Select Articles from the RWJF-Sponsored Issue of Health Affairs "Disparities in Health: Expanding the Focus"

Published: March 11, 2008

Pay special attention this week to the new March/April issue of the journalHealth Affairs. The entire issue, which RWJF sponsored, is devoted to disparities. The findings presented here—and they are striking—reveal in specific detail from a range of important perspectives how factors such as social determinants, disparities in the health care system, and the lack of diversity in the health professions coalesce to undermine the quality and fairness of our health and health care.

Start with the prologue on "The Social Determinants of Health" and the first article analyzing "Geographic and Racial/Ethnic Disparities in Child Health." Dolores Acevedo-Garcia and colleagues—including David R. Williams, director of the RWJF Commission to Build a Healthier America —paint a disturbing picture of an "unequal geography of opportunity."

Next, the article on "Race, Ethnicity and the Education Gradient in Health" by Rachel Tolbert Kimbro and colleagues, examines how education is a more powerful determinant of health behaviors and outcomes for certain racial/ethnic groups than for others.

On the health care quality side, a Datawatch article explores how the site of care affects health care disparities. The new study, "The Characteristics and Performance of Hospitals that Care for Elderly Hispanic Americans," is the first to examine where Hispanics receive hospital care and finds that a small number of hospitals care for most elderly Hispanics in the nation. The researchers document how hospitals that disproportionately serve Hispanics provide lower-quality care for common medical conditions.

Additional articles authored by RWJF-funded researchers include:

  • "Disparities in Physician Care: Experiences and Perceptions of a Multi-Ethnic America"—If public policies provided minority groups with better insurance coverage and language skills, many of the health care disparities found in this study would be narrowed.
  • "Evaluating Interventions to Reduce Health Care Disparities: An RWJF Program"—Now that racial/ethnic disparities have been well documented, what can be done to reduce them in real-world settings?
  • "Challenges to Using a Business Case for Addressing Health Disparities"—For health care organizations, the social case for reducing health disparities should be just as important as the business case.

Good health comes from healthy lifestyles, good choices and a supporting environment. Good health care comes by delivering the right care at the right time in the right way. Neither will occur without deep, long-lasting transformational change in our systems, in our behaviors and in ourselves.

Getting us there is our passion and our mission. This special issue of Health Affairs certainly helps illuminate our way forward. Our hope is that others will join us on our path and help establish quality and equality for everyone in our society. The health and well-being of all of us in America depends on it.

To learn more about RWJF's initiatives, the programs and projects the Foundation is supporting, and the partners it is working with to address social determinants of health, improve the quality and equality of our health care system, ensure a qualified and diverse health care workforce, strengthen and improve our public health system, and meet the needs of society's most vulnerable populations, subscribe to RWJF.org E-mail Services.


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Toward a Policy-Relevant Analysis of Geographic and Racial/Ethnic Disparities in Child Health

By:
Acevedo-Garcia D, Osypuk TL, McArdle N and Williams DR

Publication date:
March/April 2008

Summary:
Extreme racial/ethnic disparities exist in children's access to "opportunity neighborhoods." These disparities arise from high levels of residential segregation and have implications for health and well-being in childhood and throughout the life course. The fact...

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Race Ethnicity, and the Education Gradient in Health

By:
Tolbert Kimbro R, Bzostek S, Goldman N and Rodriguez G

Publication date:
March/April 2008

Summary:
Using pooled data from the 2000–2006 National Health Interview Survey, the authors document how the relationship between education and a broad range of health measures varies by race/ethnicity and nativity. They found that education is a more powerful...

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The Characteristics and Performance of Hospitals That Care for Elderly Hispanic Americans

By:
Jha AK, Orav EJ, Zheng J and Epstein AM

Publication date:
March/April 2008

Summary:
The site of care may play an important role in health care disparities. The authors of this study examined the 5 percent of U.S. hospitals with the highest proportion of elderly Hispanic patients and found that these hospitals cared for more than half of elderly...

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Disparities In Physician Care

By:
Blendon RJ, Buhr T, Cassidy EF, Perez DJ, Sussman T, Benson JM and Herrmann MJ

Publication date:
March/April 2008

Summary:
This 2007 Harvard School of Public Health/Robert Wood Johnson Foundation survey of 4,334 randomly selected U.S. adults compared perceptions of the quality of physician care among 14 racial and ethnic groups with those of whites. On each measure examined, at least...

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Evaluating Interventions To Reduce Health Care Disparities

By:
Schlotthauer AE, Badler A, Cook SC, Perez DJ and Chin MH

Publication date:
March/April 2008

Summary:
The Robert Wood Johnson Foundation's Finding Answers: Disparities Research for Change program funds evaluation of interventions to reduce racial and ethnic disparities in cardiovascular disease, depression and diabetes. Of the 177 applications received in...

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Challenges to Using A Business Case for Addressing Health Disparities

By:
Lurie N, Somers SA, Fremont A, Angeles J, Murphy EK and Hamblin A

Publication date:
March/April, 2008

Summary:
The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system. They describe the practical and methodological challenges faced by health...

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