Health Disparities. Implications for Public Health Policy

The term "health disparities" generally refers to differences in health status by race/ethnicity and income, wealth or socioeconomic status and has been an area of significant research over the last 20 years. While differences in health care access and quality play a role, a component of disparities relate to environmental factors, due to disproportionate exposures and to greater vulnerability among individuals and communities of color and/or lower income or wealth. Research results are beginning to identify the interplay of factors contributing to disparities for children and suggest that a variety of strategies would be needed to address disparities in early life. These may include improved capacity to identify and assess excess cumulative burdens of environmental exposure, particularly for effects such as neuro-developmental deficits that may have lifelong effects; greater attention to the significance of exposures during the prenatal period, a time of particular sensitivity but when multiple environmental and social factors may converge; focus on the particular environments that affect women and children; increased attention to the co-occurrence of social and environmental stressors; and proactive enrichment of social and physical environments for children in vulnerable circumstances. Similar strategies might apply for the most part for adults, but due to the lifelong implications of early life exposures, investments in early life may yield the greatest gains. This will likely require development of new metrics and approaches beyond the risk assessment strategies commonly applied to environmental health issues.