On Public Health Through A − − And Reducing Them − −

Attempts to explain disparities in access to health care faced by racial and ethnic minorities and other underserved populations often focus on individual-level factors such as demographics, personal health beliefs, and health insurance status. This article proposes an examination of these disparities—and an effort to redress them—through the lens of public health. Public health agencies can link people to needed services such as immunizations, testing, and treatment; ensure the availability of health care; ensure the competency of the public health and personal health care workforce; and evaluate the effectiveness, accessibility, and quality of personal and population-based services. Approaching disparities through a public health framework can provide the foundation for developing more robust evidence to inform additional policies for improving access and reducing disparities. D isparities in health care access for minority and other vulnerable populations in the United States are well documented. Researchers to date have described the problem of disparities in detail but have had less to say about “effective, real-world strategies to address it.” To develop policies and programs that reduce disparities in health care access, we need a comprehensive understanding of the multiple factors that underlie them. Over the past four decades, researchers and policy makers have developed a number of frameworks to conceptualize the factors that influence health care access. Most of these frameworks focus on individual-level factors, such as demographics, personal health beliefs, and health insurance status. There is, however, growing appreciation that factors beyond individual characteristics—including communitylevel factors—also affect disparities in health care access. Public health agencies and activities represent an importantway to address disparities in health care access, but it is one that has been little studied. Public health has been defined as “what we as a society do collectively to assure the conditions in which people can lead healthy lives.” In recent years there has been a heightened awareness of the importance of the public health system, and public health approaches were acknowledged in provisions of the Affordable Care Act of 2010. Along with environmental factors and other health determinants, public health plays an important role in understanding and resolving disparities in health outcomes, including disparities in health care access and quality. In this article we propose a framework for understanding public health’s role in addressing disparities in health care access. Frameworks Of Health Care Access To establish the empirical basis for our proposed framework, we investigated the evolution of existing health care access frameworks to identify gaps and guiding principles. We identified and reviewed the most common frameworks doi: 10.1377/hlthaff.2011.0644