterization Program
Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

View all journals
Explore content
About the journal
Publish with us
Sign up for alerts
Published: 11 March 2021

Racism: a fundamental driver of racial disparities in health-care quality

Camila M. Mateo 1 , 2 &
David R. Williams ORCID: orcid.org/0000-0002-8654-6228 3 , 4

Nature Reviews Disease Primers volume 7 , Article number: 20 ( 2021 ) Cite this article

2899 Accesses

49 Citations

40 Altmetric

Metrics details

Health occupations
Public health

Racial disparities in health-care access, quality and outcomes are pervasive and persistent. Racism is a fundamental driver of racial disparities. Individuals and institutions in the health-care system must prioritize addressing racism as their professional responsibility through training, support and inclusion.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Power calculation for detecting interaction effect in cross-sectional stepped-wedge cluster randomized trials: an important tool for disparity research

, Asem Berkalieva
… Deukwoo Kwon

BMC Medical Research Methodology Open Access 02 March 2024

Racial Concordance on Healthcare Use within Hispanic Population Subgroups

, Jason Campbell
… Mindy Ma

Journal of Racial and Ethnic Health Disparities Open Access 21 July 2023

Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa

Emily B. Barko
& Sara M. Moorman

Journal of Eating Disorders Open Access 31 January 2023

Access options

Access Nature and 54 other Nature Portfolio journals

Get Nature+, our best-value online-access subscription

24,99 € / 30 days

cancel any time

Subscribe to this journal

Receive 1 digital issues and online access to articles

111,21 € per year

only 111,21 € per issue

Buy this article

Purchase on SpringerLink
Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

2018 National Healthcare Quality and Disparities Report. AHRQ . https://www.ahrq.gov/research/findings/nhqrdr/nhqdr18/index.html (2019).

Smith, K. A., Gehricke, J.-G., Iadarola, S., Wolfe, A. & Kuhlthau, K. A. Disparities in service use among children with autism: a systematic review. Pediatrics 145 , S35–S46 (2020).

Article Google Scholar

Singh, J. A., Lu, X., Rosenthal, G. E., Ibrahim, S. & Cram, P. Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data. Ann. Rheum. Dis. 73 , 2107–2115 (2014).

Lam, M. B. et al. Changes in racial disparities in mortality after cancer surgery in the US, 2007-2016. JAMA Netw. Open 3 , e2027415 (2020).

Mateo, C. M. & Williams, D. R. Addressing bias & reducing discrimination: the professional responsibility of healthcare providers. Acad. Med. 95 , S5–S10 (2020).

Williams, D. R., Mohammed, S. A., Leavell, J. & Collins, C. Race, socioeconomic status and health: complexities, ongoing challenges and research opportunities. Ann. N. Y. Acad. Sci. 1186 , 69–101 (2010).

Mateo, C. M. & Williams, D. R. More than words: a vision to address bias and reduce discrimination in the health professions learning environment. Acad. Med. 95 , S169–S177.

Williams, D. R., Lawrence, J. A. & Davis, B. A. Racism and health: evidence and needed research. Annu. Rev. Public Health. 40 , 105–125 (2019).

White, K., Haas, J. S. & Williams, D. R. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res. 43 , 1278–1299 (2012).

Boyd, R. W., Lindo, E. G., Weeks, L. D. & McLemore, M. R. On racism: a new standard for publishing on racial health inequities. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/ (2020).

Download references

Author information

Authors and affiliations.

Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA

Camila M. Mateo

Harvard Medical School, Boston, MA, USA

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

David R. Williams

Department of African and African American Studies, Harvard University, Cambridge, MA, USA

You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David R. Williams .

Ethics declarations

Competing interests.

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article.

Mateo, C.M., Williams, D.R. Racism: a fundamental driver of racial disparities in health-care quality. Nat Rev Dis Primers 7 , 20 (2021). https://doi.org/10.1038/s41572-021-00258-1

Download citation

Accepted : 19 February 2021

Published : 11 March 2021

DOI : https://doi.org/10.1038/s41572-021-00258-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

This article is cited by

Asem Berkalieva
Deukwoo Kwon

BMC Medical Research Methodology (2024)

Change the People or Change the Policy? On the Moral Education of Antiracists

Daniel Kelly
Michael Brownstein

Ethical Theory and Moral Practice (2024)

Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009–2014

Michael William Flores
Brian Mullin
Benjamin Lê Cook

Journal of Racial and Ethnic Health Disparities (2024)

Racial Disparities in Opioid Administration Practices Among Undifferentiated Abdominal Pain Patients in the Emergency Department

Abbey Sidebottom
David Watson
Jason Campbell

Quick links

Explore articles by subject
Guide to authors
Editorial policies

< Previous

Home > Public Health > IPH_THESES > 761

Public Health Theses

Examining health disparities related to foodborne illnesses across racial and ethnic groups.

Reese Tierney Follow

Author ORCID Identifier

https://orcid.org/0000-0001-5896-664X

Date of Award

Degree type, degree name.

Master of Public Health (MPH)

Public Health

First Advisor

Dr. Christine Stauber, PhD

Second Advisor

Dr. Erica Rose, PhD

Third Advisor

Dr. Daniel Weller, PhD

INTRODUCTION: Over the past decade, changes to surveillance systems and increased research studies examining health inequities across foodborne illnesses have created a new opportunity for additional research on this topic. There is a growing interest in using this lens to understand foodborne illness in the United States and the inclusion of variables such as race and ethnicity in active surveillance systems can help.

AIM: The purpose of this thesis was to identify current trends of documenting disparities of foodborne illness across populations and evaluate the mechanism of data representations through a literature review. To further explore the topics identified in the literature review, an analysis of salmonellosis data on the county level was conducted.

METHODS: The literature review was conducted as a pseudo-systematic review with the use of keywords and a restricted year timeline. For the salmonellosis analyses, the Laboratory-based Enteric Disease Surveillance (LEDS) system dataset was aggregated to the county-level for each year between 1997 and 2018, and joined with relevant metadata, including census data on race and ethnicity, CDC data on county urbanicity and social vulnerability indices (SVI), and USDA data on food environment.

RESULTS: Disparities of foodborne illnesses across racial and minority populations are prevalent across studies included in the literature review. Of the 35 studies reviewed, methods of racial and ethnic representation were inconsistent throughout with practices of collapsing and removal of different minority and ethnic groupings due to low numbers. The salmonellosis analysis found disparities of geometric mean salmonellosis incidence across both social vulnerability index themes and food insecurity variables when examined across levels of urbanicity.

DISCUSSION: Evidence of disparities in the burden of foodborne illnesses are prevalent in literature. The categorization of race and ethnicity is inconsistent across studies which may cause misrepresentation of these disparities. Understanding the influence of these socioeconomic, geographical, and environmental factors on the incidence of salmonellosis may help us understand the reason for differences in burden across populations with different community demographics.

https://doi.org/10.57709/28913861

Recommended Citation

Tierney, Reese, "Examining Health Disparities Related to Foodborne Illnesses Across Racial and Ethnic Groups." Thesis, Georgia State University, 2022. doi: https://doi.org/10.57709/28913861

File Upload Confirmation

Since April 29, 2022

Advanced Search

Notify me via email or RSS
Collections
Disciplines
Submit ETD (Thesis/Dissertation)

Home | About | FAQ | My Account | Accessibility Statement

Privacy Copyright

ScholarsArchive@OSU

Disparities in health outcomes and health care access : a quantitative intersectional approach.

Are you sure you want to send a request to delete this work? Your request will be reviewed and you will receive an email when it's processed.

Downloadable Content

Descriptions

Attribute Name	Values
Creator
Abstract
License
Resource Type
Date Issued
Degree Level
Degree Name
Degree Field
Degree Grantor
Commencement Year
Advisor
Committee Member
Academic Affiliation
Non-Academic Affiliation
Subject
Rights Statement
Publisher
Peer Reviewed
Language
Replaces
Embargo date range

HHS Awards $11.6 Million to Address Disparities in Healthy People 2030 Leading Health Indicators

September 3, 2024

Washington, D.C. — Today, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) announced $11.6 million in grant awards to 20 organizations for its Community Level Innovations for Improving Health Outcomes Initiative. The awards will support a four-year initiative to identify community level innovations that increase the use of preventive health services with a goal of reducing health disparities – differences in health status among people in certain racial, ethnic, and Tribal communities. Health disparities are often related to social determinants of health (SDOH) .

The Initiative is focused on making progress toward Leading Health Indicator (LHI) targets. The 23 LHIs impact major causes of death and disease in the United States, and LHIs are a subset of high priority Healthy People 2030 (HP2030) objectives selected to drive action toward improving health and well-being.

“Factors such as poverty, limited access to health care, and lack of education or health literacy are examples of SDOH that individually and collectively have negative impacts on health outcomes for racial and ethnic minority and Tribal populations,” said Rear Admiral Felicia Collins, M.D., HHS Deputy Assistant Secretary for Minority Health and OMH Director. “By implementing community interventions that address multiple SDOH, awardees will advance our knowledge of how to increase preventive health service utilization and improve health outcomes related to LHIs.”

The project period for each grant is September 1, 2024 - August 31, 2028.

The recipients are:


Arizona Community Health Workers Association, Inc. (AzCHOW)	Douglas	AZ	;	$533,333.34
Cambridge Health Alliance	Cambridge	MA		$600,000
Casa Esperanza, Inc.	Roxbury	MA	;	$600,000
The Curators of the University of Missouri on behalf of the University of Missouri-St. Louis	St. Louis	MO		$600,000
Georgia State University Research Foundation, Inc.	Atlanta	GA	;	$600,000
HealthVisions Midwest, Inc.	Hammond	IN		$533,333.34
Housing Works Health Services III, Inc.	Brooklyn	NY	;	$533,333.34
ICNA Relief USA Programs	Charleston	SC		$561,318.26
Illuminate Colorado	Denver	CO	;	$584,692
Jewish Family Service of Dallas, Inc.	Dallas	TX	;	$482,805.95
Metropolitan Development and Housing Agency	Nashville	TN	;	$600,000
Pascua Yaqui Tribe	Tucson	AZ		$569,928
Project HOPE, The People-to-People Health Foundation, Inc. (Implementation Area – Bexar County, TX)	Washington	D.C.		$600,000
Rhode Island Department of Health	Providence	RI	;	$600,000
San Diego State University Foundation	San Diego	CA		$599,997
School-Based Health Alliance (Implementation Areas - New Mexico and West Virginia counties)	Washington	D.C.	;	$600,000
University of Arkansas for Medical Sciences	Little Rock	AR	;	$599,887
University of Hawaii	Honolulu	HI		$598,906
Wayne State University	Detroit	MI	;	$599,959
Western Reserve Land Conservancy	Moreland Hills	OH	;	$593,882.50

The Office of Minority Health (OMH) is dedicated to improving the health of racial and ethnic minority and American Indian and Alaska Native populations through the development of health policies and programs that will help eliminate health disparities. Through its demonstration projects, OMH supports the identification of effective approaches for improving health outcomes and promotes the dissemination and sustainability of these approaches.

Introduction
Conclusions
Article Information

The data are from the Treatment Episodes Dataset–Admissions, 2014 to 2021. The point estimates denote the probability that a treatment admission included MOUD in each year, separately for clients referred to treatment by the criminal justice system (depicted as orange circles) and other sources (depicted as dark blue squares), adjusted for patient characteristics. The figure overlays trend lines for each type of treatment referral, and the slope (95% CI) values are provided below each line. The disparities in the probability of MOUD use for individuals referred to treatment by the criminal justice system compared to other sources (holding individual-level characteristics fixed) are reported for 2014 and 2021. Percentage points are abbreviated as pp. See eAppendix 1 in Supplement 1 for more detail.

