Differences to Determinants: Elevating the Discourse on Health Disparities

Abstract

Two papers in this issue of Pediatrics highlight key aspects of racial/ethnic disparities in health care. The study by Edmonds and colleagues demonstrates higher utilization of neonatal intubation for periviable neonates born to Black and Hispanic women compared with Whites. The authors postulate that these differences may reflect underlying racial/ethnic differences in preferences and decision-making regarding end-of-life care in addition to socioeconomic status and institutional practices. The study by Nembhard and colleagues reports that Blacks and Hispanics have higher early childhood mortality for a number of congenital heart defects (CHD). The authors assert that these differences may be due to underlying biological differences, limited access to care, and differences in cultural preferences. The urgent need for a richer discourse on health disparities is underscored by these two studies. For over a decade, the medical literature has been inundated with studies documenting racial/ethnic health disparities in the U.S. health care system.1 This prolific body of work has influenced clinical care, fostered innovations in health care delivery, stimulated a new field of research, and informed health care policy.2,– … Address correspondence to Contact: Jean L. Raphael, MD, MPH, Clinical Care Center, Suite D.1540.00, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, Tele: (832) 822-1791, Fax #: (832) 825-3435, E-mail: Raphael{at}bcm.edu