Health disparities: old wine in a new bottle.

Sir,

I would like to make comment on the new term - “health disparities,” which is relatively new in the Indian context. It has been observed that socially patterned differences (by race/ ethnicity, age, gender, socio-economic position, geographical location, etc.) in disease occurrence provide the strongest clues to the complex etiology of every mass disease.(1) Such differences are well known as just “differences,” or less frequently “inequalities” in health. The new term suggested for such differences is “health disparities.”

Braverman suggested that the term “health disparities” should refer to group differences in health that were unnecessary, preventable, and unjust. She elaborated: “A health disparity/inequality is a particular type of difference in health or in the most important influences of health that could potentially be shaped for policies; it is a difference in which disadvantaged social groups (such as the poor, racial/ethnic minorities, women or other groups that have persistently experienced social disadvantage or discrimination) systematically experience worse health or greater health risks than more advantaged groups.”(2)

James SA in introduction to volume 31 of Epidemiologic Reviews traces the history of health disparities research in epidemiology and situates 10 review articles. With the aid of a conceptual model describing the key determinants of health disparities, he offers several suggestions for improving future epidemiologic research on health disparities.(3) In Indian context, the term “disparities” is mostly associated with gender, since such gender disparities are deeply rooted in all income groups, education groups irrespective of caste and creed.(4) Thus I wonder whether the term coined “health disparities” is just an old wine in a new bottle, or is it a fertile ground for research in developing countries like India.