The data are from the Treatment Episodes Dataset–Admissions, 2014 to 2021. The figure shows the annual rate of growth in MOUD use for clients referred to OUD treatment by the criminal justice system in different states. Growth rates and 95% CIs, which are represented by the error bars, were estimated using logistic regression of the probability of MOUD use on an indicator, including whether treatment was referred by the criminal justice system, year, an interaction between whether treatment was referred by the criminal justice system and year, and client characteristics, stratified by state. The figure also shows a benchmark for each state, defined as the rate of growth needed for 50% of individuals referred to treatment by the criminal justice system in each state to receive MOUD in 2021. Percentage points are abbreviated as pp. See eAppendix 1 in Supplement 1 for more detail and eTable 5 in Supplement 1 for numerical results.

eAppendix 1. Estimating Equations

eAppendix 2. Sensitivity Analysis with Additional States

eTable 1. Sample exclusions to the TEDS-A data

eTable 2. Primary substances involved in opioid admissions over time

eTable 3. Sources of referrals to treatment from the criminal justice system

eTable 4. Predicted probability of medication for opioid use disorder use during treatment by referral source, 2014-2021

eTable 5. Sensitivity analysis for Table 2 with additional states

eTable 6. Results from state-level disparities analysis

eTable 7. Differential trend in the probability of MOUD use in criminal legal-referred treatment by state

eFigure 1. Sensitivity analysis of Figure 1 with additional states.

Data sharing statement

See More About

Select your interests.

Academic Medicine
Acid Base, Electrolytes, Fluids
Allergy and Clinical Immunology
American Indian or Alaska Natives
Anesthesiology
Anticoagulation
Art and Images in Psychiatry
Artificial Intelligence
Assisted Reproduction
Bleeding and Transfusion
Caring for the Critically Ill Patient
Challenges in Clinical Electrocardiography
Climate and Health
Climate Change
Clinical Challenge
Clinical Decision Support
Clinical Implications of Basic Neuroscience
Clinical Pharmacy and Pharmacology
Complementary and Alternative Medicine
Consensus Statements
Coronavirus (COVID-19)
Critical Care Medicine
Cultural Competency
Dental Medicine
Dermatology
Diabetes and Endocrinology
Diagnostic Test Interpretation
Drug Development
Electronic Health Records
Emergency Medicine
End of Life, Hospice, Palliative Care
Environmental Health
Equity, Diversity, and Inclusion
Facial Plastic Surgery
Gastroenterology and Hepatology
Genetics and Genomics
Genomics and Precision Health
Global Health
Guide to Statistics and Methods
Hair Disorders
Health Care Delivery Models
Health Care Economics, Insurance, Payment
Health Care Quality
Health Care Reform
Health Care Safety
Health Care Workforce
Health Disparities
Health Inequities
Health Policy
Health Systems Science
History of Medicine
Hypertension
Images in Neurology
Implementation Science
Infectious Diseases
Innovations in Health Care Delivery
JAMA Infographic
Law and Medicine
Leading Change
Less is More
LGBTQIA Medicine
Lifestyle Behaviors
Medical Coding
Medical Devices and Equipment
Medical Education
Medical Education and Training
Medical Journals and Publishing
Mobile Health and Telemedicine
Narrative Medicine
Neuroscience and Psychiatry
Notable Notes
Nutrition, Obesity, Exercise
Obstetrics and Gynecology
Occupational Health
Ophthalmology
Orthopedics
Otolaryngology
Pain Medicine
Palliative Care
Pathology and Laboratory Medicine
Patient Care
Patient Information
Performance Improvement
Performance Measures
Perioperative Care and Consultation
Pharmacoeconomics
Pharmacoepidemiology
Pharmacogenetics
Pharmacy and Clinical Pharmacology
Physical Medicine and Rehabilitation
Physical Therapy
Physician Leadership
Population Health
Primary Care
Professional Well-being
Professionalism
Psychiatry and Behavioral Health
Public Health
Pulmonary Medicine
Regulatory Agencies
Reproductive Health
Research, Methods, Statistics
Resuscitation
Rheumatology
Risk Management
Scientific Discovery and the Future of Medicine
Shared Decision Making and Communication
Sleep Medicine
Sports Medicine
Stem Cell Transplantation
Substance Use and Addiction Medicine
Surgical Innovation
Surgical Pearls
Teachable Moment
Technology and Finance
The Art of JAMA
The Arts and Medicine
The Rational Clinical Examination
Tobacco and e-Cigarettes
Translational Medicine
Trauma and Injury
Treatment Adherence
Ultrasonography
Users' Guide to the Medical Literature
Vaccination
Venous Thromboembolism
Veterans Health
Women's Health
Workflow and Process
Wound Care, Infection, Healing

Others Also Liked

Download PDF
X Facebook More LinkedIn

Donahoe JT , Donohue JM , Saloner BK. Disparities in Medication Use for Criminal Justice System–Referred Opioid Use Disorder Treatment. JAMA Health Forum. 2024;5(9):e242807. doi:10.1001/jamahealthforum.2024.2807

Manage citations:

Permissions

Disparities in Medication Use for Criminal Justice System–Referred Opioid Use Disorder Treatment

1 Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
2 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland

Question Have disparities in medication for opioid use disorder (MOUD) treatment between individuals referred by the criminal justice system and other sources decreased?

Findings This cross-sectional study, analyzing more than 3 million admissions to treatment centers for opioid use disorder between 2014 and 2021, found that although the use of MOUD among people referred to treatment by the criminal justice system has increased, it remains far lower than for people referred by other sources. This disparity exists in most states and is closing slowly.

Meaning Targeted efforts to increase MOUD use among individuals with opioid use disorder and criminal justice system involvement are needed to address the poor outcomes experienced by this population.

Importance Individuals with opioid use disorder (OUD) and criminal justice system involvement experience high rates of overdose death. Historical data point to limited use of medications for opioid use disorder (MOUD) in criminal justice system–referred treatment for OUD as playing a role. However, how MOUD use among those referred to treatment by the criminal justice system has changed relative to other referral sources over time is still unclear, as well as how it varies across states.

Objective To examine disparities in the use of MOUD between individuals referred to treatment by the criminal justice system compared to other referral sources over time.

Design, Setting, and Participants This cross-sectional study included admissions to specialty substance use treatment facilities for OUD in the national Treatment Episodes Dataset–Admissions from 2014 to 2021. Logistic regression models were used to examine trends in the probability of MOUD use among individuals with and without criminal justice referrals for OUD treatment, as well as any differential trends by state. The data were analyzed from September 2023 to August 2024.

Main Outcome and Measure The main outcome was the probability that treatment for individuals with OUD included MOUD.

Results A total of 3 235 445 admissions were analyzed in the study data. Among individuals referred to OUD treatment by the criminal justice system, the probability that treatment included MOUD increased by 3.42 percentage points (pp) (95% CI, 3.37 pp to 3.47 pp) annually from 2014 to 2021. This was faster than the increase in the probability of MOUD use for noncriminal justice–referred admissions (2.49 pp [95% CI, 2.46 pp to 2.51 pp) and reduced, but did not eliminate, disparities in MOUD use between individuals with and without criminal justice system–referred treatment. In 2021, only 33.6% of individuals in criminal justice system–referred treatment received MOUD, 15.6 pp lower than for individuals referred to treatment by other sources. Trends in the probability of MOUD use varied substantially for individuals in criminal justice system–referred treatment across states, but very few experienced enough growth to eliminate this disparity.

Conclusions and Relevance The results of this cross-sectional study suggest that targeted efforts to address persistent disparities in MOUD use among those with OUD and criminal justice system involvement are needed to address the poor health outcomes experienced by this population.

Many people in the criminal justice system have opioid use disorder (OUD). In 2019, an estimated 14.5% of people in jails had OUD, 1 9 times more than in the general population. 2 Furthermore, individuals with criminal justice system involvement experience a high risk for overdose death and other poor outcomes. Among people who are incarcerated, overdose mortality rates are significantly elevated after release from incarceration 3 , 4 and community supervision. 5 OUD among people with criminal justice system involvement also contributes to increased rates of recidivism and reincarceration. 6

One potential contributor to these poor outcomes is the limited use of medication for opioid use disorder (MOUD) in criminal justice settings. MOUD is the most effective treatment for reducing mortality from OUD, 7 , 8 including for people with criminal justice system involvement. 9 - 15 However, few jails 1 and prisons 16 offer MOUD. This partly reflects significant roadblocks to paying for MOUD in carceral settings, not the least of which is the federal inmate exclusion policy which requires states to terminate or suspend Medicaid coverage when someone is incarcerated. 17 MOUD use has also historically been low in other criminal justice settings, such as drug courts 18 and specialty treatment programs referred by the criminal justice system, 19 that are explicitly intended to boost treatment rates for opioid and other substance use disorders. In 2014, just 5% of people referred to specialty treatment for OUD by the criminal justice system received MOUD compared to 41% of people referred to treatment by other sources. 19

Many studies on MOUD use in criminal justice settings have focused on data prior to several state Medicaid expansions and regulatory changes during the COVID-19 pandemic, both of which increased MOUD use among people with criminal justice involvement. 20 , 21 Moreover, a variety of national, state, and local initiatives have been promoting MOUD in criminal justice settings in recent years. 22 , 23 These factors may have helped close the disparity in MOUD use for people referred to OUD treatment by the criminal justice system and other referral sources. However, to our knowledge, this has not yet been characterized in the literature.

This cross-sectional study uses national data on all opioid-related admissions to publicly funded substance use disorder treatment facilities to examine whether the disparity in MOUD use between individuals referred to OUD treatment by the criminal justice system and individuals referred to OUD treatment by other sources has closed over time. We also examine whether the disparity has closed differentially across states. This is important given the substantial heterogeneity in efforts to increase MOUD in criminal justice settings across states, 22 , 23 which may have closed the disparity in some states but not others. These findings can help inform interventions at the federal, state, and local levels to increase the effectiveness of OUD treatment and improve outcomes in criminal justice settings.

We used data on all completed admissions to substance use disorder treatment facilities from the Treatment Episodes Dataset–Admissions (TEDS-A) from 2014 to 2021. We followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. No institutional board review or informed consent waiver was required for this analysis of publicly available and deidentified data.

The types of facilities that report to TEDS-A vary across states; however, they typically include all facilities that receive state or federal funds (eg, block grants) and additional facilities as imposed by state-specific reporting requirements. 24 We limited the sample to individuals 18 years and older who reported an opioid as the primary substance that they used. We excluded admissions with missing information for client demographics, socioeconomic characteristics, and the exposure and outcomes variables defined herein. Further, we excluded data from 7 states that did not report data in at least 1 year (Delaware, Idaho, Maryland, New Mexico, Oregon, South Carolina, and Washington), Puerto Rico, and 4 states that did not report any MOUD use or only 1 admission with MOUD, which suggested potential data quality problems (Oklahoma, Montana, Virginia, and West Virginia). 19 We also conducted sensitivity using data from 2014 and 2021 alone and a larger number of states for which data was available in those years (eAppendix 2 in Supplement 1 ).

