Unhealthy differences: the health care system needs to work smarter, not harder, to eliminate health disparities.

• Author: Foreman, Megan
• Position: HEALTH

Most Americans contribute to the $2.6 trillion spent on health care every year. Yet the health they enjoy often varies by their population group or ZIP code, not by what they spend. An uncomfortable reality exists: Racial minorities die sooner and live with diseases more than whites, even when research controls for income and health insurance coverage.

Since health disparities became part of the national dialogue in the 1980s, policymakers and public health professionals have tried to address them piecemeal, one disease and one population group at a time. But few of these activities got to the root of the problem: an inefficient health care machine.

Disparities highlight systemwide deficiencies, such as a lack of understanding about cultural differences and an uneven distribution of doctors and nurses. These issues are exacerbated in minority populations that tend to have not only fewer available health services, but also a lack of knowledge about how best to use the system.

"Our goal is to make sure people are getting preventive care--blood tests for diabetes, colonoscopies and mammograms for early cancer detection--because many in minority communities are undiagnosed," says Delaware Representative Joseph Miro (R). "The disparities in the rates of conditions like obesity, diabetes and health disease are great among minorities."

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Creating a Smarter System

Working to make the system smarter has promise, but Miro warns, "it's a struggle to find the money for research to develop programs that can help eliminate disparities."

Yet states, which spend up to a quarter or more of their yearly budgets on health care, have a stake in creating a more efficient, less costly, system.

Massachusetts Representative Jeffrey Sanchez (D) believes the health care system must work smarter, and can only do so when all of its components work together and its payment model changes.

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"Health system integration and payment reform--which are in the pipeline now--must be based on data-driven measures that account for race, ethnicity, language and income," he says.

The importance of adequate data cannot be overstated. "We don't understand all the aspects of health disparities what drives them and how to eliminate them--so we need the data to build a system where prevention and health promotion are at the crux," Sanchez says.

Sanchez believes the nation is generally moving in the right direction. "The Medicaid expansion in...