Improving the odds: dozens of states aim to help minorities and low-income residents receive better medical care and live healthier lives.

• Author: Hansen, Melissa

When it comes to health and health care, not all people are created equal.

Your race, ethnicity, income, occupation, education, insurance and even where you live can have a significant impact on your health and the quality of care you receive. As the nation focuses on health care reform, these differences--referred to as health disparities--are beginning to get more attention from lawmakers.

Some of the differences are striking. Native American women, for example, are nearly twice as likely to die from cervical cancer compared with white women. African Americans are one and a half times as likely as whites to have high blood pressure.

Given the wide range of factors than can lead to disparities, including people's own behaviors, lawmakers are looking at a broad array of policies, including ones that will improve access to care, strengthen family finances and improve the overall health of communities. And across the country, dozens of states already have taken actions that range from improving access to healthy food to lowering the cost of health coverage.

"One of the greatest public health challenges facing our nation is the elimination of health disparities, that disproportionately effect the lives and well-being of racial/ethnic minority populations," says Barbara PullenSmith, president of the National Association of State Offices of Minority Health.

"A comprehensive approach is needed, which includes national, state and local level policies and practices."

INSURANCE COVERAGE

Lack of health insurance is probably the most widely recognized dividing line between health "haves" and 'have nots." About 45.7 million Americans--17.1 percent of the population under age 65--lacked health insurance in 2007, according to the Census Bureau. Breaking those numbers down, however, shows that minorities are far less likely than whites to be covered: About 33 percent of Hispanics and Native Americans and 21 percent of African Americans are uninsured compared with 12 percent of whites. People who lack health insurance are in poorer health than those with coverage, often delay seeking services and may not receive proper care.

Hispanics are much less likely to have a regular primary care physician, and African Americans are twice as likely to use a hospital emergency room than white Americans.

Most uninsured people report the cost of premiums as the biggest barrier to coverage, so states have expanded public programs and made private coverage more affordable.

From 2005 to 2008, more than half the states passed laws to cover more kids...