This “immigrant paradox” appears to diminish with time spent in the United States, however ( Lara et al., 2005). Some minority groups-most notably, Hispanic immigrants-have better health outcomes than whites ( Lara et al., 2005). ![]() It is important to note that this pattern is not universal. population, and by 2060, nearly one in five of the nation's total population will be foreign born ( Colby and Ortman, 2014).įor racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease and premature death compared to the rates among whites. By the year 2044, they will account for more than half of the total U.S. ![]() ![]() “Minority” populations, which already constitute majorities in some cities and states (e.g., California), will become the majority nationwide within 30 years. Census Bureau, 37.9 percent of the population was identified to be racial or ethnic minorities in 2014 ( NCHS, 2016). The criteria people use to classify themselves and others racially and ethnically and the attitudes that people hold about race and ethnicity have been changing significantly in the early 21st century. Therefore, solutions for health equity need to take into account the social, political, and historical context of race and ethnicity in this country. Moreover, race and ethnicity are extremely salient factors when examining health inequity ( Bell and Lee, 2011 Smedley et al., 2008 Williams et al., 2010). Racial and ethnic disparities are arguably the most obstinate inequities in health over time, despite the many strides that have been made to improve health in the United States. Furthermore, the concept of race is complex, with a rich history of scientific and philosophical debate as to the nature of race ( James, 2016). It is important to acknowledge the social construction (i.e., created from prevailing social perceptions, historical policies, and practices) of the concepts of race and ethnicity because it has implications for how measures of race have been used and changed over time. Race and ethnicity are socially constructed categories that have tangible effects on the lives of individuals who are defined by how one perceives one's self and how one is perceived by others. In this section, we describe health disparities affecting populations across multiple dimensions. These are the type of disparities that are reflected in the committee's charge and that will be addressed for the remainder of this report. Health disparities can stem from health inequities-systematic differences in the health of groups and communities occupying unequal positions in society that are avoidable and unjust ( Graham, 2004). Indeed, the existing evidence on health disparities does reveal differential health outcomes across and within all of the aforementioned identity groups. According to Healthy People 2020, all of these factors, in addition to race and ethnicity, shape an individual's ability to achieve optimal health ( Healthy People 2020, 2016). ![]() While the term disparities is often used or interpreted to reflect differences between racial or ethnic groups, disparities can exist across many other dimensions as well, such as gender, sexual orientation, age, disability status, socioeconomic status, and geographic location. In Chapter 5 the report takes a more in-depth look into nine examples of community-driven solutions to promote health equity.įor the purposes of this report, health disparities are differences that exist among specific population groups in the United States in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, burden of disease, and other adverse health conditions ( NIH, 2014). These brief examples are meant to be illustrative of the work being undertaken by communities throughout the country. In Chapters 2 and 3, the report features examples of communities that are taking action to address the root causes of health inequity. The committee drew on existing literature, comprehensive reviews ( AHRQ, 2016 NCHS, 2016), and recent studies. In addition, this chapter summarizes data related to military veterans as well as rural versus urban-area differences. In this chapter the committee reviews the state of health disparities in the United States by race and ethnicity, gender, sexual orientation and gender identity, and disability status, highlighting populations that are disproportionately impacted by inequity. As part of its statement of task, the committee was asked to review the state of health disparities in the United States and to explore the underlying conditions and root causes contributing to health inequities and the interdependent nature of the factors that create them (drawing from existing literature and syntheses on health disparities and health inequities).
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