Racial and ethnic health inequities have long defined health and the healthcare system in the United States (Bailey et al., 2017; Okonkwo et al., 2020). The Institute of Medicine's (now re-named the National Academy of Medicine) book titled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Smedley et al., 2003) was a landmark publication that placed these disparities in the forefront. The report demonstrated that racial and ethnic disparities in health care, with few exceptions, were consistent across a range of illnesses and healthcare services. Today, as in 2003, race, ethnicity, and culture sharply divide the health and health care in the United States.

Each year, the Agency for Health Research and Quality publishes the National Healthcare Quality and Disparities Report that reports the current status of access to care, the quality of health care provided, and the health disparities seen in the United States. This year's report noted that some disparities from 2000 have decreased according to 2016-2017 data; however, disparities persist especially for poor and uninsured populations (Agency for Health Research and Quality, 2019). Much of the data reported are based on race, ethnicity, and socioeconomic status. What the quality and disparities report data tell us is there isn't health equity in the United States among different races and ethnicities. Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other means. "Health equity" implies that everyone should have a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential (World Health Organization, 2020a).

In the 1990s, the term health disparity was coined in the United States (Braveman, 2014). If you look up the word disparity, it simply means a difference or a variation. There are differences in health care that are not disparities. For example, it is likely that the treatment of a 90-year-old person with cancer would differ from the treatment of a 30-year-old. That would be a health difference, but not considered a health disparity. HealthyPeople (2020) has defined a health disparity as:

[horizontal ellipsis]a particular type of health difference that is closely linked with economic, social, or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive, sensory or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

The first part of the definition makes sense. Research confirms that social determinants of health are linked to health outcomes. Social determinants are the conditions in which people are born, grow, live, work, and age (World Health Organization, 2020b). Medical care is estimated to account for only 10%-20% of the modifiable contributors to healthy outcomes, whereas the remaining 80%-90% are thought to be related to the social determinants of health (Hood et al., 2016). There is a strong research base that supports the relationship of social determinants of health to health disparities. What concerns me is the last phrase, "historically linked to discrimination or exclusion." This tells me that some of the health disparities present in the United States are due to persons being discriminated against in the healthcare system. In other words, there is no health equity in the United States, and these disparities are really health inequities. Persons do not have a fair opportunity to access quality care or receive that care. This is a social justice issue. As citizens of the United States, as nurses, how can we allow that to happen?

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