Feature

To help improve health services to U.S. racial, ethnic and immigrant groups, a report to U.S. Secretary of Health and Human Services (HHS) Mike Leavitt recommends significantly bolstering the collection of data on race, ethnicity and primary language, as well as on small ethnic subpopulations whose numbers have been considered too small to report on.

Released this month in print form, "Eliminating Health Disparities: Strengthening the Collection of Data on Race, Ethnicity and Primary Language" (www.ncvhs.hhs.gov), also calls for developing better techniques for studying health disparities. In addition, it recommends linking different sources of data on disparities so that policy-makers and health-care providers have better information in order to tackle such disparities. The report was prepared by the National Committee on Vital and Health Statistics, which advises Secretary Leavitt and HHS on health data and health statistics.

Contributing to the report was Vickie Mays, PhD, a psychology professor at the University of California Los Angeles who studies health disparities. In fact, Mays has chaired the committee's Subcommittee on Populations for the past four years, overseeing a series of hearings drawing together experts from federal agencies, diverse racial and ethnic groups and private health-care researchers to testify about the data needs to overcome disparities.

Among the report's major recommendations to HHS to eliminate disparities are to:

  • Improve the quality, reliability and completeness of information on U.S. racial, ethnic and linguistic sub-populations.

  • Increase and strengthen the capacity of the HHS health statistics infrastructure to analyze, report and share information on racial and ethnic subpopulations.

To carry out those recommendations, the report suggests HHS:

  • Ask private health insurance plans to collect specific information on race, ethnicity and primary language from health-care plan participants.

  • Perform "cluster sample" studies on subpopulations of people who are missed on larger surveys, such as specific groups within the American Indian and Asian and other Pacific Islander populations, to better understand subgroup health problems.

  • Improve efforts to link federal databases containing information about geographic place, education and income to health data.

  • Increase the number of research centers capable of providing access to this protected data.

  • Support training efforts to increase the number of researchers from diverse communities qualified to analyze this data.

"Psychology," says Mays, "can play a significant role, not just in using the data in identifying unhealthy behaviors, but in identifying ways of increasing the adoption and maintenance of healthy behaviors in specific racial and ethnic-minority communities."

How health disparities arise

The information sought by the report are the things that make up identity-where people live, how much money they make, their education level, the language they speak and their race and ethnicity. Taken together, all of those factors play a part in determining their personal health behaviors, and have been found to relate to how much treatment they get, or don't get, from the nation's health-care system, Mays says.

Even geography, right down to the specific street where a person lives, can influence Americans' health, says Mays.

For example, people in rural areas who suffer heart attacks might not be close enough to hospital emergency rooms equipped with trauma-level services to receive care as quickly, putting their survival at greater risk.

Or, while health officials encourage Americans to eat five servings a day of fresh fruit and vegetables, some people live in inner-city urban areas where local mom-and-pop stores lack a good selection of fresh fruits and vegetables, the nearest supermarket is accessible only by bus or cab, and streets are lined with fast food restaurants. Such environmental factors make it more difficult for them to maintain healthy eating habits and put them at greater risk for the health complications of obesity.

"All of these are the kinds of factors that contribute to people's health status," Mays says. "Some people tend to live in areas where they have better access to health care, and to health-care plans that provide them greater choices in that care."

How psychology can help

As a profession, psychology can help address health disparities in a number of ways, Mays says.

One of the most significant ways would be to develop the field of psychological measurement and statistics to provide researchers with better training and methods for analyzing small-population data, while at the same time ensuring protection of privacy and confidentiality, Mays says.

She notes that health-disparities research participants are needed across all groups-including smaller ones such as American Indians or larger ones such as African Americans or Latinos. Through such participation, they can make their data count and more likely benefit from actions taken based on the research results.

Psychology can also help the field by requiring its journals to report the race, ethnicity and primary language of participants in the research they publish, says Mays, who notes that the report asks the federal government to do the same.

Once the information is available, psychologists can play a critical role in helping turn the statistics and findings into better health outcomes for people, by crafting prevention and health-care messages for specific ethnic groups based on what psychologists know about what messages will resonate with which group, according to Mays.

APA Executive Director for Public Interest Gwendolyn P. Keita, PhD, reiterates the role of data in helping psychologists and others reduce disparities.

"Better and more complete data is critical for improving research and our ability to understand health risks and effective interventions," says Keita. "It's not just ethnic-minority status, but where we live, socioeconomic position, gender, age, etcetera, that are also important."

Armed with geographic data on obesity risk, for example, psychologists could support measures such as walking trails so people can work out in public space and expanded after-school athletic programs so that children exercise more.

"Some poor health isn't just due to an individual behavior," Mays says. "It's also a result of larger contextual issues, such as safe walking spaces, nutritious, affordable food and the ability to earn a living wage with health-insurance benefits."


Christopher Munsey contributed to this report.