Hi,

While I agree with the generalization that "the United States has tended to focus on disparities in access and race/ethnicity" it is certainly not the
whole story, as Olivia indicates, and many of us in US research-to-policy circles are concerned with inequalities between various advantaged and disadvantaged groups in the US, the data that allow us to measure those gaps, the best and most appropriate comparisons for various health outcomes, as well as more equitable policies -- not only health care policies but also more equitable policies in health-related sectors such as housing, education, economic opportunity, tax and transfer programs to redistribute income and wealth, etc -- that would most effectively allow us to reduce health inequities while improving overall health.  

Barbara

Barbara Kivimae Krimgold
Center for the Advancement of Health
2000 Florida Avenue, NW, Suite 210
Washington DC 20009-1231
202-387-2829  [log in to unmask]  www.cfah.org

-----Original Message-----
From: The Health Equity Network (HEN) [mailto:[log in to unmask]] On Behalf Of Valéry Ridde
Sent: Thursday, March 08, 2007 4:10 PM
To: [log in to unmask]
Subject: Fw: use of term disparity in US

This discussion could be interesting for the list
Valéry

----- Original Message ----- 
From: <[log in to unmask]>
To: "Valéry Ridde" <[log in to unmask]>; "Barbara Krimgold" 
<[log in to unmask]>
Sent: Thursday, March 08, 2007 3:44 PM
Subject: Re: use of term disparity in US


> The writeup that you forwarded is a bit confused.  Inequality simply means 
> a difference. What I have seen more often used in international circles 
> compared to the US is the term inequity. That term is not used very often 
> in policy circles in the US.
>
> whereas the UK has examined more "disparities" by social class (mostly 
> occupational), the US has focused more on disparities by race/ethnicity. 
> But the term "disparity" is NOT restricted to just race/ethnicity in the 
> US. That is simply false. Just look at the Healthy People 2010 goal: "Goal 
> 2: Eliminate Health Disparities. The second goal of Healthy People 2010 is 
> to eliminate health disparities among different segments of the 
> population." Elsewhere in the Healthy People 2010 documents, they list the 
> various subgroups of interest (gender, sexual orientation, socioeconomic 
> status, etc.)--much more than race/ethnicity. And, data are presented by 
> more than just race/ethnicity.
>
> While the US has been collecting data on race/ethnicity for many decades, 
> we have been slower in collecting complete data on other socioeconomic 
> status markers. For instance, education was not included on the standard 
> birth and death certificates recommended for use by the states until 1989. 
> Occupation was included much earlier but we don't use it as often in our 
> presentation of health data as they do in the UK.  We have collected SES 
> data for many other important national health data systems (e.g., National 
> Health Interview Survey) for many decades.
>
> What is interesting is that the UK is trying to learn how we collect 
> racial/ethnic data with their increasing immigrant population. You see 
> more reports coming out of the UK which do present data by "racial/ethnic" 
> categories.
>
> The use of the word disparity in the US is also not limited to health 
> care. It has been used for some time for a broad range of health status 
> indicators (e.g., the 1979 document that I forwarded to you referred to 
> disparities in birthweight).  Indeed, this usage happened even before the 
> 1985 Task force on Black and Minority health was released by the Secretary 
> of Health and Human Services (a report considered a landmark document 
> drawing national attention to minority health concerns).
>
>
> Olivia Carter-Pokras, Ph.D.
> Associate Professor
> Department of Epidemiology and Biostatistics
> College of Health and Human Performance
> University of Maryland
> 1240D HHP Bldg.
> College Park, MD 20742
> Phone: 301-405-8037
> Fax: 301-314-9366
> [log in to unmask]

***
Thanks for that Olivia.
My understanding of the US context is better now but I'm also confuse now
because I understood the inverse between "disparities" and "inequalities",
following, for exemple, this interpretation from Exworty and al..
Are you agree with them ?

"Although the definitions of both inequalities and disparities capture

the systematic differences, disparities are interpreted differently by U.S.

and U.K. policymakers. Whereas the United States tends to use the term

disparities, the United Kingdom commonly uses the term inequalities. The

United States often concentrates on health care issues (especially access

and insurance coverage) and race/ethnicity, reflecting two critical
dimensions

of U.S. society: the number of persons without health insurance

(45 million in 2003) (Lillie-Blanton and Hoffman 2005) and the significance

of racial politics. In the United Kingdom, the term inequality

(usually referring to differences in socioeconomic status) has been

"officially sanctioned" since the Labour government of Tony Blair was

elected in 1997. Previously, under the Conservative administrations of

Margaret Thatcher and John Major, the term and the issues were

ignored or euphemistically called "variations" (Exworthy, Blane, and

Marmot 2003). Recently, however, U.K. policy has tried to influence

the wider/social determinants of health and has focused mainly on

disparities in socioeconomic status and geography (Exworthy, Blane,

and Marmot 2003). In short, the United States has tended to focus on

disparities in access and race/ethnicity, and the United Kingdom has

been more concerned with developing a population-based approach

(with populations largely stratified by socioeconomic status), although

the two countries still have much in common"


Exworthy M, Bindman A, Davies H, Washington E. Evidence into Policy and
Practice? Measuring the Progress of U.S. and U.K. Policies to Tackle
Disparities and Inequalities in U.S. and U.K. Health and Health Care.
Milbank Quarterly 2006;84(1):75-109.