Health disparities probed

Faculty, students, and fellows interested in disparities in health care due to ethnic and racial differences convened at the Harvard School of Public Health (HSPH) Friday (May 7) for a symposium seeking to translate research into practice.

Topics discussed at the all-day event, the Second Annual Symposium on Racial and Ethnic Health Disparities Research in the U.S., included Latino and Asian mental health, the increasing presence of minority researchers in the field, societal determinants of health, quality of care, and politics and policy as related to ethnic and racial health disparities.

The event, sponsored by the Interfaculty Program for Health Systems Improvement and by the U.S. Department of Health and Human Services (HHS) Office of the Regional Health Administrator and Office of Minority Health, both in Region 1 (New Englad), was held at the School of Public Health’s Snyder Auditorium.

Event organizers said they were hoping the symposium would build a bridge between research and practice and help narrow the disparities in health care due to ethnic and racial differences.

“We all have the same goal: the elimination of starkly disparate health status across racial and ethnic groups,” said Reginald Tucker, one of three co-chairs of the symposium planning committee.

Tucker said it’s important to link researchers to those working to reduce health disparities in the field so that research remains informed of new trends and developments that are occurring.

“We hope today to build a bridge between theory and practice,” Tucker said.

Janet Scott Harris, of the Department of Health and Human Services, said the regional office was happy to sponsor the event because it is by bringing research in this area to practical application and evaluation that the gaps in health care can be closed.

Karla Pollick, executive director of the Harvard Interfaculty Program for Health Systems Improvement, said the conference is just the type of event the interfaculty initiative was intended to stimulate.

Among the wide variety of topics discussed was new research on the mental health status of Latinos and Asians in America. Margarita Alegria, director of the Center for Multicultural Mental Health Research at the Cambridge Health Alliance and a visiting professor of psychiatry at Harvard, presented preliminary research from the National Latino and Asian American Study, begun in 2002.

The study, conducted in five languages, is a broad survey of Latinos and Asian Americans across the country and aims to fill in gaps in the information available on the mental health of those two ethnic groups.

The study so far shows that Puerto Ricans have a higher incidence of mental health disorders than other Latino groups, which also include Mexicans, Cubans, and a category for other Latinos. It also shows a strong trend of increasing mental health problems for Mexican-born immigrants the longer they are in the United States. To a lesser extent, other groups showed a similar correlation of increasing mental health problems with time in the United States, until they had lived 70 percent of their lives in the United States at which point the trend levels off.

For Asians, Vietnamese show a lower incidence of mental health disorders than other groups, which include Chinese, Filipinos, and other Asians. Alegria said researchers couldn’t yet explain that low incidence of mental health problems for Vietnamese.

Alegria said the survey shows considerable regional variation, with mental health disorders increasing for individuals who live in parts of the country where their ethnic group is not concentrated. For example, she said, Mexicans, who are concentrated in the Southwest, had higher mental health problems when living in the Midwest. Cubans, who are concentrated in the South, had greater problems when living in the Northeast.

“Where you live really makes a big difference in your risk for psychological disorders,” Alegria said.

One possible explanation for the higher rates of mental disorders among Puerto Ricans, Alegria said, is selective immigration. Alegria said more Puerto Ricans than other groups reported that they had immigrated because of health reasons. In addition, she said, there may be a demoralizing factor at work. Puerto Ricans, unlike members of the other ethnic subgroups, are U.S. citizens. They also report higher levels of English fluency. Alegria said Puerto Ricans may expect to be more socially mobile after arriving in the United States.

Alegria said the survey provides an important starting point for further research. Among important questions to be answered are the higher rates of disorders among Puerto Ricans, the lower rates among Vietnamese, the roots of geographic differences in different parts of the country, and the connection between length of time in the United States and rising incidence of mental health disorders.

“There are a lot more questions than answers at this point,” Alegria said.