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Trust in Health Care
June 7, 2019

Building Trust in Health Systems to Eliminate Health Disparities

Author Affiliations
  • 1Department of Internal Medicine, Texas A&M Health College of Medicine, Dallas
  • 2Baylor Scott & White Health and Wellness Center, Dallas, Texas
  • 3Department of Internal Medicine, University of California, San Francisco
  • 4Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 5Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA. 2019;322(2):111-112. doi:10.1001/jama.2019.1924

Health systems play a vital role in enhancing the health of the communities they serve, including historically underserved populations with disparate health outcomes. Eliminating health disparities is a critical aspect of enhancing population health that requires collaborative input from multiple entities including health systems, government agencies, community organizations, and residents. A lack of clarity among contributing entities about the roles and responsibilities of health systems in addressing root causes of health disparities make the challenging goal of eliminating them even more so. This raises questions in communities served about the extent to which health systems are truly committed to advancing health. The resulting tension compounds the historic lack of trust between health systems and underserved communities and undermines collaborative work toward mutually beneficial outcomes of improved health. Health system leaders need to lead in addressing this tension by building and sustaining trust with and for their communities.

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    1 Comment for this article
    Useful attention to health and healthcare disparities cannot ignore problems in measurement
    James Scanlan, J.D. | James P. Scanlan, Attorney at Law
    This commentary mentioned “measurement” or “measure” three times but does not address the problems in health and healthcare disparities research arising from the fact that different measures commonly yield different conclusions about whether a particular policy increases or decreases a disparity, and that no health and healthcare research has examined the extent to which an observed change in some measure of disparity is simply a function of the change in the prevalence of an outcome and the extent to which it reflects something else, including the effects of policies aimed at reducing disparities [1,2].  

    Two facts highlight the problematic nature
    of essentially all health and healthcare disparities research. First, even though the National Center for Health Statistics fifteen years ago recognized that as health and healthcare generally improved, relative differences in the increasing (favorable) outcomes tended to decrease while relative differences in the decreasing (adverse) outcomes tended to increase, very few health or healthcare disparities researchers are aware that it is even possible for the relative difference in a favorable health or healthcare outcome and the relative differences in the corresponding adverse outcome to change in opposite directions as the prevalence of an outcome changes. To my knowledge, no research into cancer outcomes disparities has recognized that it makes any difference whether one examines relative difference in mortality from cancer or relative differences in survival from cancer, even though the two approaches commonly yield opposite conclusions about directions of changes in disparities and the comparative size of disparities for different cancers or different subgroups.

    Second, even when researchers have recognized situations where the relative difference in the outcome (favorable or adverse) they happened to be examining and the absolute difference have changed in opposite directions, none has mentioned the relative difference for the opposite outcome. This has occurred even though anytime it is mentioned that a relative difference in an outcome and the absolute difference have changed in opposite direction, the unmentioned relative difference will necessarily have changed in the opposite direction of the mentioned relative difference and the same direction as the absolute difference.


    1. Scanlan JP. Race and mortality revisited. Society 2014;51:327-346

    2. Scanlan JP. The mismeasure of health disparities. J Public Health Manag Pract 2016;22(4):416-19.