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An Internet Guide to Racial Disparities in Health,

by Rebekah Park & Kristina Joye An Internet Guide: Health Disparities in Minority Communities

GENERAL INFORMATION ON HEALTH
The major U.S. government agency that deals with health policies and services is the Department of Health and Human Services (HHS) which oversees over 300 federal programs and contains several programs that are designed to address racial disparities in health outcomes. Under "Specific Populations," go to "Ethnic and Racial Minorities," where you will find research engines for specific ethnic/racial groups. Two other websites to visit at the beginning of your research are: The National Health Law Program (NHeLP), a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities. NHeLP has one of the most comprehensive websites on health issues, and features a section called "Racial Issues/Civil Rights." In addition, NHeLP features a "Health Advocate's Guide to the Internet". To access this guide, click here. Second, Families USA, a nonprofit and nonpartisan organization that advocates for affordable and quality healthcare, also has numerous publications on current health policies and minorities. Here you will find relevant articles and references about racial and ethnic disparities under the "Communities of Color."

PRRAC has developed a directory of state and local initiatives on health disparities.

For an overview on racial health disparities, the National Research Council produces a free online publication called American Becoming. The health section features articles that seek to improve the health status of racial and ethnic minorities:

Chapter 11 by Herbert W. Nickens, "Racial and Ethnic Differences in Health: Recent Trends, Current Patterns, Future Directions."
Chapter 12 by Vonnie C. McLoyd and Betsy Lozoff, "Racial and Ethnic Trends in Children's and Adolescents' Behavior and Development."
Chapter 13 by Renée R. Jenkins, "The Health of Minority Children in the Year 2000: The Role of Government Programs in Improving the Health Status of America's Children."
Chapter 14 by David R. Williams, "Racial Variations in Adult Health Status: Patterns, Paradoxes, and Prospects."

In addition, the American Public Health Association also features a website on Minority Health.


PUBLIC POLICY AND RESEARCH STUDIES
There are major efforts underway to address racial disparities in health both in clinical practice and in the way social science studies are designed. The Center for the Advancement of Health in conjunction with the MacArthur Foundation recently held a conference on April 29, 2004 in Washington D.C. that highlighted key research on the relationships among socioeconomic status, race/ethnicity, and health. The main purpose of the Center for the Advancement of Health is to bring together health research, medical practice and health and social policy with the intention of accelerating the application of scientific advances for public benefit. On their website, you can find their latest research on social and health inequities in communities across the United States, including research by: Ichiro Kawachi of Harvard University and David R. Williams of University of Michigan.

Some leading researchers who examine the role that discrimination and racism play in causing racial health disparities are:
Norman Anderson
Camara Jones
Raymond Kingston
Nancy Krieger
The 2004 conference agenda and presentations from some of the leading researchers in the field can be accessed here.


A valuable independent scientific organization is The Institute of Medicine, a component of the National Academy of Sciences, which works outside of government and serves as an independent voice on matters relating to biomedical science, medicine, and health. Go to "Minority Health" for a listing of their reports. (Also see discussion below about their 1999 report Unequal Treatment: Confronting Racial & Ethnic Disparities in Healthcare).

Another leading research center that provides information around affordable and quality healthcare for policymakers, public health officials, healthcare administrators and advocates is the George Washington University Center for Health Services Research and Policy. This website is more useful for those looking for information related to current health policies, such as Medicaid, SCHIP and Medicare, and poverty. Also, the Institute on Race, Healthcare, and the Law provides information on how the law can be used to eliminate racial disparities in health status and healthcare.

One of the main areas of research on racial disparities is centered on the difference in treatment and experience of patients among different racial/ethnic groups. The Provider's Guide to Quality and Culture, a website to assist healthcare organizations to provide culturally competent services, features a section on "Health Disparities" that addresses ways in which access, communication, screening, diagnosis, and treatment lead to discrepancies in mortality and disability rates among different cultural groups.

Also visit the University of California San Diego School of Medicine link to the Comprehensive Research Center in Health Disparities, to gain an in depth look at research strategies, pilot projects, and valuable community partnerships in combating health disparities.

For more specific information on particular racial groups, the following organizations are working on health disparities in specific communities:

African Americans
The Congressional Black Caucus Health Foundation focuses on health issues relevant to the African and African American community
and posts articles under "Health Disparities." The Black Women's Health Imperative is a leading African American health education, research, advocacy, and leadership development institution. They co-sponsored three research studies that address socioeconomic factors and disparities: Reach 2010: At the Heart of New Orleans, Black Women's Wellness Study, and The Impact of Pyschosocial Factors on Health: A Study of African American Women that can be accessed here. In addition, on Medline Plus, you can search for recent research articles on African American health.

