Academic journal article Atlantic Economic Journal

The Contribution of Economists to Understanding Racial Health Disparities in the US

Academic journal article Atlantic Economic Journal

The Contribution of Economists to Understanding Racial Health Disparities in the US

Article excerpt


Throughout US history health status gaps between the majority white population and numerous racial/ethnic subpopulations have been observed and have persisted. Life expectancy at birth, a gross measure of the adequacy of health care, nutrition, and population well being, was 47.1 years for blacks in 1921, while for whites it was 57.5 years (Dynan 2007). Although health status improved for all Americans over the course of the twentieth century, the gap despite narrowing, persists: in 2005 life expectancy at birth was 78.3 years for whites and 73.2 years for blacks (CDC 2005).

The US government has made this issue one of national concern. As a result, the National Institute of Medicine (IOM) published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (IOM 2002) to raise concern and policy debate surrounding health disparities. Much research has been produced by health services researchers across disciplines, particularly medical care providers, public health workers and sociologists. Many economists have also studied health disparities. This special issue of Atlantic Economic Journal highlights in particular the role of economic scholarship in this important national debate.

This article categorizes the contribution of many economists to the literature on health disparity. The literature reviewed ultimately includes 107 articles published between 1998 and 2008. Articles by any of the 932 economists that were members of the American Society of Health Economists in 2006 publishing about racial/ethnic health disparities as found in Medline, articles related to racial/ethnic health disparities published in Health Economics, the Journal of Health Economics or through searches in EconLit were reviewed for inclusion.

The reviewed literature can be categorized (some research papers fall into more than a single category) along a path that seeks to understand and remediate the health status gap in the following way:

1) Conceptualizing and measuring disparity (16%)

2) Documentation of differences/disparities in health outcomes (10%)

3) Correlation and causation--How (by which causes and mechanisms) are the observed disparities generated? (57%)

4) How do disparities impact other outcomes? (3%)

5) Policy advice--What can we do about it? (7%)

6) Evaluation-Do policies and programs work? (19%)

The references in this introductory article are arranged according to these categories. Summary tables of the 107 articles are available on-line ( \~dynan1) and include the research question addressed, data description and population studied, study design/method, key findings, control variables (how the question of race is identified) and a categorical indication.

Figure 1 illustrates that economists have been strong in identifying potential mechanisms by which the observed disparities are generated and evaluating the impact of programs and policies on health disparities. Less activity has focused on linking underlying health disparities across groups to differential outcomes in human capital acquisition and labor market outcomes.

Highlights from the Categories

Conceptualizing and Measuring Disparity

In Unequal Treatment, IOM (2002) developed a definition of disparity as follows: a disparity is a difference in treatment provided to members of different racial or

ethnic groups not justified by the underlying health conditions or treatment preferences of the patient (emphasis added). Hebert et al (2008) have sought to distinguish between differences and disparities as well.

Cook (2007) and Cook et al. (2007) have sought to empirically implement the IOM definition. Gaskin and Frick (2008) and Gaskin et al. (2007) have found no racial differences in the valuation of health states or attitudes towards health care while Hebert et al. (2005) have found racial/ethnic differences in preferences (resistance to) flu vaccination and White-Means and Rubin (2004) have found racial differences in need and preferences with respect to home health. …

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