Exposure was defined as referral to treatment by the criminal justice system. This was constructed using the “court/criminal justice referral/Driving Under the Influence/Driving While Intoxicated” category of the “PSOURCE” variable in the TEDS-A data, which indicates treatment admissions where the referral source was “any police official, judge, prosecutor, probation officer or other person affiliated with a federal, state, or county judicial system.” 25 This captures a wide variety of criminal justice system referral sources, including probation and parole officers, court-ordered treatment, and law enforcement–assisted diversion programs. Referrals by probation and parole officers also capture referrals made following release from jails and prisons, due to these officers typically handling postrelease placements. Comparison referrals included referrals by all other sources—individuals (oneself, family, and/or friends), health care professionals, schools, employers, and other community organizations.

The outcome was an indicator of whether any medication was included in a client’s treatment plan. We measured this using the “METHUSE” variable in the TEDS-A data, 25 consistent with prior research. 19 , 21 , 26 Facilities are instructed to report medication use for a treatment admission if any MOUD, including methadone, buprenorphine, or naltrexone, was included as part of the individual’s treatment plan.

The data were analyzed from September 2023 to August 2024. We fit logistic regression models that predicted the probability of MOUD use as a function of a binary variable for whether treatment was referred by the criminal justice system, a continuous variable for year, interactions between criminal justice referral and a continuous variable for year, and individual characteristics (age, sex, race and ethnicity, educational attainment, US Census region, and self-reported co-occurring harmful alcohol and benzodiazepine use). We controlled for race and ethnicity as there are well-known differences in receipt of medications to treat OUD 27 and criminal justice involvement 28 by race and ethnicity. We used the “RACE” and “ETHNIC” variables provided in the TEDS-A dataset.

The interaction term between criminal justice referrals and year allowed trends in the probability of MOUD to differ between individuals with criminal justice system referrals to treatment and other referral sources. For all analyses, we report results as average marginal effects 29 and use robust standard errors. Using our estimates, we also calculated fitted probabilities that treatment admissions included MOUD separately under counterfactuals that all admissions were referred by the criminal justice system and were referred by other sources each year from 2014 to 2021.

We next examined whether disparities in MOUD use closed differentially for individuals in different states. To do this, we stratified the models by state. For each state, we quantified the trend in the probability of MOUD use for clients with criminal justice referrals to treatment. We also quantified a benchmark for each state, defined as the trend needed to achieve at least 50% probability of MOUD use among individuals referred to treatment by the criminal justice system in 2021. This is approximately the probability of MOUD use for noncriminal justice referrals in the TEDS-A data in 2021 and in other large population-based studies. 30 Additional details are provided in eAppendix 1 in Supplement 1 . Analyses were implemented in Stata statistical software, version 18 (StataCorp LLC). The results of 2-sided testing with P values less than .05 were considered statistically significant.

The final analytic sample included data on 3 235 445 total OUD admissions across 40 states (eTable 1 in Supplement 1 ; Table 1 ). Overall, 509 765 treatment admissions (15.8%) were referred by the criminal justice system. Most admissions involved individuals aged 25 to 54 years (79.5%) and male individuals (63.5%). Heroin was the most common primary opioid used (76.8%), although the use of other opiates and synthetics increased in 2021 (eTable 2 in Supplement 1 ). The overall racial and ethnic composition of individuals was 15.3% Hispanic, 10.4% non-Hispanic Black, 1.1% non-Hispanic American Indian or Alaska Native, 69.4% non-Hispanic White, and 3.8% other race and ethnicity (non-Hispanic individuals whose race was Asian, Native Hawaiian, other Pacific Islander, another single race, 2 or more races, or missing from database).

Table 1 also reports descriptive statistics stratified by referral source. Relative to individuals referred to treatment by other sources, criminal justice–referred individuals were younger, more likely to be male and non-Hispanic White, and more likely to live in the Midwest, South, or West Census regions.

The most common sources of criminal justice treatment referrals were probation and parole officers (26.6%) (eTable 3 in Supplement 1 ). This was followed by state and federal courts (16.6%), diversion programs (6.4%), other courts (6.2%), other legal entities (4.6%), prison (3.6%), and driving under the influence/driving while intoxicated programs (1.3%). The specific entity was recorded as other (no specific entity recorded) for 7.8% of criminal justice referrals and missing for 26.8% of criminal justice referrals.

Results from the regression models are presented in Table 2 . On average, individuals referred to treatment by the criminal justice system were 21.06 percentage points (pp) (95% CI, −21.19 pp to −20.94 pp) less likely to receive MOUD as part of treatment compared to individuals who were referred to treatment by other sources. Overall (ie, across both criminal justice–referred and noncriminal justice–referred admissions), the probability that treatment admissions included MOUD increased over time by 2.61 pp (95% CI, 2.58 pp to 2.63 pp) annually. Compared to individuals referred to treatment by other sources, the probability that treatment admissions included MOUD increased by 0.94 pp (95% CI, 0.88 pp to 0.99 pp) more each year for individuals referred to treatment by the criminal justice system.

Based on the regression estimates, Figure 1 shows fitted probabilities that treatment admissions included MOUD each year, separately assuming that all admissions were referred to treatment by the criminal justice system and that all admissions were referred by other sources (eTable 4 in Supplement 1 for numerical results). The figure also overlays the trend in the probability of MOUD use for individuals referred to treatment by the criminal justice system (3.42 pp [95% CI, 2.46 pp to 2.51 pp]) and for individuals referred to treatment by other sources (2.49 pp [95% CI, 2.46 pp to 2.51 pp]). The differentially greater rate of increase in the probability of MOUD use for individuals referred to treatment by the criminal justice system with respect to time helped reduce the disparity in the probability of MOUD use between individuals referred to treatment by the criminal justice system and other referral sources (from 22.9 pp in 2014 to 15.6 pp in 2021).

A significant disparity in MOUD use between individuals referred to treatment by the criminal justice system and other referral sources remained in 2021. Overall, 49.3% of individuals referred to OUD treatment by noncriminal justice sources received MOUD. A total of 33.6% of individuals referred to OUD treatment by criminal justice sources received the same treatment, adjusting for individual characteristics. Results from the analysis with additional states are reported in eTable 5 and eFigure 1 in Supplement 1 and are very similar.

Figure 2 reports results from the analysis of the disparity in MOUD use for individuals referred to treatment by the criminal justice system in different states (eTables 6 and 7 in Supplement 1 ). The figure shows 2 estimates. First, it shows the trend in the probability of MOUD use for individuals referred to treatment by the criminal justice system in each state from 2014 to 2021. Second, it shows a benchmark for what the trend would have needed to be for at least half of criminal justice system–referred treatment admissions to have received MOUD in 2021. Variability in the benchmark across states is driven by baseline variability in probability of MOUD use among criminal justice system–referred treatment admissions.

A substantial amount of heterogeneity was found in trends in MOUD use among criminal justice system–referred treatment across states. Several states experienced negative or no (ie, not statistically significantly different than zero) growth in the probability of MOUD use for criminal justice system–referred treatment. These included Arkansas, the District of Colombia, Nebraska, Colorado, Montana, Louisiana, Tennessee, Hawaii, Illinois, California, and Wyoming. Most states experienced increased MOUD use for criminal justice system–referred treatment, but not enough to eliminate disparities. These included South Dakota, Wisconsin, Alabama, Pennsylvania, Ohio, Texas, New Hampshire, Rhode Island, Maine, Arizona, Florida, Nevada, Kansas, Georgia, Michigan, Iowa, Kentucky, North Dakota, Connecticut, Indiana, Mississippi, and Minnesota. Lastly, a small number of leading states experienced sufficient growth to close the disparity. These included Massachusetts, Vermont, New York, Alaska, Utah, and New Jersey.

Consistent with prior research, 19 this cross-sectional study, which included updated data from the past decade, documented low use of MOUD for OUD treatment among individuals referred by the criminal justice system. On average, clients referred to OUD treatment by the criminal justice system were 21 pp (58%) less likely to receive MOUD during treatment compared to individuals who were referred to treatment by other sources. We found that the use of MOUD in criminal justice system–referred treatment has increased substantially since 2014, helping reduce this disparity. Although fewer than 10% of clients referred to treatment by the criminal justice system received MOUD in 2014, 19 close to one-third did in 2021.

However, while increased use of MOUD in criminal justice settings is encouraging, use of MOUD is still far lower than is likely needed based on comparisons with MOUD use among individuals who are referred to OUD treatment by other sources and have similar characteristics. In 2021, individuals referred to treatment by the criminal justice system remained 15.6 pp less likely to receive MOUD compared to similar individuals referred to treatment by other sources. This is concerning due to MOUD being the most effective way to reduce overdose mortality among people with OUD 7 and the very high rate of overdose death among people with criminal justice system involvement. 31

To shed additional light on this issue, we examined whether it closed differentially across states. We found that the disparity was highly persistent across states and that, in total, just 6 states (Massachusetts, Vermont, New York, Arkansas, Utah, and New Jersey) experienced enough growth in the use of MOUD among individuals referred to treatment by the criminal justice system to achieve at least 50% of individuals receiving MOUD in criminal justice–referred OUD treatment in 2021. The persistence in the disparity across many states suggests differences between OUD treatment that originates in the criminal justice setting and other settings remain significant in many states, and that it will require further efforts to address. Potential causes could include stigma and preference for nonmedication treatment by officials in the criminal justice system, 32 individual and family stigma around MOUD among individuals with criminal justice system involvement, 33 fear of forced withdrawal from MOUD, 33 differences in the kinds of health care professionals willing to develop relationships with the criminal justice system, 33 , 34 and institutional barriers to availability of MOUD in criminal justice settings. 33

Future research should tease out mechanisms for the continued disparity and targets for intervention by collecting and analyzing data on the preferences and decisions of criminal justice officials and entities. Studies are also needed to examine the causal effects of initiatives to boost MOUD use in criminal justice settings, such as recently approved and pending state Medicaid waivers to waive the federal inmate exclusion policy, 35 on health and public safety outcomes. These efforts will inform interventions to address the poor outcomes experienced by individuals with criminal justice system involvement.

The study had several limitations. First, quality assurance of TEDS-A data at the federal level is limited, leading to differences in reporting across states. To our knowledge, validation of how accurately TEDS-A data measure MOUD use has not been conducted. To the best of our ability, we addressed this by excluding states with inadequate data reporting and by comparing differences in the probabilities that admissions included MOUD (rather than the overall number). Nevertheless, poor reporting may still lead us to underestimate or overestimate the extent of MOUD use in some areas. Second, the TEDS-A data only include admissions to specialty substance use treatment facilities. Thus, we were unable to examine OUD treatment episodes that involve health care professionals who practice outside these settings (eg, in primary care). Other research, however, suggests this is not a large issue in the context of our study because primary care clinicians are less likely to receive referrals from the criminal justice system relative to specialty substance use treatment facilities. 34

Third, we were unable to distinguish which medications (buprenorphine, methadone, or naltrexone) contributed to reduced disparities in MOUD use for individuals with and without criminal justice system involvement. Recent press investigations suggest that naltrexone has been heavily marketed in carceral settings, 36 despite buprenorphine and methadone being more established medications for reducing overdose risk. Higher use of naltrexone in carceral settings could lead us to underestimate disparities in effective medication use; however, other data suggest that naltrexone accounts for a small and declining share of MOUD use in carceral settings. 37 Fourth, the TEDS-A data do not report detailed information on the types of substance use disorder treatment facilities that individuals are admitted to. This prevented us from being able to assess whether certain types of facilities (eg, opioid treatment programs) achieve better outcomes. Finally, unobservable changes (eg, in OUD severity) among the populations of individuals referred to treatment by the criminal justice system and other referral sources may have also contributed to changes in the probability of MOUD use over time, creating potential bias in our estimates of the extent to which disparities have been reduced.

