While the U.S. has the best medical care in the world, our citizens do not enjoy the best health. Moreover, the quality of health care in the U.S. is not uniform across all ethnic groups, nor for urban versus rural populations. "Health" is a state of optimal well-being. Affluent citizens enjoy better health and better health care than their minority and poor neighbors. And while America will soon become a nation of minorities, there is still a woeful lack of minority physicians and health care workers to take care of patients who look like them.

What are disparities?

The term “health disparity” is roughly defined as an inequality in health care. The term “disparity” is sometimes used interchangeably with terms such
as “racial and/or ethnic differences in health.”

Disparity in the context of public health and social science has begun to take on the implication of injustice. A health disparity should be viewed as a chain of events signified by a difference in environment, access to, utilization of and quality of care, health status, or a particular health outcome that deserves scrutiny. Such a difference should be evaluated in terms of both inequality and inequity, since what is unequal is not necessarily inequitable.

Why should we care?

Health disparities threaten the lives of our minority and ethnic populations. For example, minorities are less likely to be given appropriate cardiac medications.

African Americans suffer from stroke at a 35 percent higher rate than their white counterparts, and several studies have found that they are less likely to receive major diagnostic and therapeutic interventions. Minorities with HIV are less likely to receive antiretroviral therapy and other state-of-the-art treatments, which could forestall the onset of AIDS. Regrettably, the list continues.

African Americans, Native Americans, and Latino Americans, while making up an increasing percentage of the U.S. population, remain significantly under-represented in the medical and research professions, in science, economics, and in leadership positions in government. In addition, these ethnic groups rank well below the national average in education, employment and health status.

Race is a powerful determinant of health. We know that access to medical care in our country differs for people of different ethnicity. We also know that patients of different races presenting with similar diseases, signs and symptoms may be offered different therapies and may have different outcomes. Further, we know
that some of these differences cannot be explained solely by economic status nor genetic differences.

Everyone in this great country should receive the best health care available. For this to occur, it is essential that there be more minority practitioners in our nation, including more faculty, researchers, academic chairs and administrators in our professional schools and more senior policy-makers nationally.

We will not solve the problem until we discover where the disparities are and why they continue to exist. The University of Maryland School of Medicine Center for Health Disparities seeks to identify specific disparities, and, in collaboration with local communities, develop culturally competent strategies to eliminate them. America will soon become a nation of minorities, and if
we continue on this path of unequal treatment we will not have fulfilled our roles as ambassadors of the American health care system.

Donald E. Wilson, MD, MACP
Director, Program in Minority Health and
Health Disparities Education and Research,
Former Dean, Professor of Medicine
University of Maryland School of Medicine