Differential health outcomes in racial and ethnic minorities include: obesity in African Americans [1], liver cancer in Asian Americans [2], infectious diseases in Latinos [3], and diabetes in Native Americans.[4]

Access and quality factors are additional markers of disparities. According to the 2006 National Healthcare Disparities Report, differentials exist in quality measures, access to care, different level and type of care, many care settings, and in subpopulations. Attempts to address these factors to eliminate health disparities have not been sufficient. Of the measures documented in the 2006 report, a quarter has shown improvement, while a third has worsened.[5] There is a need to both reconceptualize existing frameworks as well as develop strategies that are more effective.

The Institute of Medicine in its notable 2002 report, Unequal Treatment, declared that health disparities for racial and ethnic minorities persist despite controlling for access-related factors. Furthermore, “the sources of these disparities are complex, are rooted in historic and contemporary inequities, and involve many participants at several levels…” [6] Residential segregation and its ability to shape socioeconomic status at individual, neighborhood, and community levels have been cited as a major cause of differential health outcomes.[7]

These structural considerations offer a new perspective for understanding health disparities. Current frameworks attempt to eliminate disparities without addressing the structural barriers that institutionally reinforce differential outcomes. As the Institute of Medicine suggests: “a comprehensive, multi-level strategy is needed to eliminate these disparities.” [8]

Priorities
All priorities attempt to address any combination of access, quality, and/or societal structures as part of a multi-level effort to eliminate racial and ethnic health disparities.

Priority 1: Universal coverage should also include immigrants, many of whom are currently restricted from accessing Medicaid and SCHIP.[9]
PRO: Ensuring access to all people despite immigration status would diminish the utilization of safety net resources.[10][11] Prevention could diminish the incidence of many communicable diseases.[12][13]
CON: Funds are required in order to expand coverage. Furthermore, anti-immigrant sentiment may lead to opposition. The issue should be promoted as a public health issue.

Priority 2: Incorporate equity goals into existing policy for related fields such as education, schools, and housing.
PRO: By focusing upon socioeconomically related areas, improving societal structures will indirectly help eliminate health disparities where access and quality strategies have made insufficient progress [14][15][16] Development of entirely new strategies is unnecessary due to reliance upon existing goals. Low-income racial and ethnic communities would support.
CON: Improvements in health status are not directly obvious. Those opposed are likely to disfavor integrationist policies.

Priority 3: Direct the Department of Health and Human Services (HHS) to improve standardized collection of disaggregated data that includes both socioeconomic factors and ethnic specific information.
PRO: Insufficient data collected for ethnic subgroups have reinforced the lack of attention to disparities. In particular, Latino and Asian American data are inadequate as reflected in few Healthy People objectives.[17][18][19] Systematic data collection could monitor the impact of health policy changes on racial and ethnic groups. [20]
CON: Investment of resources is required to develop a coordinated and comprehensive system that could collect information nationally.

Priority 4: Expand HHS efforts to develop, disseminate, and enforce quality standards.
PRO: Translating research into practice and policy would apply evidence-based methods to improve tested standards of quality.[21]
CON: The coordination of systematic literature reviews, large-scale dissemination of guidelines, and enforcement of standards require an investment of resources.

Priority 5: Structurally improve provision of culturally appropriate services in medical institutions through language assistance, culturally sensitive practices, and provider education curricula.
PRO: Title VI (Civil Rights Act) prohibiting discrimination by institutions receiving federal funding is already in place to legally enforce measures such as language assistance. [22][23] Racial/ethnic concordance of providers and language assistance only are insufficient to ensure high quality.[24][25]
CON: Healthcare institutions and schools may object to interference by legal standards. Administrators of institutions should be carefully approached to garner support.