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 11-2), which displays information about disparities among select populations for which data were available for assessment.

Among select racial and ethnic populations, the non-Hispanic Asian or Pacific Islander group had the best rate for Internet access (11-1). The black non-Hispanic population had the best rate for all four subobjectives for satisfaction with providers' communication skills (11-6).

Compared with females, males had the better rate for Internet access (11-1). Males had better rates for reporting that providers always listen to them (11-6a), show respect (11-6c), and spend enough time with them (11-6d). Females had the better rate for reporting that providers always explain things in a way they can understand (11-6b).

Among education groups, persons with at least some college had the best rate for Internet access (11-1) and for reporting that providers explain things in a way they can understand (11-6b). For providers' listening, showing respect, and spending enough time (11-6a, c, and d), the best rate was among persons with less than a high school education. Persons living in urban or metropolitan areas had better Internet access than residents in rural or nonmetropolitan areas. The latter, however, had the better rate for all four subobjectives for providers' communication skills. Persons with disabilities had the better rate for providers' listening carefully. Persons without disabilities had the better rate on the other three dimensions for providers' communication skills (11-6b, c, and d). No statistically significant disparities or disparities of 10 percent or more were noted for gender, urban-rural location, or disability status.

Less than half as many households in the Hispanic and black non-Hispanic populations had Internet access (11-1), as did households in the non-Hispanic Asian or Pacific Islander (best) population. Between 1998 and 2001, the disparity between these two populations and the best group increased by 50 to 99 percentage points. A smaller increase in disparity (10 to 49 percentage points) was seen between the white non Hispanic population and the best group. Disparities also increased among households headed by persons with a high school education or less, compared with persons with at least some college. Despite these increases in disparity, all racial and ethnic populations and populations by level of education moved toward the target. For example, between 1998 and 2001, the percent of Hispanic and black non-Hispanic households with Internet access more than doubled. Internet access in households of high school graduates also doubled.

The non-Hispanic Asian or Pacific Islander group had the largest disparities from the black non-Hispanic (best) population for patients reporting that health providers always listen, provide understandable explanations, and show respect (11-6a, b, and c). The white non-Hispanic population had an increase in disparity for persons reporting that their providers always listen carefully to them (11-6a) and have respect for what they say (11-6c). The Hispanic group experienced a decrease in disparities of 10 to 49 percentage points from the best group in reporting that their providers explain topics in a way they understand (11-6b). High school graduates experienced a 10 to 49 percent point increase in disparity, compared with persons with less than a high school education, regarding providers always showing respect for them (11-6c).

More research is needed to identify the most important factors affecting patient-provider communication and the ways these factors interact with each other. Even without additional research, patients representing select racial and ethnic populations may experience a change in their providers' behavior as a result of initiatives in cultural competency. Multiple organizations, including OMH and the Health Resources and Services Administration within HHS, as well as the Nation's medical schools, are working to provide standards and training in cultural competency skills. Cultural competency training is designed to enhance providers' ability to listen effectively, show respect, and provide information to patients in appropriate ways. The dissemination of cultural competency training for health care students and practitioners already in the community is one promising approach that could help decrease disparities.^{10, 11}

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