Disparities and eHealth: Achieving the promise and the potential

Over the last two decades, research from several distinct lines of investigation have coalesced to underscore the relationship between medical care, biophysiologic processes, and sociocultural and other environmental influences on healthcare outcomes generally and healthcare disparities specifically (see Chaps. 1-5). In the early 1980s, researchers examining variability in clinical practice patterns found nonrandom distributions in care across geographic locations. In the mid-1980s, the report of the Secretary's Task Forces on Black and Minority Health highlighted the fact that the health of Blacks and minorities significantly lagged behind that of Whites in the US (Department of Health and Human Services, 1985). By the early 1990s, large scale epidemiologic studies confirmed earlier findings of nonrandom distribution of clinical practice patterns and the association between substandard care with low income and minority patients. These early findings encouraged a focus on healthcare quality problems with the US healthcare system, which revealed that problems associated with quality and healthcare disparities were in fact linked and should be considered together. In the case of healthcare disparities, the more recent attempts to address disparities have in most cases yielded disappointing results. As such, efforts were undertaken to clarify better the impact of nonmedical communications and social factors on healthcare disparities and healthcare outcomes. These investigations highlighted the need to integrate better the biomedical and sociobehavioral disciplines in current health care and clinical practice to improve quality and address disparities among an increasingly diverse population. They also highlighted the fact that communication barriers, literacy, as well as cultural and behavioral influences likely play a far more significant role in healthcare disparities than previously appreciated by the broader medical community.