摘要：An impressive body of public health knowledge on health care disparities among Latinos has been produced. However, inconclusive and conflicting results on predictors of health care disparities remain. We examined the theoretical assumptions and methodological limitations of acculturation research in understanding Latino health care disparities, the evidence for socioeconomic position as a predictor of health care disparities, and the effectiveness of cultural competency practice. Persistent use of culture-driven acculturation models decenters social determinants of health as key factors in health disparities and diminishes the effectiveness of cultural competency practice. Social and economic determinants are more important predictors than is culture in understanding health care disparities. Improvements in the material conditions of low-income Latinos can effectively reduce health care disparities. HEALTH DISPARITIES, AND THE association between disparities and social determinants, are not new concepts. W. E. B. DuBois noted racial and ethnic disparities more than a century ago in his analysis of 1890 census data in Philadelphia, Pennsylvania. 1 DuBois observed that health disparities reflected a vast set of problems having a common center that must be studied according to some general plan. 2 Since 1906, considerable interest in understanding the causes of these differences has prompted attention to health care disparities and their association with race, ethnicity, gender, socioeconomic position (SEP), 3 and culture. 4 Acknowledgment is widespread that population health is more a function of good public health measures and socioeconomic conditions than biomedical advances. Public health has focused on population health since the 19th century but has not consistently addressed social and economic inequality and inequity. Scientific assumptions that omit consideration of structural and economic factors in the study of Latino health disparities must be challenged. 5 – 10 Tentative associations between acculturation research and health care disparities, as the empirical foundation for cultural competency practice, require further interrogation. In our consideration of this issue, we asked three questions: (1) How does acculturation research elucidate predictive factors that contribute to health care disparities? (2) How does the body of work on social determinants of health and structural inequality inform acculturation research? (3) Does cultural competency practice contribute to decreasing disparities among Latino groups?