Despite modest improvements in the use of evidence-based treatment for OUD in criminal justice settings, clients with criminal justice involvement remain far less likely to receive evidence-based care than clients referred to treatment by other sources. The persistence of this problem across time and states highlights that additional efforts are urgently needed, particularly given the escalation of opioid overdose death rates in recent years. Improving tracking of the type and extent of medication use in criminal justice referred treatment (eg, through improving standards and oversight of TEDS data reporting) is also needed for ongoing assessments of how well policy is doing with respect to providing evidence-based care to the highly vulnerable population of individuals with OUD and criminal justice system involvement.

Accepted for Publication: July 14, 2024.

Published: September 6, 2024. doi:10.1001/jamahealthforum.2024.2807

Corresponding Author: J. Travis Donahoe, PhD, Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 De Soto St, Pittsburgh, PA 15261 ( [email protected] ).

Author Contributions: Dr Donahoe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Donahoe.

Drafting of the manuscript: Donahoe.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Donahoe.

Conflict of Interest Disclosures: Dr Donahoe reported personal fees from Greylock McKinnon Associates outside the submitted work. Dr Saloner reported grants from the Greenwall Faculty Scholars Program and the National Institute on Drug Abuse during the conduct of the study and personal fees from Susman Godfrey outside the submitted work. No other disclosures were reported.

Disclaimer: Julie M. Donohue, PhD, is an Associate Editor of JAMA Health Forum but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Data Sharing Statement: See Supplement 2 .

Select "Patients / Caregivers / Public" or "Researchers / Professionals" to filter your results. To further refine your search, toggle appropriate sections on or off.

Home > About the AACR > Newsroom > Media Advisory > Register Today: AACR Conference on Cancer Health Disparities, September 21-24, 2024

News Releases
Media Advisories
Media Contacts
AACR Fast Facts
Apply for Embargoed Access
Media Coverage
AACR Cancer Disparities Progress Report 2024
AACR Annual Meeting 2024
AACR Cancer Progress Report 2023
The AACR June L. Biedler Prize for Cancer Journalism
San Antonio Breast Cancer Symposium 2023
Press and PIO Registration
AACR Annual Meeting
Press Program 2024
Peer-reviewed Journals
National Cancer Research Month
Resources for Cancer Center PIOs and Communications Staff
AACR Stories Index
AACR Blog: Cancer Research Catalyst
Cancer Today Magazine

Register Today: AACR Conference on Cancer Health Disparities, September 21-24, 2024

LOS ANGELES – The American Association for Cancer Research (AACR), in association with the AACR Minorities in Cancer Research Council, will host the 17th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorites and the Medically Underserved from September 21-24 in Los Angeles, California. Registration is complimentary for credentialed members of the media.

This meeting will take place as an in-person event and will not be live-streamed for virtual participation. Lecture sessions will be made available for on-demand viewing approximately 7-14 days after the meeting has concluded and will remain available until November 30.

This conference is dedicated to advancing the understanding of cancer disparities that pose significant public health challenges. Reflecting this transdisciplinary field, professionals from academia, industry, government, and the community will come together to exchange innovative ideas, discuss the latest findings in the field, and catalyze the development of new research initiatives in the field of cancer health disparities.

The conference will include sessions on the impact of structural racism, financial toxicity, and climate change on cancer disparities; using artificial intelligence and big data to address cancer disparities; and more. View the full conference program .

MEDIA REGISTRATION

Journalists planning to cover the meeting must register through the AACR public relations team via the form linked below to receive the embargoed press program.

Journalists must provide official press credentials and bylined coverage to register as press. Before requesting registration, please review the full media registration requirements and embargo policies .

Journalists can request registration by filling out this form . Contact Kathleen Venango at [email protected] or 215-290-5408 with registration questions.

For more information, contact a member of the AACR public relations team:

Julia Gunther, director, public relations, [email protected] or 770-403-7690
Kathleen Venango, manager, public relations, [email protected] or 215-290-5408
Julia DeMalto, coordinator, public relations, [email protected] or 215-446-7127
Rick Buck, chief communications officer, [email protected] or 856-562-5668
Healthcare Professionals Membership
What Is Cancer Research
Various Types of Cancer

Election 2024
Entertainment
Newsletters
Photography
AP Buyline Personal Finance
AP Buyline Shopping
Press Releases
Israel-Hamas War
Russia-Ukraine War
Global elections
Asia Pacific
Latin America
Middle East
Election results
Google trends
AP & Elections
U.S. Open Tennis
Paralympic Games
College football
Auto Racing
Movie reviews
Book reviews
Financial Markets
Business Highlights
Financial wellness
Artificial Intelligence
Social Media

Hundreds of places in the US said racism was a public health crisis. What’s changed?

Children attend a back to school health fair in Milwaukee, on Saturday Aug. 10, 2024. (AP Photo/Jeffrey Phelps)

Children paint a display on the ground at a back to school health fair in Milwaukee, on Saturday Aug. 10, 2024. (AP Photo/Jeffrey Phelps)

Kids and adults take part in a back to school health fair in Milwaukee, on Saturday Aug. 10, 2024. (AP Photo/Jeffrey Phelps)

A child helps paint a display on the ground at a back to school health fair in Milwaukee, on Saturday Aug. 10, 2024. (AP Photo/Jeffrey Phelps)

Children and adults attend a back to school health fair in Milwaukee, on Saturday Aug. 10, 2024. (AP Photo/Jeffrey Phelps)

Copy Link copied

More than 200 cities and counties declared racism was a public health crisis in the past few years, mostly after George Floyd was murdered by police in Minneapolis in May 2020. Racial justice advocates said they finally felt heard by the quick swell of political will to address disparities like disproportionate COVID-19 deaths or infant and maternal mortality rates .

The declarations “signified this might be us finally breaking through the noise that they haven’t been willing to hear,” said Ryan McClinton, who works at the nonprofit Public Health Advocates in Sacramento County, California. Marsha Guthrie, the senior director at the Government Alliance on Race and Equity, called 2020 a “catalytic moment for us to kind of reimagine social consciousness.”

“Think about the ... decades (and) decades of just fighting to get the conversation about race even centered in the American psyche,” she said. “Now people talk about it as a general course of fact.”

Some places’ health departments took on the work of the declarations, creating improvement plans centered on racial equity . Others turned the work over to task forces and consultants to look at internal work environments or make action plans and recommendations.

Years after the declarations, community organizers and public health advocates in Milwaukee and Sacramento County say not much has changed. Officials counter that it’ll take more than a few years to undo centuries of structural and institutional racism.

But experts, officials and advocates all agreed on one thing: The declarations were an important first step toward creating a racially equitable society. Extensive research shows racism can have detrimental health impacts on people of color, including chronic stress and anxiety and higher rates of heart disease and asthma.

AP AUDIO: Hundreds of places in the US said racism was a public health crisis. What’s changed?

AP correspondent Kenya Hunter reports on how communities responded to racism being declared a public health issue.

“If we’re not going to name racism in the first place, then we’re not going to start to develop solutions to address it,” said Dara Mendez, who teaches epidemiology at the University of Pittsburgh and studied the early declarations. “... Then the next step is (asking) what are the actions behind it? ... Are there resources? Is there community action?”

Milwaukee’s approach

Lilliann Paine wanted to see everyday public health work focus on the intersection of racism and public health, and in 2018 brought the idea to the Wisconsin Public Health Association. Milwaukee, where Black people are the largest minority group, became one of the first cities in the country to adopt a declaration in 2019.

“If racism as a public health crisis was truly operationalized, we would have more people graduating from high school. If it was truly operationalized, people could live to their full potential and not worry about being mistaken by a police officer for having a gun,” said Paine, who was the chief of staff at the city’s health department from late 2019 to March 2021. “And those aren’t changes you can speak to overnight.”

Wisconsin’s biggest city now has a community health improvement plan , released in December, that wants to address racism as a public health crisis in various ways — from increasing voter registration to improving infant mortality rates, which are three times higher among Black infants than white infants.

The plan also highlights the need to improve housing conditions, and one of the health department’s key priorities is addressing lead poisoning in older homes. Black children in Milwaukee are up to 2.7 times more likely to have elevated blood lead levels compared to other races, according to the community health improvement plan.

“When the built environment is essentially a poison in your families, you’re going to see health outcomes that affect that,” health department commissioner Dr. Michael Totoraitis said, giving an example that kids might be “deemed problematic at school because they were lead-poisoned and have permanent brain damage.”

Deanna Branch’s 11-year old son, Aidan, got lead poisoning when he was a toddler. She pointed to the dilapidated housing that she and many Black Milwaukee residents have to live in.

“We have to work with what we have and do what we have to do to keep that place safe for our kids,” Branch said, adding, “rent is getting higher, but the upkeep of apartments isn’t changing at all.”

Longtime racial equity advocate Melody McCurtis said she’s interested in some parts of the plan — but is largely still skeptical.

“When it comes down to tackling racism, I don’t want to see, I don’t want to hear the word ‘explore,’” said McCurtis, who is deputy director of Metcalfe Park Community Bridges, a resident-led community group. “I know you have to explore things, but some of these things, there’s been plenty of research done already … What is the real strategy that’s really going to get folks where we need to be?”

Sacramento County’s efforts

Putting money toward racism-as-a-public-health-crisis declarations is an important way for governments to show they’re committed to implementing the steps, Mendez said. But money was a rarity in her review of 125 declarations that had been adopted by the end of September 2020.

“It actually is also going to take some financial will and some real investments to create the types of layered strategies that can move the needle on well-being outcomes,” said Guthrie with the Government Alliance on Race and Equity, which works with governments on racial equity in about 20 states. “That doesn’t happen overnight.”

The Centers for Disease Control and Prevention offered millions of dollars in federal grants in 2022 for state and local health departments to address racial disparities and develop the workforce.

Sacramento County, California, received $7 million and has used it to to pay various consultants to create an action plan for its health department and to train the staff on implicit bias and racial equity.

The county, which passed its declaration in November 2020, has significant Latino, Asian and Black populations, each with varying health disparities . Black infants in Sacramento County had a death rate twice as high as the overall infant death rate in 2020. And between 2010 and 2020, Black, Asian and Hispanic women were all more likely to die during childbirth than white women.

The declaration gave the health department a “green light” to begin addressing equity at the root, county public health officer Dr. Olivia Kasirye said. That included creating a fellowship program for college students by 2029 to create a pathway to employment.

Community organizers from Public Health Advocates praise the health department for starting up a health and racial equity unit. But they are frustrated by the lack of outward-facing progress.

A year ago, the organization confronted the county board of supervisors during a meeting over concerns that the county was too focused on internal diversity, equity and inclusion as opposed to racial justice. They were frustrated that the county spent $190,000 on an out-of-state consultant and didn’t put community members on the DEI cabinet — which was established in May 2023, three years after the declaration.

The county also lagged in hiring a DEI chief to oversee the action plan. The Civil Service Commission, which runs the process for choosing and retaining county employees, initially didn’t approve the job description because the commission was concerned it would be redundant.

