Research on the health status of various social groups demonstrates a differential pattern of morbidity and mortality among groups based on socioeconomic status, race/ethnicity, and access to care. These differential patterns - termed "health disparities"- refer to the gaps in health status between advantaged and disadvantaged groups. Health services research, biobehavioral research, and epidemiologic studies concur that people of color, people living in poverty, and marginalized persons experience poorer health status than their more advantaged counterparts. Discrimination, stigmatization, and disenfranchisement as well as a lack of economic resources and access to care are implicated in health disparities.
Nursing research contributes to the body of knowledge on health disparities in several ways. In this issue devoted to health disparities, nursing research demonstrates the existence of health disparities between various groups. Funk and colleagues report differences in the use of cardiac procedures between Black and White patients and question whether racial bias in healthcare delivery contributes to this disparity. Appel, Harrel, and Deng examine the relationship of education and income level, and race/ethnicity to an increased risk for cardiovascular disease in Southern rural women.
Other studies explore risk factors or markers associated with health disparities. Baumann, Chang, and Hoebeke report a high prevalence of obesity and smoking in low-income, predominantly uninsured adults. Lutenbacher examines the relationship of psychosocial risk factors and abuse in low-income, single mothers. Heilemann, Lee, and Kury address the risks and the intrinsic strengths that might protect women of Mexican descent from depressive symptoms. Guthrie and associates propose relationships among societal discrimination, stress, and smoking in African American girls.
Fewer nursing studies examine the relationships of societal-structural variables such as access to care, poverty, discrimination, and social/political status to health disparities. These variables seem to lie at the heart of identifying the social groups who experience poorer health status. Rew, Chambers, and Kulkarni show that cost, accessibility and availability of healthcare are major barriers to sexual health promotion with homeless adolescents. As noted above, two studies concluded that racism and discrimination might explain the health disparities found.
If our goal is to reduce health disparities rather than to just study them, nursing research must include a major focus on resources such as income, education, access to care, social and political power, and human rights. We will not achieve this goal by focusing on individual behaviors and risk factors alone. We need a new paradigm that recognizes societal factors as primary pathogenic forces in the major health problems facing the U.S. today. Our research methods and designs must include the acquisition of economic resources and political power by the participants. This is done by involving them in the entire research process from identifying relevant and important research questions to sharing the products of the research.