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Health Disparity: A Primary Care Challenge in

an Urban Population

Introduction

The issue of health disparity affects millions of

people worldwide.

Unfortunately, in America, health disparity is as

much an issue for individuals, families, and

communities, as it is in less developed countries.

Despite efforts to bridge the gap between

populations, health disparities disproportionately

affects urban communities, in comparison to other

populations.

Introduction The Centers for Disease Control and Prevention (CDC), cites “poverty,

unequal access to health care, poor environmental conditions,

educational inequalities, individual behaviors, and language barriers

as significant contributors to health disparities” (CDC, 2011).

To illustrate the complexities of health disparity, Fink (2009) define

health disparity as the “difference in a measurement of access to or

quality of health care services between an individual and or group

possessing a defined characteristic when other variables such as

individual health choices, and disease progression, are manipulated”

(Fink, 2009).

The Impact of Health Disparity in Urban Populations

Consider for instance low health literacy as an element of health

disparity. If patients are not able to read and understand basic

health information which will help them contribute to their health,

then they face a disparity.

La Vonne and Zun (2008) writes “low health literacy is associated

with lower compliance with treatment regimens and lower self-rated

health status, as well as decreased ability to share in healthcare

decision-making”. When low health literacy causes health disparity,

the health care system becomes overburdened with cost.

The Impact of Health Disparity in Urban Populations

Health disparity accentuates diseases such as tuberculosis,

sexually transmitted diseases, influenza, pneumonia and other

air borne diseases, and has the potential of turning these

diseases into a public health nightmare.

The afore mentioned diseases are preventable and manageable

diseases, however, when health disparity exists, preventive care

becomes, rare, and management of common ailments become

difficult to treat, causing more people in the population to

become sick, and difficult to treat.

Prevalence of Health Disparity in Urban Populations

People who reside in urban communities tend to be of a minority race, have a

low socioeconomic status, and likely to lack access to health insurance. It is

therefore not surprising that, “these populations face barriers to care, receive

poorer quality care, and disproportionately use emergency systems” ("Urban

versus rural,”).

Although health disparities transcends above racial lines, it is common to

determine the extent of disparity along racial lines. In comparison to other

populations, African Americans, Hispanics, and Native Americans, have poor

disease survival rates. According to Williams and Mohammed (2008) “for most of

the 15 leading causes of death including heart disease, cancer, stroke, diabetes,

kidney disease, hypertension, liver cirrhosis and homicide, African Americans (or

blacks) have higher death rates than whites”.

Resources/Agencies that have taken Initiatives/Efforts to Address Health Disparity

Centers for Disease and Control Prevention (CDC)

The Affordable Care Act (ACA) of 2010

the National Institute of health (NIH), the New York Academy

of Medicine (NYAM)

National Center for Complementary and Alternative Medicine

(NCAAM

Food and Drug Administration (FDA), and a whole lot more.

Barriers Which Impede Resolving Health Disparity

A common trend is racial discrimination. Long standing racism, has led to

unequal access to essential social, educational, and material resources.

These “ resources have both direct effects on health status and indirect

effects on health status, through their influence on stress, psychosocial

resources, and positive and negative emotions” (Williams & Mohammed,

2008).

Social, economic, and educational factors can also impede efforts to reduce health disparity in urban population. Woolf and Braveman (2011) argue that “inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities can harm health through complex pathways”.

Review of Literature

A minority initiative health fact sheet documents

that “67 million people that is one out of every three

Americans under the age of 65 were uninsured for

some period of time during 2007-2008.

However; a closer look at the numbers reveals

alarming racial and ethnic disparities in health

coverage” ("Health care reform: Critical," 2009).

Implications of Health Disparity for Nurse Practitioners

As more efforts are being made through legislative efforts, it is time for nurse

practitioners to get involved in the process of legislation that seeks to provide

equal opportunities for better health maintenance in all communities.

Nurse practitioners “should take advantage of opportunities to comment on

proposals, legislative or otherwise, that have the ability to influence the health of

themselves, their families, their patients, their communities, and the nation”

(Newland, 2009).

It is important that nurse practitioners recognize the magnitude of the problem,

and work in collaboration with other agencies to help eliminate health disparity,

and provide better health for all citizens, regardless of race, culture, gender, ager

or socioeconomic background.

References

Centers for Disease Control and Prevention, (2011). CDC releases first periodic health

disparities. Retrieved from website: CDC Health Disparities & Inequalities Report

(CHDIR)

Fink, A., M. ( 2009). Toward a new definition of health: A concept analysis. Journal of

Transcultural Nursing, 20(4), 349 – 357.

La Vonne, A. D., & Zun, L. S. (2008). Assessing adult health literacy in urban. Journal of the

National Medical Association, 100(11), 1304-1309.

Newland, J. (2009). Editor's memo: Healthy people 2020 reflects our changing times. The Nurse

Practitioner: The American Journal of Primary Health Care, 34(12), 5.

Orsi, J. M., Margellos-Anast, H., & Whitman, S. (2010). Black-white health disparities

in the United States and Chicago: A 15-year progress analysis. American Journal of Public

Health, 100(2), 349-56.

References Raphael, J. L., & Beal, A. C. (2010). A review of the evidence for disparities in child vs. adult

health care: A disparity in disparities. Journal of the National Medical Association, 102(8), 684-691.

U.S Department of Human and Health Services, (2011). HHS action plan to reduce racial and

ethnic health disparities. Retrieved from website: http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285

USA Minority Health Initiatives, (2009). Health care reform: critical to closing the gap for

communities of color. Retrieved from website: http://www.familiesusa.org/assets/pdfs/health-reform/closing-the-gap.pdf

Urban versus rural health. (n.d.). Retrieved from http://www.uniteforsight.org/global-health-

university/urban-rural-health

Woolf, S. H., & Braveman, P. (2011). Where health disparities begin: The role of social and

economic determinants-and why current policies may make matters worse. Health Affairs, 30(10), 1852-9.

Williams, D. R., & Mohammed, S. A. (2008). Discrimination and racial disparities in health:

Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20-47.