Cephoni Jackson eventually was hired in January. She shared a draft of the yet-to-be-finalized plan, which outlines goals of creating a “culture of belonging,” building more inclusive leadership, and coming up with strategies to retain and develop talent. She wants to establish a committee made up of community members by 2025.

The goals don’t have a timeline, and various county leaders are tasked with “championing” each step. Jackson said she’s seeing high energy from employees to begin implementing the action plan, adding: “It’s like the conditions are right for the culture to shift.”

It’s progress that’s “more than the bread crumbs they’ve given us,” said Kula Koenig, the chief program officer at Public Health Advocates.

And Phil Serna, the county board member who brought forth the declaration, said it’s important to recognize what has been done — and what still lies ahead.

“I think in many respects dealing with racism, addressing racism responsibly, is kind of like painting the Golden Gate Bridge, right?” he said. “As soon as you think you’re done, you’re not. You have to go back and start painting again.”

This story is part of an AP ongoing series exploring the impact, legacy and ripple effects of what is widely called the Ferguson uprising , which was sparked a decade ago by the fatal shooting of Michael Brown by police in Ferguson, Missouri.

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Warning: The NCBI web site requires JavaScript to function. more...

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings
Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Hardcopy Version at National Academies Press

RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE: AN ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER

Madison Powers and Ruth Faden

The Kennedy Institute of Ethics

Georgetown University

Introduction

Recent health services research literature has called attention to the existence of a variety of disparities in the health services received by racial and ethnic minorities. As well, racial and ethnic disparities in health outcomes from various health services, including screening, diagnosis, and treatment for specific diseases or medical conditions have also been noted. Such findings provide the impetus for the consideration of two primary moral questions in this paper. First, when do ethnic and racial disparities in the receipt of health services matter morally? Second, when do racial and ethnic disparities in health outcomes among patient groups matter morally?

Our approach in answering these questions takes the form of two theses. Our first thesis, the neutrality thesis , is that disparities in health outcomes among patient groups with presumptively similar medical conditions should trigger moral scrutiny. Our second thesis, the anti-discrimination thesis, is that disparities in receipt of health care or adverse health outcomes among racial, ethnic or other disadvantaged patient groups should trigger heightened moral scrutiny. The theses are presented as lenses through which the morally salient features of health services can be viewed. Most theories of justice can accept some version of both the neutrality thesis and the anti-discrimination thesis. However, as we shall see, these theories differ in the nature and strength of their moral conclusions and in the reasoning they employ in reaching those conclusions.

The bulk of this paper will focus on the foundations of the theses, their relation to competing accounts of justice, and the considerations relevant to their moral analysis. In Section II, we articulate the moral foundations for the neutrality and anti-discrimination theses, and in Section III, we examine some potentially morally relevant considerations that inform the conclusions from the perspectives of alternative theoretical frameworks. Finally, in Section IV, we consider the moral implications of these findings for physicians and other health care providers.

The preliminary task, however, is to clarify several conceptual issues lurking in the formulation of the theses. Although the theses overlap in certain important respects, it is even more important to be clear about how they differ.

Differences Between the Neutrality Thesis and the Anti-Discrimination Thesis

The first conceptual distinction has to do with who is covered under the thesis. The neutrality thesis covers disparities in health outcomes among any patient groups with presumptively similar medical conditions and prognoses. By contrast, the anti-discrimination thesis refers specifically to a subset of what falls under the neutrality thesis–the special case in which the outcome disparities involve racial, ethnic or other disadvantaged patient groups.

The second conceptual distinction has to do with what is covered. The neutrality thesis covers only disparities in health outcomes. But the anti-discrimination thesis, which specifies that the disparity must occur in a disadvantaged social group, means that disparities in the health care services people receive, and not just the outcomes they experience, also matter.

The neutrality thesis is thus intended to cover any instance in which it is established that there are differences in outcomes among patient groups that are in relevant respects otherwise medically similar. If it was determined, for example, that white men with colon cancer had poorer survival rates than African- American men with colon cancer, then the neutrality thesis should trigger the same moral scrutiny as if the situation was reversed. In addition, this claim would hold even if it was clear that there were no differences in the medical services the two groups received. However, what if it was determined that white men were less likely than African- American men to have screening colonoscopies after age 50? As long as this disparity did not result in different medical outcomes, there are no moral implications under the neutrality thesis.

In contrast, the anti-discrimination thesis assumes that disparities in both health services received and disparities in health outcomes are independent and distinct reasons for moral concern when the disparities disfavor racial and ethnic groups. These groups are “morally suspect categories,” understood here as analogous to legally suspect categories in equal protection law. Under the anti-discrimination thesis, either type of disparity-- alone or in combination is treated as morally problematic as long as the disparity disfavors a morally suspect group. This is markedly different from the neutrality thesis, in which disparities in utilization are only problematic if they have a disparate impact on health outcomes.

Underlying the neutrality thesis is the implicit assumption that the moral value of medical interventions is generally instrumental. In other words, whether it is good or bad to receive or fail to receive-- a medical intervention depends on the impact each option would have on individual health and well-being. . In the case of racial and ethnic minorities, however, a different moral value is at stake. The very fact that a minority population might receive fewer services believed to be beneficial suggests the potential for morally culpable discrimination. This is a significant moral concern in its own right, regardless of the medical consequences. Under the anti-discrimination thesis, disparities of either sort trigger an additional or heightened level of moral scrutiny beyond that warranted by health outcomes disparities generally. i

Moral Foundations for the Two Theses

Thus far, we have merely articulated some of the implications of and analytic differences between the two theses and the implications of the differing forms of moral judgment that can flow from the use of either moral lens. In this section, we offer a philosophical defense of the two theses and link them to the more general theoretical foundations on which they rest.

A principle that has come to be known as the formal principle of equality is often the starting point for discussions as to when some sort of disparity or inequality in the way persons are treated (in a more general sense than meant in health care contexts) is morally problematic. It is a minimal conception of equality attributed to Aristotle, who argued that persons ought to be treated equally unless they differ in virtue of some morally relevant attributes. It is, of course, critical to determine in any particular context just which attributes are morally relevant and which are not. Often these determinations are matters of disagreement and controversy that can be traced to significant differences in rival theories of justice. The degree of agreement across theories of justice on the matters under discussion in this paper is, therefore, surprising.

Libertarian Theories

Consider first a type of theory of justice many would think least likely to agree with either the neutrality thesis or the anti-discrimination thesis. The libertarian theorist rejects any pattern of distribution as the proper aim of justice, arguing instead that whatever pattern of distribution emerges from un-coerced contracts and agreements is morally justified (Nozick, 1974). Moreover, coercive attempts by the state to enforce a preferred pattern of distribution are themselves viewed as unjust. To the libertarian, inequalities are counted as merely unfortunate and not unjust, unless they are the product of some intentional harm or injury.

Initially, one might think that the libertarian position leaves little room for objecting to disparities in health outcomes among patient groups, whether defined along racial lines or otherwise, or to disparities in the receipt of health services among racial and ethnic groups. As long as patient preferences are not overridden and no harm to those patients was intended, no injustice or other moral failing would obtain. Indeed, it seems highly unlikely that the libertarian could accept the neutrality thesis, failing to see any basis for demanding moral scrutiny merely because some patient groups fare less well than other patient groups.

The libertarian conclusion may well be different, however, when, as contemplated by the anti-discrimination thesis, the patient groups involve morally suspect categories. Some conceptual room is left open for endorsement of the anti-discrimination thesis, and that room is a consequence of the limited domain of moral judgment for which the libertarian theory is meant to apply. The libertarian view is primarily a theory of societal obligation, or what society collectively owes its members, and not a comprehensive moral doctrine spelling out the full range of individual or other non-governmental moral obligations. Libertarians often assert that particular individuals have duties of mutual aid, even fairly stringent ones, even though state coercion to enforce them would be unjust (Engelhardt, 1996), as do certain non-governmental institutions and professional bodies that assume certain social functions as part of their self-defined moral missions. Thus, even in the libertarian view, the failure of individuals and institutions to offer health services to all racial groups on an equal basis can be a significant basis for moral condemnation.

A point of particular significance for this discussion is that nothing in the libertarian view necessarily excludes the existence of parallel moral obligations that are rolespecific, such as those ordinarily obtaining between physician and patient. Such special obligations are often referred to as agent-relative obligations. Some libertarians have argued that because of the existence of these agent-relative obligations, which in their view form the core of our moral requirements, coercive state action is morally condemnable. Such interference is said to be morally condemnable insofar as it may interfere with an individual's most basic agent-relative moral duties (Mack, 1991). The libertarian, therefore, may limit what government may do to enforce cer tain individual moral obligations, but it does not purport to be a comprehensive moral doctrine that effaces those individual obligations.

The upshot is that the libertarian view, even in its strictest form, need not reject a thesis asserting that disparities involving racial and ethnic minorities should trigger special moral scrutiny. However, libertarians will locate their judgment of moral failing in the failure of specific individuals or institutions to discharge their moral duties, not in the society at large. Nor would the libertarian necessarily see the moral problem as a failure of government to enforce neutrality in the receipt of care or achievement of the outcomes that specific individuals and institutions are properly committed to achieving.

In sum, even libertarianism, the theory of justice least compatible with the neutrality thesis, can substantially endorse the anti-discrimination thesis as applied to disparities in the receipt of services and in health outcomes. When using the lens of the anti-discrimination thesis, a libertarian might reach a more modest moral conclusion than the one we shall defend,and a libertarian does not endorse the more inclusive moral concern shown for disparities in health outcomes embodied in the neutrality thesis. However, in Section III, we explore some instances in which the libertarian view might agree with our conclusion that some patterns of racial and ethnic disparities should be counted as injustices, and not simply moral failings.

Egalitarian Theories

A family of justice theories known as egalitarian theories offers more solid support for both the neutrality thesis and the anti-discrimination thesis, even as those theories diverge substantially in their theoretical foundations. Egalitarians, unlike libertarians, are intrinsically concerned with the existence of inequalities. Egalitarians themselves differ as to how much inequality they find morally tolerable, the reasons they find inequalities to be morally problematic, and the kinds of inequalities they consider to be the central job of justice to combat.

One strand of egalitarianism prominent in the bioethics and health policy literature borrows heavily from the work of John Rawls (Rawls, 1971). The first principle of the Rawlsian theory is that everyone should be entitled first to an equal bundle of civil liberties (e.g., political and voting rights, freedom of religion, freedom of expression, etc), which shall not be abridged even for the sake of the greater welfare of society overall. Secondarily, everyone should be guaranteed a fair equality of opportunity. That principle of fair equality is given a robust, substantive interpretation such that permissible inequalities in such things as income and wealth work to the advantage of the least well-off segments of society. Fair equality of opportunity is thus a term of art, signaling more than a formal commitment to non-discrimination, but also an affirmative commitment to resources necessary to ensure that all citizens of comparable abilities can compete on equal terms. For Rawls, this commitment means a guarantee of educational resources sufficient for all persons to pursue opportunities such as jobs and positions of authority available to others within society.

