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Disparities in Health Among Racial and Ethnic Groups 25

bureaucratic processes, utilization managers, health care professionals and patients
(National Academy of Sciences, 2002, p. 1).
A number of demographic changes in the United States over the past twenty years
make it imperative that practicing health education and promotion professionals learn
more about disparities for particular population groups, specifically low - income peo-

ple and racial and ethnic groups. These demographic changes (discussed in detail in
Chapter One ), include an increase in the number of individuals belonging to minority
racial and ethnic populations, an increase in the number of foreign - born residents, and
an increase in the number of residents who do not speak English as their primary lan-
guage at home. To compound these concerns, minorities and non - English speakers

have greater difficulty in accessing needed health care services. Minorities are dispro-
portionately more likely than the general population to be uninsured and are overrep-
resented among those in publicly funded insurance programs such as Medicaid.
The purpose of this chapter is to describe how these demographic shifts under-
score the need to teach health care professionals and students studying to become
health professionals concepts about health disparities, to describe these disparities in
various ethnic and racial groups, and to train health care professionals, including
health educators and managers, how to better meet the objective of providing high -
quality care for all their patients. The term demographic shift is used to describe the
totality of these changes and the beginning of the shift in the ethnicity of the U.S. pop-
ulation from a majority of non - Hispanic whites to a majority made up of other ethnici-
ties. This chapter concludes with a discussion of how to address health care disparities
in four major ethnic groups: African Americans, American Indians and Alaska Natives,

Asians and Pacific Islanders, and Hispanics. (This chapter uses the terms Hispanic and
Latino and also African American and black interchangeably.) Finally, a brief case
study is presented that provides a hands - on opportunity for learners in a classroom or
small - group setting to practice critical thinking skills concerning ways to overcome
disparities in access to health promotion services for Mexican immigrant women.

HEALTH DISPARITIES BY CONDITION AND TREATMENT

There are numerous health disparities among racial and ethnic and low - income groups
in the United States, and although the specific reasons why these disparities exist are

not well understood, there is a consensus that in general they are largely due to com-
plicated interrelationships among socioeconomic status, race, ethnicity, and culture.
The following discussion highlights a number of the major disparities.

Cancer Screening and Management
Cancer is the second leading cause of death in the Unites States, causing more than
500,000 deaths each year (Centers for Disease Control and Prevention [CDC], 2006a).
That is, one out every four deaths is due to cancer. There are many examples of impor-
tant disparities in cancer screening and management. Health educators are in a unique

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