Disparities Dialogue

By David A. Kindig, MD, PhD

Over the past couple of months, I’ve given some attention to the issue of health disparities by asking how we should focus our efforts and giving a perspective on bending health disparity curves.

I always appreciate when readers respond, whether to agree, disagree, or offer an alternative perspective and I’d like to share a couple of comments on the disparities posts that expand on my ideas.

Craig Mosbaek wrote that "I agree that what we need to do is improve health for less healthy groups. And it is true that many public health policies and programs actually increase disparities because these policies/programs are more effective in healthier populations. But, we can do better. We should look at each policy/program and see if it is increasing or decreasing health equity. Where it is decreasing health equity, we should modify the policy/program to address the disparity.”

Likewise, Ed Donovan wrote, “I agree that focusing directly on racial disparities in health often helps identify obstacles rather solutions. Focusing rather on the social and physical environmental determinants of health may help directly answer the "what's in it for me" question and indirectly address racial/ethnic disparities.”

In addition to working to address both overt and subtle forms of racism in our society, we must also recognize that income and education are powerful drivers of health regardless of race and ethnicity. A commitment to strengthening policies that bolster access to adequate income, employment, education, and early childhood opportunities will lift all boats, and improve overall health as well as health reduce disparities.

As Craig and Ed remind us, we need to be deliberate and broad-minded in our approach.

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In recent and related news, HHS Secretary Sebelius announced last week the release of two strategic plans aimed at reducing health disparities.

The HHS Action Plan to Reduce Health Disparities outlines the role to be taken by the federal government, while the National Stakeholder Strategy for Achieving Health Equity focuses on recommendations for public and private sector initiatives.

David A. Kindig, MD, PhD, is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health.