Norman Daniels seizes on Rawls's core arguments (Daniels,1985). He accepts the core Rawlsian framework but offers a friendly amendment to the Rawlsian theory. Daniels claims that once we acknowledge that there are considerable differences in the health of individuals and that the consequence of those differences is that individuals differ substantially in their opportunities to pursue lifeplans, we must relax Rawls's own assumption about the rough equality of persons. Once this assumption is relaxed, the theory has implications for how we think about healthcare resources. If, as Daniels argues, health is especially strategic in the realization of fair equality of opportunity, and that healthcare services (broadly construed by Daniels) make a limited but important contribution to health, then we derive a right to healthcare sufficient to pursue reasonable life opportunities. The logic of Daniels' account clearly lends support to the neutrality thesis in as much as disparities in health outcomes are precisely the sort of consequences that the principle of fair equality of opportunity treats as unjust and therefore, as proper objects of remedial governmental action.

In addition, Daniels' version of the Rawlsian theory can be seen as lending support for the anti-discrimination thesis, although this is not an element of Daniels' theory that he himself highlights. For example, the theoretical support for treating inequalities in health outcomes among racial groups as unjust, as distinguished from a rationale that makes inequalities among persons generally unjust because of their adverse impact on equality of opportunity, lies in its endorsement of Rawls' core notion of a formal principle of equality. Rawls and Daniels both start their discussion of equality of opportunity with the formal principle that morally irrelevant distinctions should not be employed as a basis for determining the range of life opportunities open to persons. Matters of race, gender, and the like are counted as irrelevant, so if their claims are plausible, then even disparities in services received ( as well as disparities in health outcomes) based on racial and ethnic categories warrant some moral scrutiny.

Other members of the egalitarian family of justice theories offer more direct support for both theses. The “capabilities” approach argues that it is the job of justice to protect and facilitate a plurality of irreducibly valuable capabilities or functionings (Sen, 1992; Nussbaum, 2000). Capabilities theorists, led by Amartya Sen, generate slightly different lists of the core human capabilities central to the job of justice, but all converge on the idea that a variety of health functionings, including longevity and absence of morbidity, are among those centrally important human capabilities. Unlike the modified Rawlsian concept, which makes the importance of health and hence healthcare derivatively important because of health'se specially strategic role in preserving equality of opportunity, the capabilities approach reaches similar conclusions about the intrinsic importance of health, and more directly, the goods instrumental to its realization. Based on Sen's theory, inequalities among any of the core capabilities are matters of moral concern. Thus, as the neutrality thesis asserts, any finding of disparities in health outcomes should trigger moral scrutiny.

Among the core capabilities included on Sen's list are capacities for all to live their lives with the benefit of mutual respect and free from invidious discrimination.Thus, support for the anti-discrimination thesis also flows naturally from the capabilities approach inasmuch as the value of equal human dignity and respect is of fundamental moral importance, as is health. Disparities in services received, no less than disparities in health outcomes, therefore trigger a heightened moral scrutiny under a theory that renders inequalities of both sorts morally problematic.

Democratic Political Theory

Libertarian and egalitarian theories are two broad theoretical traditions that at face value seem to have the greatest divergence in their implications. However, they have been shown to result in greater convergence, at least on the anti-discrimination thesis, than might otherwise be suspected. Apart from the (perhaps) unexpected convergence of two quite different comprehensive moral theories on the interpretation of the formal principle of equality, there are additional philosophical arguments favoring the anti-discrimination thesis that do not require taking sides with any comprehensive moral views.

Recent work in political philosophy by John Rawls begins with the assumption of what he calls a reasonable pluralism of comprehensive moral views (Rawls, 1993). In a democratic nation, persons motivated to reach agreement on the basic social structure, understood as shared basis for social cooperation, will seek an overlapping consensus on some evaluative questions. That consensus will necessarily include a commitment to the view of each person as a free and equal citizen. While critics have questioned how much substantive moral content can be derived from this perspective, they generally agree that some underlying commitments are widely shared in any democracy (Gutmann and Thompson, 1996). Among them are the ideas that the interests of all should be given equal weight regardless of race, creed, color, gender or other attributes deemed morally irrelevant. Although such a notion does not settle the deeper moral question of which attributes are morally irrelevant, the crucial point is that such views form the bedrock of most Western democracies. Underlying this desire for equal respect and concern is the vague but powerful idea of human dignity and the importance we attach to equality of treatment for the least advantaged that the more powerful members of society have secured for themselves (Harris, 1988).

Thus, although there is a diversity of possible justifications for the importance of health and healthcare services, there is widespread basis for agreement that inequalities in health outcomes that track racial and ethnic lines, especially when racial and ethnic lines also track other indices of social disadvantage, are ethically problematic. This feature of democratic theory, reflected also in equal protection law, justifies at minimum the added moral scrutiny required by the anti-discrimination thesis.

The Relevance of Causal Stories

So far we have established that egalitarian theories, and in particular capability theory, provide moral justification for the neutrality thesis. Thus, even with a libertarian view, the failure of individuals and institutions to offer health services to all racial groups on an equal basis can be a significant basis for moral condemnation. Even if the moral scrutiny demanded by the neutrality thesis and the added moral scrutiny demanded by the anti-discrimination thesis are warranted, this is not the final word. All that has been established thus far is that governments and health care institutions have a moral obligation to investigate identified disparities. The key questions are how governments and health care institutions should interpret the moral meaning of the results of such an investigation, whether disparities should be considered injustices, and under what conditions. On many moral accounts, an evaluation of the explanations for the disparities is needed to make a judgment about whether the disparities represent an injustice. In other words, whether disparities in health outcomes or in the services patients receive constitute an injustice depends for some on the causal story that stands behind the disparity. Thus, while there may be wide agreement about the moral imperative to investigate identified disparities, at least with respect to morally suspect groups, there is far less agreement about how to interpret the moral significance of the results of such an investigation.

The moral significance of causality is a difficult sticking point in moral philosophy. There is a natural inclination in theories of individual morality, as there is in law, to bind moral responsibility and causal responsibility together. We do not ordinarily think, for example, in law or morality, that an individual is morally culpable for adverse consequences arising from circumstances over which that individual had no control. Lack of causal efficacy is the end of the story for many assessments of moral and legal responsibility. Moreover, a judgment of causal responsibility is a threshold concern for many accounts of individual moral and legal responsibility, and the presence of some causal contribution to the harm of others opens the door to legal analysis. Theories of justice, however, are more varied and often more controversial than the individual model in their understandings of the relation between causal and moral responsibility.

Libertarian Views of the Relevance of Causal Explanations

Some theories of justice employ something similar to this individual moral responsibility model in their assessments of the justice of social institutions. Libertarians, for example, link a judgment of injustice to some intentional harm. That view holds that adverse consequences or disproportionate burdens borne by some individuals or groups as a consequence of the structure of social institutions do not warrant a judgment of injustice. The libertarian views these consequences for the most part as merely unfortunate, not unfair.

The libertarian view is an especially stringent rendering of the claim that moral responsibility for society and its political institutions is linked necessarily to a direct causal responsibility. It is a stringent standard as it demands that the causal connection be an intentional harm.

However, there is theoretical room for the libertarian to reach an even stronger conclusion that racial and ethnic disparities in health outcomes and the receipt of health services are morally condemnable failings of particular persons or institutions. In some cases, the libertarian can conclude that these disparities are injustices. There are at least three ways that the libertarian can reach such conclusions.

First, for the libertarian, patterns of inequality are not morally troubling in themselves. However, this assertion is qualified by the proviso that those patterns are morally unproblematic only as long as they are not the consequence of prior injustices in social exchanges or agreements. This nod to historical context is crucially important. If the social and institutional history that causally contributes to present patterns of inequality are in and of themselves unjust, perhaps the result of past intentional harms whose adverse consequences remain today, then present patterns of inequality may be judged as unjust, and not merely a matter of moral failing of individuals or non-governmental institutions. There is nothing intrinsic to the libertarian view that makes it hostile to such historical claims regarding the legacy of racism, the intentional harms based on racial or ethnic prejudice, or the moral taint on the advantages obtained from such practices.

Second, for one brand of libertarian theorist, the constraint on coercive state appropriation of private assets for the purposes of achieving certain patterns of distribution does not entirely restrict what states can do with respect to redistribution. While private assets are put beyond the reach of states, not all resources are private. According to some libertarians, redistribution for the purposes of combating inequalities in the health care context are acceptable when it involves public resources or the decision to devote resources to activities that benefit the public at large. Medical education and the construction and operation of health care facilities are clear examples of public resources being invested deliberately for the promotion of the common good.

Even if the libertarian can argue that there is no antecedent duty to support such activities for the common good, the claim of allegiance to the state itself is said by some libertarians to de pend upon strict neutrality between its citizens (Nozick, 1974). This requirement of neutrality clearly makes all disparities in services received, as well as disparities in health outcomes such as racial and ethnic health outcome disparities, unjust. If the neutrality requirement endorsed by some libertarians is a strict one, as it is in Nozick's libertarian theory, then the proper test of neutral state action is neutrality of effect on its citizens (Raz, 1986). Thus, one particular interpretation of libertarianism supports the neutrality thesis.

Moreover, the moral failing associated with its violation is an injustice. Of course, not all libertarian theorists endorse the political neutrality thesis and accordingly, those libertarians would be committed neither to the neutrality thesis we have defended nor to the finding of an injustice if neutrality of effect is not achieved.

A third possible exception to the libertarian's general reluctance to see an injustice in any disparities in receipt of services or health outcomes, even in the case of racial and ethnic minorities, lies in the libertarian's account of what constitutes intentional harm. The typical definition of an intentional harm is one that is generated from a fully conscious or present-to-mind motivational stance. Therefore, overt racist actions would surely count as intentional harms. For example, if services were not offered to racial and ethnic minorities because of a conscious intention to make their health outcomes worse, or as a deliberate assault on their dignity, these denials of services would count as intentional harms. In this narrow range of cases, the libertarian has no choice but to support the anti-discrimination thesis and conclude that the moral failings involved are injustices.

Less clear, however, is how the libertarian must account for more subtle, often unconscious, instances of racism. The resolution depends on the view of intention employed by the theory. In our judgment, nothing intrinsic to the libertarian theory rules out a more expansive account of what constitutes an intentional harm, even though the ideological thrust of most libertarian theories would be naturally resistant to any effort to look behind an agent's conscious state of mind. The libertarian would have to articulate a plausible rationale for adopting the narrow construal, and as long as the core intuition of what constitutes an injustice is tied to intentional harm, limits on the psychological transparency of an agent's own true intention would seem to need a persuasive argument for such a restriction.

Brute Luck and Social Structural Egalitarian Views of Causality

Other justice theories, including two prominent versions of egalitarianism, make the locus of causal responsibility an important consideration. Consider first a rather permissive standard sometimes referred to as the brute luck conception of justice (Scanlon, 1989). Brute luck theories count as an injustice all those inequalities that are not due to the choices of individuals. All inequalities that are beyond a person's control are therefore judged as brute bad luck and deserving of remedy, or if the inequality cannot be eliminated, compensation. Such theories take an indirect account of the causal story leading to the inequality in as much as the only inequalities society does not have to eliminate are those said to be chosen. While responsibility for some inequalities is laid at the individual doorstep, the brute luck standard holds society morally responsible for all inequalities that the individual did not bring on by his or her own choices. For example, the brute luck view recognizes that inequalities that result from genetics, ill health not brought on by lifestyle choices, and being born into a poor, uneducated family are all illustrative of inequalities that should be remedied by society. The brute luck theory can be contrasted with an alternative claim that attempts to reign in the moral responsibility of society for unchosen ine qualities. The social structural concept argues that two conditions must be satisfied for society to incur an obligation to remedy inequalities: 1) the inequalities must not be the result of an individual's own choices and 2) those inequalities must not be attributable to natural fortune that the society had no hand in creating. Examples of natural bad fortune, for which no social remedy is due, include genetic differences and natural disasters. The focus is on the way social structures contribute to inequalities, and more specifically on the way that unjust social structures influence the creation of inequalities that reduce the life prospects of some people relative to others. Like the libertarian view, the social structural view demands proof that society had a causal hand in producing the inequality before it assigns society the moral responsibility for its elimination or reduction. The difference is that the social structural view does not require that the causal link between society and the inequality involve intentional harm. Instead, the social structural view adopts a less stringent requirement demanding only that the inequalities be an artefact or consequence of a particular social arrangement.

