Abstract
Annual Review of Public Health
Vol. 27:
167-194
(Volume publication date April 2006)
(doi:10.1146/annurev.publhealth.27.021405.102103)
First published online as a Review in Advance on October 24, 2005HEALTH DISPARITIES AND HEALTH EQUITY: Concepts and Measurement Paula BravemanCenter on Social Disparities in Health, University of California, San Francisco, San Francisco, California 94143-0900; email: braveman@fcm.ucsf.edu ▪ Abstract There is little consensus about the meaning of the terms “health disparities,” “health inequalities,” or “health equity.” The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups—such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination—systematically experience worse health or greater health risks than more advantaged social groups. (“Social advantage” refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category—e.g., the wealthiest, the most powerful racial/ethnic group—and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities. Most recent citing papers (via CrossRef)Health disparities in liver disease: Time to take notice and take action Hepatology 50(1):309-313 (2009) Race, gender, and language concordance in the primary care setting International Journal of Health Care Quality Assurance 22(4):340-352 (2009) Ethnic advantages in kidney transplant outcomes: the Hispanic Paradox at work? Nephrology Dialysis Transplantation 24(4):1103-1109 (2009) Measuring Disparities in the Incidence of Sexually Transmitted Diseases Sexually Transmitted Diseases 35(Supplement):S40-S44 (2009) Equity of Access to Outpatient Care and Hospitalization Among Older Community Residents in Brazil Medical Care 46(9):930-937 (2008)
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