Asians
A general website on health issues specific to Asian Americans is the National Library of Medicine Asian American Health. The Asian and Pacific Islander American Health Forum, has resources for those in advocacy work. Another place to find fact sheets is the Asian Health Services, where they work on immigrant and refugee issues in the Asian community, particularly around access to healthcare. For information on health campaigns to promote better care and access for Asian American and Pacific Islander communities, visit Association of Asian American Community Health Organizations. On Medline Plus you can access the latest research articles on Asian American health.

Latinos
One of the most comprehensive sites for Latinos is the National Alliance for Hispanic Health. The National Alliance for Hispanic Health is the nation's oldest and largest network of Hispanic health and service providers. Their website includes fact sheets, links, reports, legislative updates, and policy briefs.
The Centers for Disease Control features a website in Spanish that provides information about health, recent articles, and a link to their website on Minority Health, also in Spanish. For the same website in English, click here. Visit Medline Plus for the latest research articles on health for Latinos.

COMMUNITY SUPPORT
The Center for Minority Health at University of Pittsburgh features a website on community outreach and information dissemination. On this website you can find suggestions on "What You Can Do" as well as "Web Tool Kits" on various health issues, including HIV/AIDS, Infant Mortality, and Diabetes.

Another website that has useful public education tool kits and applicable publications is Community Voices, which works to pilot different approaches and strategies and bridge healthcare delivery to underserved populations with new policy solutions. On their website you can download policy briefs, including: Community Voices: Lessons for a National Health Policy, Community-Based Health Coverage Programs: Models and Lessons, Community Health Workers and Community Voices: Promoting Good Health, and Saving Men's Lives (on the silent health crisis affecting men of color).

Other grassroots and advocacy groups include the Healthcare Leadership Council, providing a healthcare provider's point of view and the National Association of Community Health Centers, a "non-profit organization whose mission is to enhance and expand access to quality, community-responsive health care for America's medically underserved and uninsured." The website provides information on key issues affecting community-based health centers and the delivery of health care for the medically underserved and uninsured.

FEDERAL STUDIES ON MINORITY AND HEALTH
There are a few federal reports and centers that are worth mentioning here. The Office of Minority Health Resource Center (OMHRC) was established by the U.S. Department of Health and Human Services (HHS) offices of Minority Health in 1987, and serves as the clearinghouse for research and referral services on issues relating to American Indian and Alaska Native, African American, Asian American and Pacific Islander and Hispanic populations. The OMHRC also hosts "Closing the Health Gap," an educational campaign designed to make "good health" an issue among racial and ethnic groups who are affected by issues and health conditions at far greater rates than other Americans.

Several Surgeon General reports of the U.S. Public Health Service are also available online. To access a recent 2001 report, "Mental Health: Culture, Race and Ethnicity, A Supplement to Mental Health: A report of the Surgeon General," click here.

The Agency for Healthcare Research and Quality released, National Healthcare Disparities Report, a report that tracks disparities in health care delivery pertaining to racial and socioeconomic factors. The purpose of this report is to provide a comprehensive view of the differences in health care quality and access associated with patient race, ethnicity, income, education, and place of residence. You can access the report here. This report drew criticism from Democrats on the Bush administration for allegedly altering the report to put a positive spin on the racial disparities. See the New York Times article.

Currently, several leading federal agencies and the HHS have partnered with businesses and membership and state organizations to promote the "Healthy People, 2010" campaign. This is a national prevention initiative to increase the quality and years of life and to decrease health disparities. For commentary on this report, the National Alliance for Hispanic Health released "Hispanic Health Needs Assessment" in response to the lack of attention paid to the objectives and recommendations made by the Hispanic community leadership during the public comment period.

The Institute of Medicine released a report commissioned by Congress in 1999 to assess the disparities among U.S. minorities and provide policy recommendations. The report from this study, Unequal Treatment: Confronting Racial & Ethnic Disparities in Healthcare, found considerable amount of research on the existence of racial disparities in spite of comparable insurance status, income, age, and severity of conditions.

The Provider’s Perspective

Understanding and addressing health disparities requires the involvement of healthcare providers. A valuable research tool from this standpoint is the Finding Answers, National Program of the Robert Wood Johnson Foundation at the University of Chicago. It awards and manages research grants to healthcare organizations implementing interventions aimed at reducing disparities. This initiative fosters the involvement of hospitals, community health clinics, and health plans to focus on racial and ethnic disparities in their procedural agendas. The goal is real-world implementation


For information on specific evidence-based health care quality measures and measure sets, access the National Quality Measures Clearinghouse, sponsored by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. NQMC is designed to promote widespread access to quality measures by the health care community and interested individuals.