Let us next consider how the social structural and brute luck concepts might justify or limit the scope of application of a claim of injustice for disparities in health outcomes or health services. There are two important implications of the brute luck view. First, the brute luck standard provides robust justification for the injustice of inequalities that are covered by the neutrality thesis, but no special justification for the discrimination thesis. It would find all inequalities in health outcomes morally unjust, except for differences in health outcomes that are attributable to patient choice. . The brute luck view reaches this conclusion independent of whether the inequalities are concentrated within racial and ethnic minorities or the majority ethnic and racial population. The fact that inequalities cluster along racial and ethnic lines or along lines of social disadvantage adds nothing to the moral assessment insofar as no further factual information of any sort (including some sort of causal story) is needed to find an injustice.

Second, because the brute luck concept is indifferent to any casual inquiry beyond the role of individual choice, the brute luck view can provide no special justification for viewing inequalities in health services as injustices. For example, the brute luck view is indifferent to whether inequalities in health outcomes between patient groups are a result of disparities in access to health services or the impact of differential socioeconomic status and educational background. Both generate social duties to reduce or eliminate disparities in health outcomes. The fact of brute, unchosen inequality is enough.

The social structural concept takes a different view. Attaching a judgment of injustice to disparities in services or outcomes along lines of racial and ethnic minority status-- especially if burdened with other social disadvantages (the anti-discrimination thesis)-- is entirely consonant with the social structural view. The claim of the neutrality thesis, which is that disparities in health outcomes that do not necessarily involve disadvantaged groups also constitute an injustice, also can be accommodated by the social structural view, but only if a different set of morally relevant considerations can be brought to bear. Because the social structural view requires a causal story linking the social structure to health outcomes disparities, the case for injustice when disparities involve majority racial and ethnic patient groups would be more difficult to make than it would be for racial and ethnic groups who also experience broader social disadvantages. Even for these latter groups, a social structural view would necessitate the telling of a somewhat complex causal story to reach the conclusion that the inequalities are a matter of injustice and the responsibility of society to remedy. .

The Relevance of Individual Causal Responsibility

A key question faced by libertarian, social structural, and brute luck theories is just how much of the causal story needs to be sorted out before deciding whether a disparity constitutes an injustice. All of these theories exclude from the realm of social responsibility inequalities generated by the choices and actions of individuals. But is this blanket exclusion plausible? This is where many of our most influential theories of justice appear ham-handed when compared with the kinds of moral intuitions that influence much of social policy in the United States and other industrial nations. For example, health insurance and welfare laws generally eschew fine-grained apportionment of individual, social and natural causal contributions to ill health. In many respects, health insurance plays the role of a kind of social safety net, catching those who fall through, regardless of the cause.

There are at least two potential explanations for why the moral foundations of many aspects of social policy do not fit well with some leading theories of justice. First, the apportionment of individual, natural, and social responsibility is, in practice, extremely difficult to disentangle. Second, because apportioning causal responsibility is often so hard to do, it is fraught with the risk of error and is potentially unfair. There is no doubt that these difficulties both explain and justify why public policy relies on moral lenses that deliberately leave some elements of the causal story out of focus. We think that the right mix of moral lenses leaves such differences out of account when examining health outcomes , This is the insight captured in the claim of injustice attaching to the inequalities coming under the scrutiny of the neutrality thesis. It is also the moral basis of public health, which finds any disparity in health outcomes to be morally problematic, regardless of who is affected. However, we argue that a a special moral sensitivity to the constellation of race, ethnicity, and social disadvantage should be added back into the mix , especially when we have ample reason to believe that, although the precise causal story is complex, racial differences have made a dramatic contribution to the disproportionate burdens that are an artefact of the social structure. This is the insight captured by the claim of injustice attaching to the inequalities coming under scrutiny by the anti-discrimination thesis.

From this stereoscopic vantage point we turn to a few examples of how patient choices and behavior fit into the arguments thus far. Although neither the neutrality thesis nor the anti-discrimination thesis rejects the notion that patient choices and actions make a moral difference in assessing the injustice of disparities in health outcomes, we deny that patient choice and behavior necessarily vitiate a conclusion of injustice.

Consider, for example, how that argument for the moral decisiveness of a patient's own choice to refuse treatment offered and recommended might seem to settle the issue of injustice once and for all. One possible explanation for some disparities in health services is that racial and ethnic groups exhibit different preferences for some types of medical care. Some groups may have higher aversion rates, for example, to invasive coronary care procedures. In some instances, preference differences make all the moral difference and a conclusion of injustice associated with disparities in the receipt of care may be rebutted. However, even if disparities in utilization rates are explained primarily by differences in uptake, rather than differences in offering, that is not necessarily the end of the matter. For example, gaps in mammography use between white and African-American women have closed considerably over less than a decade. This has been a consequence of public health education and outreach campaigns mounted on the assumption that gaps in knowledge and awareness, not merely a matter of differences in individual preferences or cultural values, accounted for differences in mammography rates.

Others have argued that minority aversion to the utilization of beneficial treatments might be based on a reasonable distrust of medical institutions and personnel (Randall, 1996). Whether such distrust is widespread is an empirical matter, and determining whether such distrust is reasonable lies beyond our task here. However, to the extent that the formation of preferences among racial and ethnic minorities is a product of a legacy of intentional discrimination that results in disparities in utilization and health outcomes, the fact that patient preferences account for all or some portion of those disparities does not obviate their injustice. If the preferences themselves are the fruit of a morally tainted history of institutional relationships, those who occupy positions of authority within those institutions have continuing moral obligations to ensure that patient preferences that are detrimental to racial and ethnic minorities are not systematically disadvantaging. In short, our view argues for looking behind or beyond mere preference in some instances to make a moral assessment of racial and ethnic disparities in the uptake of health services and in the resulting disparities in health outcomes.

Libertarian theories of justice, as well as most forms of egalitarianism, are mute on whether preferences must be taken at their face value. Many brute luck theorists believe that some preferences are beyond voluntary control and are instances of brute bad luck for which there is a duty to remedy (Cohen,1993). The capability theorist also admits the possibility that some preferences are shaped by norms and institutions that involve unjust discrimination (for example, women's preferences for female circumcision . However, the idea of looking behind preferences is not the exclusive theoretical property of the brute luck theorist or any other particular theory. If the preferences themselves bear the moral taint of social structural injustices, then the social structural theorist cannot object. If the preferences bear the moral taint of intentional harms, then the libertarian cannot object. The difference is that each requires a different causal story to reach a conclusion of injustice when individual preference would ordinarily settle the moral matter in favor of there being no injustice.

Under all major accounts of justice, much of the work leading to a judgment of injustice involves getting the causal story straight, with some seeing overwhelming social determinants of such behaviors at work and others doubting the conclusiveness of the evidence and fearing the consequences of widespread belief in its truth. Although we lack the expertise to sort out these factual debates, our claim is a simpler one: there is too much at stake morally in ignoring the real possibility of some social structural causation. The demand for a precise apportionment of causal responsibility fails to take seriously the potential moral salience of the continuing effects of the legacy of racism and discrimination. Attaching a presumption of injustice to disparities in health outcomes that cluster along racial, ethnic, and socioeconomic lines is responsive to the need to fashion public policy with an awareness of the moral saliency of that legacy. Once again, we note that even the libertarian must attend to the importance of that history, for libertarianism is, in its own terms, a theory whose application is constrained by the assumption that patterns of inequalities are morally benign only when they emerge from a historical milieu in which injustices are not causally transmitted into the present context. In our view, few libertarians can claim that confidence when it comes to matters of race.

Moreover, at least for matters as central to human flourishing as health, we agree with the capabilities approach. The capabilities approach does not generally insist on the complete causal story to count disparities in health outcomes as instances of injustice. Moreover, the capabilities view demands additional moral scrutiny for racial and ethnic disparities in health care services and outcomes for moral reasons that have their foundation in capabilities other than health. These are capabilities that signal the importance of living a life as a free and equal moral person and enjoying the respect and dignity accorded to all citizens (Faden and Powers, 1999).

Implications for Physicians, Nurses and Other Providers of Health Care Services

From the perspective of the health professional, the bottom line of this analysis can be summarized as follows. All the theories that we have reviewed have reasons to morally condemn disparities in health services and health outcomes involving racial and ethnic minorities. These theories have different reasons for reaching this conclusion, and they do not all agree that such disparities necessarily constitute an injustice. However, they all agree that race and ethnicity are morally irrelevant to the distribution of health care services and the outcomes with which these services are associated. Even from a libertarian viewpoint, the failure of individuals and institutions to offer health services to all racial groups on an equal basis can be a significant reason for moral condemnation.

In some respects, this is stating what is morally obvious. It is wrong for health professionals to discriminate on the basis of race or ethnicity. General moral duties of equal respect, as well as role-specific duties of the healing professions, obligate health professionals to accord equal consideration to each patient. The Hippocratic Oath requires physicians to apply treatments “for the benefit of the sick”and to “keep [patients] from harm and injustice” (Edelstein, 1967). The standard interpretation of the Hippocractic tradition concludes that such duties be applied impartially, and that no matter of personal preference or prejudice should compromise those duties with respect to any patient (Pellegrino and Thomasma, 1988). The Code of Ethics of the American Nurses' Association similarly argues that the foundation of their professional duties rests in duties of beneficence impartially applied to all patients (American Nurses' Association, 1985). Health care professionals are also obligated to address the moral context in which they work and to take responsibility for ensuring that equal respect and treatment is accorded by colleagues and by the health care organization where they work. To the extent that unconscious biases compromise their impartial duties toward their patients, there are derivative moral duties to identify and counteract those biases.

One aim of this paper is to defend the view that racial and ethnic disparities are not merely matters of individual moral failing on the part of health professionals, but are also social injustices. Insofar as health professionals and professional organizations subscribe to this view, they should take a leadership role in advocating for interventions to reduce these disparities. It is here that good empirical data, capable of teasing apart the various factors that contribute to racial disparities, are critical. Ethical arguments can justify the need for social action, but knowing precisely how to effectively intervene requires an integration of ethics with facts.

