Clinical Care and Health Disparities

Abstract

Health disparities, also known as health inequities, are systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, economically, demographically, or geographically (88). This topic has been the subject of research stretching back at least decades. Reports and studies have delved into how inequities develop in different societies and, with particular regard to health services, in access to and financing of health systems. In this review, we consider empirical studies from the United States and elsewhere, and we focus on how one aspect of health systems, clinical care, contributes to maintaining systematic differences in health across population groups characterized by social disadvantage. We consider inequities in clinical care and the policies that influence them. We develop a framework for considering the structural and behavioral components of clinical care and review the existing literature for evidence that is likely to be generalizable across health systems over time. Starting with the assumption that health services, as one aspect of social services, ought to enhance equity in health care, we conclude with a discussion of threats to that role and what might be done about them.

Health Disparities Research in Global Perspective: New Insights and New Directions

“…Dr. Starfield was a true giant-in both commitment and contributions-in the global field of health equity research. Her review (20) pinpoints several issues that, if understood and addressed, would remove major roadblocks to eliminating health disparities associated with the delivery of clinical care. Citing examples from an array of low-, middle-, and high-income countries, Starfield and colleagues elucidate the many pathways through which the type (i.e., primary versus specialty care), quality (problem recognition, diagnosis, treatment, and follow-up), and focus (e.g., preventive, person-focused versus disease-focused) of health services determine their potential to decrease or, in some cases, increase inequities.…”

“…Disparities must be addressed within the specific contexts in which they arise, but strategies to address disparities in any setting can be informed by an appreciation of the commonalities and differences in how they occur and are remedied in different societies. The symposium consists of five in-depth reviews led by established scholars who approach the topic from their different disciplinary and topical perspectives (4,6,13,17,20). The objective is to uncover what is needed, going forward, to realize the goal of eliminating disparities and achieving equity.…”

Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop

“…From a care perspective, morality requires not hurting others, condemning all violence and exploitation, and nurturing relationships and connections between persons. These two frameworks guided the workshop’s discussions and were addressed in the opening presentations on Health and Justice (IH), pointing to the framing of inequity calling for GP’s advocacy and attention, [25] and on current initiatives and best practices in primary care (ES), suggesting the ways the structure and processes of care can alleviate the effects of inequity [26]. …”

Primary healthcare interventions for people with intellectual disability

“…Health assessment booklets generally contain information regarding commonly missed comorbidities experienced by people with ID, and after the GP has completed several health assessments, it can be expected that this will improve GPs knowledge of these conditions in this population. Furthermore, research supports improving primary care as a way to improve general population health and reduce rates of hospitalisations (Starfield, 1994(Starfield, , 2012Starfield, Gervas, & Mangin, 2012;van den Berga et al, 2015). This may mean that people with ID are less likely to present to the emergency department and be hospitalised for common conditions, as GPs may have a greater awareness of these potential conditions, and these conditions can be identified, treated and managed through use of a health assessments in primary care.…”

“…High hospital use also increases nationwide health costs (Australian Bureau of Statistics., 2010). Highquality healthcare, which can be provided through primary care, would reduce stress on individuals using the health system and also on services within the health system, including the financial strain caused by over-use of hospitals (Starfield, 1994(Starfield, , 2012Starfield, Gervas, & Mangin, 2012).…”