African Americans: disparities in health care access and utilization.

Despite remarkable improvements in the overall health of our nation during the past two decades, compelling evidence suggests that our nation's racial and ethnic minority Americans suffer increasing disparities in the incidence, prevalence, mortality, and burden of diseases and adverse health outcomes compared with white Americans. The 1998 Presidential Initiative on Race and Health was the first national commitment to eliminate health disparities between majority and minority population groups. Because racial and ethnic minority groups will increase to nearly 40 percent of the U.S. population by 2030 (U.S. Department of Health and Human Services [HHS] 2000), a stronger commitment to better understand health disparities and develop new diagnostic, treatment, and prevention strategies for their elimination is a sound investment. Only rigorous population and epidemiologic research can discern where these disparities exist, define the scope of the problem, and identify and evaluate new interventions to reduce and eliminate them. Sources of these disparities are multivariate, complex, and rooted in an inequitable health care system. Contributing factors include lack of access to health care; barriers to care; increased risk of disability and disease resulting from occupational exposure; biological, socioeconomic, ethnic, and family factors; cultural values and education; social relationships between majority and minority population groups; autonomous institutions within ethnic minority group populations; and culturally insensitive health care systems (Geronimus, 2000; HHS, 2000; HHS, 2001b; Jackson et al., 2001; Smedley, Stith, & Nelson, 2003). The practice implications of disparities in health care deserve the attention of health care professionals, administrators, policymakers, and consumers. Health disparities pose moral and ethical dilemmas in our rapidly changing health care system. They threaten our efforts to improve health outcomes and create problems for a society that continues to struggle with a legacy of racial discrimination and oppression. Because health care resources are tied to social justice, opportunity, and quality of life, the productivity of the workforce is linked to the health status of its workers. The cost of inadequate health care has a huge impact on overall health care expenditures. In the final analysis, these disparities prompt concerns about the overall quality of health care in the Unites States (Smedley et al., 2003). The professional values of social work practice compel us to participate in the fight for a health care system that is sensitive to the health care needs of all, regardless of race or ethnicity. Service equity is part of our call to social justice. Having a diverse society is an asset and a challenge for our nation. Racial and ethnic disparities in health care occur among several population and subpopulation groups: American Indians, Alaska Natives, Asian Americans and Pacific Islanders, and Hispanic Americans; rural and urban populations; infants, children, and youths; adults and senior citizens, and so forth. The scope of this column does not permit an in-depth discussion of the relationship between health disparities and cultural and ethnic characteristics unique to each group. Nor is it appropriate to approach the health disparity problem from a racial or an ethnically blind perspective. The focus of this column is African Americans, who have a unique history in the United States, rooted in slavery, emancipation, segregation, racism, and discrimination. AFRICAN AMERICANS AND HEALTH DISPARITIES Approximately 12 percent (34.7 million) of the U.S. population is African American (HHS, 1999). Compared with white Americans, they are less likely to have private or employment-based health insurance, more likely to be covered by Medicaid or other publicly funded insurance, and twice as likely to be uninsured, even though eight of 10 are in working families. …