American Nurses Association. 1985. Code for Nurses with Interpretative Statements . Kansas City, MO: American Nurses' Association.
Cohen, GA. 1993. Equality of what?: on welfare goods and capabilities . In M. Nusbaum, editor. , ed., The Quality of Life . Oxford: Clarendon Press.
Daniels, N. 1985. Just Health Care . New York: Cambridge University Press.
Edelstein, L. 1967. Ancient Medicine . Baltimore, MD: Johns Hopkins University Press.
Engelhardt, HT. 1996. The Foundations of Bioethics , 2 nd ed. New York: Oxford University Press.
Faden, R. and Powers, M. 1999. Justice and Incremental Health Care Reform . Washington, DC: Henry J. Kaiser Foundation.
Gutmann and Thompson 1996. Democracy and Disagreement . Cambridge, MA: Harvard University Press.
Harris, J. 1988. More and better justice . In M. Bell, editor; and S. Mendus, editor. , eds. Philosophy and Medical Welfare . Cambridge: Cambridge University Press, 75-96.
Mack, E. 1991. Agent-relativity of value, deontic restraints, and self-ownership . In R. Frey, editor; and C. Morris, editor. , eds. Value, Welfare, and Morality , 209-32.
Nozick, R. 1974. Anarchy, State, and Utopia . New York: Basic Books.
Nussbaum, M. 2000. Women and Human Development . Cambridge: Cambridge University Press.
Pellegrino, E and Thomasma, D. 1988. For the Patient's Good: The Restoration of Beneficence in Health Care . New York: Oxford University Press.
Randall, V. 1996. Slavery, segregation, and racism: trusting the health care system ain't always easy! an African-American perspective on bioethics . St. Louis University Public Law Review 88:191. [ PubMed : 11656870 ]
Rawls, J. 1971. A Theory of Justice . Cambridge, MA: Harvard University Press.
Rawls, 1993. J. Political Liberalism . New York: Columbia University Press.
Raz, J. 1986. The Morality of Freedom . Oxford: Oxford University Press.
Scanlon, TM. 1989. A good start: reply to Roemer . Boston Review 20(2):8-9.
Sen, A. 1992. Inequality Reexamined . Cambridge, MA: Harvard University Press.

. We do not claim that the neutrality thesis and the anti-discrimination thesis offer an exhaustive account of the sources of value underpinning the broader range of moral concerns in health care policy. We have argued elsewhere that in addition to medical outcomes some arguments for universal health care may depend as much on their impact on aspects of human well being other than health (Faden and Powers, 1999).

Cite this Page Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington (DC): National Academies Press (US); 2003. RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE: AN ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER.
PDF version of this title (6.3M)

In this Page

Related information.

PubMed Links to PubMed

Recent Activity

RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE: AN ETHICAL ANALYSIS OF WHEN AND HO... RACIAL AND ETHNIC DISPARITIES IN HEALTH CARE: AN ETHICAL ANALYSIS OF WHEN AND HOW THEY MATTER - Unequal Treatment

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

IMAGES

Defining Health Disparities and What They Mean
(PDF) Health Disparities by Race and Class: Why Both Matter
Disparities in Health and Health Care
≫ Health Disparities Research Free Essay Sample on Samploon.com
Black Americans’ views about health disparities, experiences with
Health Disparities a Growing Concern in the United States Research Paper

VIDEO

Three Minute Thesis (3MT) 2011
Phd Defence of Jan Caspar Peeken
MPH Thesis & Capstone Presentations
American Indian Health Disparities, Allison Peltier (2015 Winner)
Three Minute Thesis (3MT) 2013 QUT runner up
Roberta Rietti: CT Colonography Master Thesis

COMMENTS

Race, Healthcare, and Health Disparities: A Critical Review and
In this review we aimed to examine racial health disparities through the SDoH model and apply socioenvironmental theory 12 and resource deprivation theory 13 as race-conscious filters through which racial disparities data is analyzed and synthesized (Table 1). The analysis informed the conceptual framework through which we developed and propose ...
Health Equity Among Black Women in the United States
Black women in the United States experienced substantial improvements in health during the last century, yet health disparities persist. Black women continue to experience excess mortality relative to other U.S. women, including—despite overall improvements among Black women—shorter life expectancies 1 and higher rates of maternal mortality. 2 Moreover, Black women are disproportionately ...
PDF Racial Disparities in Infant and Maternal Care in The United States: a
Disparities in Mental Health Care 92 Disparate Impacts Related to the Lack of Representation of Black Health Care Workers 94 ... was inspired to write this thesis based on the disparities in birth outcomes experienced by Black mothers and their Children in my hometown, the City of Norfolk, VA. The
PDF Black Maternal Health Disparities Thesis (1)
This thesis is centered around Black maternal health disparities and the. impact of Roe v Wade being overturned on the future of Black maternal health. start off by first looking at the facts of maternal health disparities and how Black. women are dying at a higher rate than their White counterparts.
Dissertation or Thesis
Creator. Richmond, Jennifer. Affiliation: Gillings School of Global Public Health, Department of Health Behavior; Abstract. Background. Black patients are less likely than White patients to receive treatment for lung cancer, the leading cause of cancer death in the U.S. Mistrust of health care providers and systems contributes to disparities in several health services use outcomes, including ...
The concepts of health inequality, disparities and equity in the era of
2.2. Health disparities. Braveman et al. (2011) defined health disparities as systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups. In this definition, health disparities refer to both the different distribution of health outcomes as well as the different distribution of social determinants that are antecedents responsible for either promoting or ...
Race, Healthcare, and Health Disparities: A Critical Review and
An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently ...
Understanding and Mitigating Health Inequities
Eliminating racial health inequities requires a movement away from disparities as the focus of research and toward a research agenda centered on achieving equity by dismantling structural racism.
PDF Examining the Health Disparities in African American Women in the
This thesis will be specifically focusing on the health disparities of the women in the African American community, as well as the institutional, biological, behavioral, sociocultural, and environmental factors that influence these disparities (Chinn, 2021).
Disparities Among Black Women in Maternal Health
Abstract. The literature shows that Black women face many disparities in terms of health care ac-. cess and the quality of care. These obstacles could negatively affect the health of the mother and. their child. This paper includes a literature review and proposed research study. The objective of.
PDF Explaining Health Disparities: Evaluating and Advancing Methodology
The Problem of Health Disparities Health disparities are among the most salient public health concerns in the United States. Cancer, HIV/AIDS, homicide, cardiovascular, reproductive, and pediatric health outcomes are all strongly patterned along socio-demographic lines, with disadvantaged populations carrying a disproportionate disease burden.
Reducing Health Disparities in African American Communities through
Nevertheless, disparities in health care remain, which suggests that additional measures may be needed to meet the demands of the U.S. population. According to the Centers for Disease Control and Prevention (CDC; 2013), health care disparities continue to exist for minority populations, including a lack of access to care; limited health care
Racial Ethnic Health Disparities: A Phenomenological Exploration of
racial ethnic health disparities that require further studies to help mitigate the disparities. Racial/ethnic minorities experience poor health indicators including higher morbidity and mortality rates than non-Hispanic Whites (Davis, Cook, & Cohen, 2005), which is a problem to the nation. For instance, Native Americans, African Americans,
Measurement of Health Disparities, Health Inequities, and ...
elimination of health disparities and the advancement of health equity. The 2013 forum focused on mea-surement and monitoring of health disparities, health inequities, and social determinants of health. On the basis of knowledge of the literature, the authors of this article outlined key principles of measurement in advance of this forum.
Racism: a fundamental driver of racial disparities in health-care
Racial disparities in health-care access, quality and outcomes are frequent. Here, the authors discuss how racial disparities can be addressed at an individual and institutional level.
Structural Racism In Historical And Modern US Health Care Policy
Disparities in health and health care: 5 key questions and answers [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2021 May 11 [cited 2021 Dec 10].
Examining Health Disparities Related to Foodborne Illnesses Across
AIM: The purpose of this thesis was to identify current trends of documenting disparities of foodborne illness across populations and evaluate the mechanism of data representations through a literature review. To further explore the topics identified in the literature review, an analysis of salmonellosis data on the county level was conducted.
AmadorMaricarmen Health Disparities Among Hispanic Low Socioeconomic
Health Disparities Among Hispanic Low Socioeconomic Communities A THESIS Presented to the University Honors Program California State University, Long Beach In Partial Fulfillment of the Requirements for the University Honors Program Certificate Maricarmen Amador May 2022 .
An atlas of health inequalities and health disparities research: "How
Cluster 3: Health Disparities Research (US). Almost all (96%) of the network's largest cluster is located within the US, and half hold a PhD or other doctoral degree in Public health (including epidemiology) or medicine. Nursing, psychology and sociology PhDs are also represented, but political science and the humanities are absent.
Health Equity and the Circle of Human Concern
This process leads to tension between the principles of liberty and equality and contributes to the creation of systemic disadvantage as manifested in health disparities. Creating an equitable health system must begin with this root understanding and generate greater belonging through the policy process of targeted universalism. Targeted ...
PDF The Top 100 Cited Papers in Health Care Disparities: a Bibliometric
The most cited article was Martin's 2002 work identify-ing the demography of incidence and occurrence of sepsis with specific analysis of race, sex, and disposition of US patients. The second most cited article was Kamangars 2006 paper. '. outlining geographic patterns in cancer incidence, mortality, and prevalence.
Oregon State University
We would like to show you a description here but the site won't allow us.
Addressing Health Disparities—The Case for Variant Transthyretin
There has been a transformational change in understanding heart failure due to transthyretin cardiac amyloidosis (ATTR-CA). Previously considered a rare condition, the widespread adaptation of nuclear imaging to establish the diagnosis has led to the recognition that ATTR-CA is commonly encountered...
HHS Awards $11.6 Million to Address Disparities in Healthy People 2030
Today, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) announced $11.6 million in grant awards to 20 organizations for its Community Level Innovations for Improving Health Outcomes Initiative. The awards will support a four-year initiative to identify community level innovations that increase the use of preventive health services. The community level ...
2024 NCDHHS Health Disparities Analysis Report
2024 NCDHHS Health Disparities Analysis Report 2024 NCDHHS Health Disparities Analysis Report. ... September 4, 2024. Contact Information. NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000 Customer Service Center: 1-800-662-7030 Visit RelayNC for information about TTY services. Follow Us. Network Menu ...
Disparities in Medication Use for Criminal Justice System-Referred
Key Points. Question Have disparities in medication for opioid use disorder (MOUD) treatment between individuals referred by the criminal justice system and other sources decreased?. Findings This cross-sectional study, analyzing more than 3 million admissions to treatment centers for opioid use disorder between 2014 and 2021, found that although the use of MOUD among people referred to ...
Register Today: AACR Conference on Cancer Health Disparities, September
LOS ANGELES - The American Association for Cancer Research (AACR), in association with the AACR Minorities in Cancer Research Council, will host the 17th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorites and the Medically Underserved from September 21-24 in Los Angeles, California. Registration is complimentary for credentialed members of the media.
Hundreds of places in the US said racism was a public health crisis
More than 200 cities and counties declared racism was a public health crisis in the past few years, mostly after George Floyd was murdered by police in Minneapolis in May 2020. Racial justice advocates said they finally felt heard by the quick swell of political will to address disparities like disproportionate COVID-19 deaths or infant and maternal mortality rates.
Racial and Ethnic Disparities in Health Care: an Ethical Analysis of
The neutrality thesis covers disparities in health outcomes among any patient groups with presumptively similar medical conditions and prognoses. By contrast, the anti-discrimination thesis refers specifically to a subset of what falls under the neutrality thesis-the special case in which the outcome disparities involve racial, ethnic or ...
UAMS awarded nearly $600,000 HHS grant to reduce infant ...
The ultimate goal is to reduce disparities in health status among people of particular racial, ethnic and tribal backgrounds. The studies are based in two public health technical measures: Social Determinants of Health (SDOH) and Leading Health Indicator (LHI), measuring one against the other. HHS Deputy Assistant Secretary for Minority Health ...