摘要：Objectives. We created an index quantifying the longitudinal burden of racial health disparities by state and compared this index to variables to guide the construction of, and validate support for, legislative efforts aimed at eliminating health disparities. Methods. We evaluated 5 focus areas of greatest racial disparities in health from 1999 to 2005 and compiled state health disparities index (HDI) scores. We compared these scores with variables representing the purported social determinants of health. Results. Massachusetts (0.35), Oklahoma (0.35), and Washington (0.39) averaged the fewest disparities. Michigan (1.22), Wisconsin (1.32), and Illinois (1.50) averaged the greatest disparities. The statistical reference point for nationwide average racial disparities was 1.00. The longitudinal mixed model procedure yielded statistically significant correlations between HDI scores and Black state population percentage as well as with the racial gap in uninsured percentages. We noted a trend for HDI correlations with median household income ratios. Conclusions. On the basis of the HDI-established trends in the extent and distribution of racial health disparities, and their correlated social determinants of health, policymakers should consider incorporating this tool to advise future efforts in minority health legislation. The US Congress took its first stand against minority health disparities with the passage of the Minority Health and Health Disparities Research and Education Act in October 2000. This measure commissioned the creation of the National Center for Minority Health and Health Disparities and mandated health disparities research and reporting. 1 The goal was to conscientiously move the discourse from identifying health disparities to eliminating them. The years that followed brought progress in researching causation, positing solutions, and supporting promising models for the elimination of these disparities. The congressionally mandated Institutes of Medicine report Unequal Treatment grouped factors of causation into 3 basic areas: health system–level factors, care process variables, and patient-level variables. 2 In addition, its authors proffered strategies for achieving health equity with recommendations that included legal, regulatory, and policy interventions. 2 With increasing research and dialogue, legislators began considering the next appropriate intervention. Congress has continued to debate solutions to the health care issues facing minority communities, introducing 6 comprehensive minority health equity bills since 2000. In 2007, the 110th Congress saw the introduction of an unprecedented 16 health disparities–focused bills. 3 Despite the increasing legislative interest in improving minority health, no comprehensive minority health measure has become public law since the Minority Health and Health Disparities Research and Education Act of 2000. The proposition of legislative remedies for health disparities has not been unique to Congress. Since 1999, a majority of state legislatures have passed minority health legislation. 4 These laws have addressed cultural competency, health professional recruitment and retention, and disease burden or risk factor management. Furthermore, 40 states created offices of minority health, and 4 states designated official minority health contacts. 5 When considered in sum, these state and federal legislative efforts have ushered in a new age of health disparities discourse. Champions of comprehensive health equity legislation argue that it is a necessary adjunct to existing efforts to eliminate racial and ethnic health disparities. Skeptics assert that the disparities can be largely addressed through generally improving access to quality care for all Americans. Most, however, appreciate the utility in bringing the discussion into the legislative arena as this issue continues to gain momentum. In this context, we recognized a need to create tools to guide legislative efforts for achieving minority health equity. The goals of our analysis were 3-fold: (1) to establish an index depicting variations in US racial health disparities; (2) to evaluate the association between this health disparities index (HDI) and known social determinants of health; and (3) to use statistical correlations to help guide minority health legislative interventions at the state and federal levels.
