Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 18-2), which displays information about disparities among select populations for which data were available for assessment.

The white non-Hispanic population had the best rate for five of the six objectives with significant racial and ethnic disparities. The disparities in treatment of mental illness (18-9a, b, and c) between the white non-Hispanic (best group) and the Hispanic and black non-Hispanic populations were between 50 percent and 99 percent. The disparity between the black and white non-Hispanic (best) populations in the treatment of mental illness (18-7) in persons aged 4 to 17 years was also in the 50 percent to 99 percent range.

The Asian or Pacific Islander population and the black non-Hispanic population had the lowest (best) rate for suicide (18-1). The rate for the white non-Hispanic population was twice the rates of these populations, and the disparity increased between 1999 and 2002. In the Asian or Pacific Islander population and the black non-Hispanic population (best groups), the suicide rate decreased; in contrast, the suicide rate for the white non-Hispanic population increased. However, the white non-Hispanic population consistently had the best rate for accessing and receiving treatment for a variety of mental disorders (18-9). The white non-Hispanic population also was best for persons with SMI obtaining employment (18-4), although the differences among racial and ethnic populations were not statistically significant.

Females had better rates than males for four of the six objectives and subobjectives with significant gender differences. The disparities between the two populations were generally less than 50 percent, with the notable exception of suicide (18-1). Between 1999 and 2002, male suicide rates were consistently more than double those of females.

Persons with at least some college had the best rates for three of the five objectives with significant differences among education levels, while high school graduates had the best rates for two objectives. Persons with less than a high school education did not have the best rate for any mental health objective. For this population, the treatment rate for schizophrenia (18-9c) and employment for persons with SMI (18-4) demonstrated disparities of more than 50 percent from the best group rates. During the period 1999 and 2002, the disparity in the suicide rate between the population with less than a high school education and the best group (those with at least some college) declined. The suicide rate for persons with a high school education was twice the rate observed in the best group. Limited data exist to examine disparities among populations by income level.

Data demonstrate that the rates for mental disorders are similar across all populations in the United States. Yet, select populations face significant barriers in accessing quality and culturally competent behavioral health care.⁵ The Surgeon General's report on mental health, culture, race, and ethnicity offers several recommendations for addressing these disparities.²³ The recommendations include the expansion of scientific research into mental health in select populations, more widespread geographic distribution and availability of mental health care services, integration of mental health with primary care, improved linguistic access for mental health care services, and coordinated care to vulnerable, high-need populations.

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