Patterns and Causes of Disparities in Health

David Williams further develops the disparities issue as it affects racial and ethnic groups. He shows that such health disparities are large and persistent. Like Link and Phelan, he sees them as embedded in larger influences, primarily socioeconomic disadvantage, social isolation, and economic marginalization. He notes the multiple pathways through which these larger influences affect health, such as noxious working and living environments, unemployment, exposure to persistent stress, lack of resources to cope and promote healthy living, and constrained access to medical care. Williams makes the essential point that analysts too easily combine people in racial and ethnic groups that are actually heterogeneous and whose members face different life and health challenges. He argues for data that allow us to better unpack such gross and uninformative categories as Hispanic, black, and Asian.

Williams believes that most of our efforts to reduce disparities are unequal to the challenge and that many interventions that would be more effective face social and political barriers. He cites a survey showing that despite all of the media attention to racial disparities in health, more than half of Americans seem not to understand their extent. Thus, like Link and Phelan, he seeks to identify approaches to meaningful policy changes that would win public support and address basic influences.