Reducing health disparities requires looking at more than just poverty, say experts

March 13, 2002

Reducing health disparities in America will require a "broad-gauged approach" aimed not just at poverty and insurance coverage but at economic, education, labor and housing policies, say researchers.

Writing in the March-April edition of Health Affairs, a bimonthly health policy journal, the researchers look at the relationship between health outcomes and socioeconomic status in the United States.

According to the authors, differences in socioeconomic status underlie most key determinants of health, and lower status is associated with higher mortality, with the greatest disparities occurring in middle age.

In one article, Nancy Adler and Katherine Newman argue that government policy makers consider the benefit of improved health the same way that they evaluate economic efficiencies. "What they often leave out -- when the subject is not explicitly health -- is the health promoting, and potentially cost saving, prospects of policies that improve education or equalize resources," the authors say.

"Failing to capture health improvements that may follow from reduction of inequality may mean that policies look more expensive to implement than they are if one takes health expenditures into account," according to Adler and Newman.

"Since the relevant sectors operate somewhat independently ... it makes sense to push on as many fronts as possible," they say. "What is needed is a broad-gauged approach to the multiple determinants of (socioeconomic) disparities in health if we are to eliminate, or even greatly reduce, these disparities."

Authors S. Leonard Syme, Bonnie Lefkowitz, and Barbara Kivimae Krimgold, in an article examining barriers to coherent policy-making, argue, "Health agencies and programs are part of the problem. They and their supporters are frequently organized around separate clinical diseases -- the so-called 'disease-of-the-month club,' with separate staffing and budgets," they say. "Because evidence shows that many diseases are affected by a similar range of social forces, there is a need for better coordination, crosscutting policy initiatives and, in some cases, organization by population group or underlying problem rather than disease.

Among their suggestions are adoption of governmental "health impact assessments" on non-health policies, similar to economic or environmental impact statements; establishing common ground among the public health and population health constituencies while adding allies from other sectors; and creation of a White House "Council of Health Advisors to bring clout to intersectoral efforts."

In another article, Sir Michael Marmot suggests that the social environment, including job status and work satisfaction, may play a larger role than income in explaining health disparities. "Lack of income may not be related to deprivation ... but lack of income hinders full participation in society," Marmot says. Government policies to narrow income disparities "would improve overall health, by relieving the fate of the poor more than it hurts the rich."
Nancy Adler is professor of medical psychology at the University of California, San Francisco; Katherine Newman is professor of urban studies at Harvard University; S. Leonard Syme is professor emeritus of epidemiology at the University of California, Berkeley; Bonnie Lefkowitz is a health policy consultant in Bethesda, Md.; Barbara Kivimae Krimgold is director of the Scholars in Health Disparities program at the Center for the Advancement of Health in Washington, D.C.; Sir Michael Marmot is a professor of epidemiology at University College London.

The Center for the Advancement of Health is an independent nonprofit organization funded by foundations to promote greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness.

Health Affairs can be viewed on the Web at For more information, contact Jon Gardner, (301) 656-7401 ext. 230, or

Posted by the Center for the Advancement of Health For more research news and information, go to our special section devoted to health and behavior in the "Peer-Reviewed Journals" area of Eurekalert!, For information about the Center, call Ira Allen, (202) 387-2829.

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