One of the primary goals of Healthy People 2010 is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

The statewide measures used in America`s Health RankingsTMreflect the condition of the "average" resident. However, when those measures are examined more closely, startling differences can exist within a state when race, gender, geographic location and/or economic status are considered.

The National Healthcare Disparities Report (http://www.ahrq.gov/qual/nhdr08/nhdr08.pdf), released each year by the Agency for Healthcare Research and Quality, highlights disparities at a national level. The report analyzes numerous measures and indicates that disparities exist for many groups, including women, children, the elderly, rural residents, and among racial and socioeconomic groups. The report also indicates that such disparities affect all aspects of health and health care delivery, including preventive care, acute care and chronic disease management, and affect many delivery locations including primary care, home health care, hospice, emergency care, hospitals and nursing homes.

The report highlights three themes:

• Disparities persist in health care quality and access.
• The magnitude and pattern of disparities are different within sub populations.
• Some disparities exist across multiple priority populations.

While each state has unique issues that contribute to disparities, states that have been successful in reducing disparities in health indicators while retaining high overall health can serve as models for other states.
The 2009 Edition of America`s Health RankingsTM contains an explicit metric for disparities - Geographic Disparity. This indicator reflects the range of age-adjusted mortality rates that exist within a state at the county level. Graph 1 shows geographic disparity increasing in the United States over the last five years. Disparity in mortality rates occur for many reasons, including differences in behaviors, genetics, community and environmental situations, health care policies and clinical interventions. State data is at www.americashealthrankings.org/2009/disparity.aspx

While this overall disparity metric provides a broad view of the challenges facing a state, specific measures shed more light on the sources of the disparity and how disparity exists in behaviors, disease and mortality for subgroups in the United States.		Graph 1 Geographic Disparity for United States Since 2004

While it is helpful to understand disparity across all factors, data for disparity differences by race/ethnicity is the most readily available in the United States at the individual state level. Four different aspects of disparity are presented; two behaviors (smoking and obesity), one chronic disease (diabetes) and one outcome (mortality).

Prevalence of Smoking by State and Race/Ethnicity for 1999, 2004 and 2009
Prevalence of Obesity by State and Race/Ethnicity for 1999, 2004 and 2009
Prevalence of Diabetes by State and Race/Ethnicity for 2009
Mortality by State and Race/Ethnicity for 2009

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Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Rockville, Md., http://www.healthypeople.gov/About/goals.htm