Health Disparities In The U.S. Have Narrowed And Widened

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Main Category: Public Health
Also Included In: Seniors / Aging;  Medicare / Medicaid / SCHIP
Article Date: 03 Mar 2008 - 0:00 PDT

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Heath inequities between rich and poor, as well as between different racial and ethnic groups, shrank in the U.S. from 1966 to 1980, then widened from 1980 to 2002, as measured in rates death in the young and in infants. This was reported in a study recently published in PLoS Medicine.

Additionally, according to the study, if all people in the US had experienced similar health gains to the most advantaged groups (namely, whites in the highest income groups) between 1960 and 2002, 14% of premature deaths among whites and 30% of premature deaths among people of color would not have occurred.

Among public health experts around the world, there has been constant debate regarding whether health disparities widen or narrow when overall mortality rates decline. Some research indicates that as overall health improves, the disparities in health between rich and poor and between different ethnic groups narrow. However, other research indicates the opposite, and that these overall health gains simply mask worsening disparities. That is, while rich, white Americans get healthier, members of ethnic minority groups and lower income brackets get sicker or at least improve less.

To investigate the issue of health inequity over time, Nancy Krieger (Harvard School of Public Health, Boston, MA, USA) and colleagues examined death statistics from different counties in the United States, which are routinely collected by U.S. States and submitted to the federal government. In these populations, they studied the rates of premature mortality (death before age 65) and infant mortality (death before age 1 year), which are two common measures of the health of a population. These mortality rates were compared for different income levels, for the US population as a whole, and for whites versus people of color.

This finding, that the socioeconomic and racial or ethnic inequities in premature mortality and infant death in the U.S. needs further investigation. According to the authors, it "refutes the view that improvements in population health by default entail growing or shrinking health disparities."

They conclude, "Death is inevitable. Premature mortality is not."

About PLoS Medicine

PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org.

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org.

The Fall and Rise of US Inequities in Premature Mortality: 1960-2002
Nancy Krieger, David H. Rehkopf, Jarvis T. Chen, Pamela D. Waterman, Enrico Marcelli, Malinda Kennedy
1960-2002. PLoS Med 5(2): e46.
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Written by Anna Sophia McKenney
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