Ethnic Disparities in Health: The Public's Role in Working for Equality

is the current phase of the Healthy People Initiative, which began in 1979 with the vision of making America's communities healthier and happier places (http:⁄⁄www.healthypeople. gov). Healthy People 2010 is a comprehensive set of health objectives to be achieved over the fi rst decade of the century. The overarching goals are to increase the quality of life and years of healthy life for all Americans and to eliminate racial and ethnic health disparities [1]. This has been an ambitious undertaking, but we are making progress. Americans have gained 30 years in life expectancy in the last century overall, from 47 years in 1900 to 77.6 years in 2003. But African American men, with a life expectancy of 69.2 years compared to 76.1 years for African American women and 75.4 years for white men, continue to lag behind. Nevertheless, all groups have made signifi cant progress in years of life lived. However, 50 percent of persons over 80 are incapacitated physically, mentally, or both— illustrating the importance of both quality of life and years of healthy life. The signifi cant gender and racial gaps for African American men are likely to persist because of death rates associated with the prevalence of cardiovascular disease, diabetes, hypertension, cancer, HIV/AIDS, and homicide among this group. African American men are more likely to die from these diseases, or their associated problems, and from homicide than their white counterparts. However, we have made signifi cant progress in addressing racial and ethnic disparities in the number of children immunized and in screenings for breast cancer. But ethnic and racial disparities persist in areas such as diabetes, HIV/ AIDS, cardiovascular disease, and others for both African American men and women. In an attempt to put health disparities in perspective, for a recent special issue of Health Affairs devoted to racial and ethnic disparities, we asked the question, " What if we had eliminated disparities in health in the last century? " [2] By our calculations, there would have been 83,500 fewer black deaths overall in the year 2000 alone. That would have included about 24,000 fewer black deaths from cardiovascular disease. If infant mortality had been equal across racial and ethnic groups in 2000, 4,700 fewer black infants would have died in their fi rst year of life. Without disparities, there would have been 22,000 fewer black deaths from diabetes and almost 2,000 fewer black women would have …