Similar to the discussion of widespread access to quality measures is the exploration of widespread infectious diseases adversely affecting communities across racial, gender, an ethnic borders is the Office of Minority and Women’s Health of the Center for Disease Control. Key issues are addressed through research, surveillance, education, training, and program development. Click here to gain access to “Healthy People 2010,” which describes the nation’s guidelines for eliminating racial and ethnic disparities in health.

The Maryland Department of Health and Mental Hygiene provides a database of Health Disparities Websites aimed at raising consciousness both locally and nationally. Click here to gain access. For a comprehensive database of journal articles in the areas of health topics, racial/ethnic populations, organizational settling, and intervention strategies, visit the FAIR Database.


ADDITIONAL INFORMATION
Periodicals

Several periodicals confront health disparities issues head-on. Check out these selected
titles, below.

Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson, Unequal Treatment:
Confronting Racial and Ethnic Disparities in Healthcare.

Thomas A. LaVeist, Race, Ethnicity, and Health: A Public Health Reader.

Dolores Acevedo-Garcia and Theresa Osypuk, Impacts of Housing and Neighborhoods
on Health: Pathways, Racial/Ethnic Disparities, and Policy Directions, Chapter 6 from
Segregation: The Rising Cost for America, eds James H. Carr and Nandinee K. Kutty.

Nestle, M. Food Marketing and Childhood Obesity-A Matter of Policy. (New England
Journal of Medicine).

M.M. Mello, D. M. Studdert, and T.A. Brennan, Obesity-The New Fronteier of Public
Health Law. (New England Journal of Medicine).

Asch, et al, Who is at Greatest Risk for Receiving Poor-Quality Health Care? (New
England Journal of Medicine)

Federal Agencies
For a general listing of Federal Agencies offering research and support in the areas of
minoritys and health, health disparities, and healthcare, see below.
Department of Health and Human Services
o Administration for Children and Families (ACF)
o Administration on Aging (AOA)
o Agency for Healthcare Research and Quality (AHRQ)
o Agency for Toxic Substances and Disease Registry (ASTDR)
o Centers for Disease Control and Prevention (CDC)
o Centers for Medicare and Medicaid Services (formerly Health Care
Financing Administration)
o Food and Drug Administration
o Health Resources and Services Administration (HRSA)
o Indian Health Service (IHS) (The Federal Health Program for American
Indians and Alaska Natives)
o National Center for Health Statistics
o National Institutes of Health
o National Library of Medicine
o Office for Civil Rights (OCR)
o Office of Women's Health (OWH)
o Office of Minority Health (OMH)
o Office of Inspector General (OIG) - internal auditing
agency for DHHS
o Office of the Surgeon General (OSG)
o Substance Abuse and Mental Health Services Administration (SAMHSA)

State Agencies
For a general listing of State agencies, check out the following three websites:
• State & Territorial Links (The Association of State and Territorial Health Officials) provides links to state health agencies
Statehealthfacts.org (Kaiser Family Foundation) provides contact information of
health agencies by state
• State Health Policy Web Portals (Center for Health Policy, Law and Management, Duke University) links to all known state-level health policy portals. If no portal has yet been identified for a state, a link to the state hospital association is provided.

Medical and Health Dictionaries
Understanding medical and health terminology is an important facet of assessing health
disparities. For links to commonly used medical/health dictionaries, see the following.
Glossary of Commonly Used Health Care Terms (Academy Health)
Gray's Anatomy
MedTerms.com
Medi Lexicon (formerly Pharma-Lexicon) Includes "over 110,000 medical, pharmaceutical, biomedical and healthcare acronyms and abbreviations."

Statistics
For healthcare-related statistics, there are several databases on the issue. They include:
National Center for Health Statistics is the "Nation's principal health statistics agency." This is a compilation of statistical information to guide actions and policies to improve the health of Americans.
Medicaid Research, Statistics, Data & Systems The Centers for Medicare & Medicaid Services (CMS) "offers researchers and other health care professionals a broad range of quantitative information on (its) programs, from estimates of futher Medicare and Medicaid spending to enrollment, spending, and claims data. CMS also offers a broad range of consumer research to help its partners and staff. "
Statehealthfacts.org (Kaiser Family Foundation) provides data on more than 450 health topics across all 50 states and the District of Columbia. Data are collected from a variety of public and private sources, including: original Kaiser Family Foundation reports, data from public Web sites, and information purchased from private organizations.
American FactFinder (U.S. Census Bureau)
For a General Health Law Research Guide, available from the law library of Georgetown Law, click here.

Rebekah Park is a PRRAC Research Associate.
 
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