Commentary: Open Access Educating primary care clinicians about health disparities

The U.S. racial and ethnic minority population will grow from 28% in 1998 to nearly 40% in 2030. According to the Institute of Medicine (IOM), health disparities inarguably exist among racial and ethnic minorities. It is important to address health disparities because consequences include poorer health, increased suffering, and higher mortality. Many racial and ethnic minorities have higher mortality rates from cancer, diabetes, and cardiovascular disease. African Americans have a higher cancer mortality rate (243.1 vs. 193.9 per 100,000, respectively) and twice the cardiovascular mortality rate compared to white Americans. Among Hispanics, the diabetes death rate ranges from 47–172 per 100,000 depending on nationality (Cuban, Mexican, Puerto Rican, etc.), more than twice the rate of white Americans (23 per 100,000). Furthermore, Hispanic women have the highest cervical cancer incidence rate.

Health disparities have a financial toll as well. The higher burden of disease affects the health of the nation as a whole. Poorer health requires increased expenditure, especially when complications arise from uncontrolled or undetected disease. For example, African American women are more likely to have late-stage breast cancer at the time of diagnosis, more often requiring intensive treatment and hospitalization, and leading to more disability. Loss of individual productivity also contributes to national health care costs, impacting all individuals regardless of race or ethnicity.

Despite concerted efforts to address and eliminate health disparities, many complicated, interrelated factors still need to be overcome. According to the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, health disparities occur at different levels, including health care systems and their administration, clinicians and their practices, and patients themselves. At the clinical level, there are several factors that may contribute to racial and ethnic health inequity [2]. Clinicians, patients, and the clinical encounter all impact health disparities. For example, a person's interaction with the clinician may lead to non-adherence, distrust, and misunderstandings that lead to poor health. Therefore, primary care clinicians have an important role and the ability to decrease health disparities [8,9].

The purpose of this paper is to expose primary care clinicians to the current state of health inequality and to describe how they may positively impact health disparities in their practice.