Race, Ethnicity and Preventive Services:

Originally published as Issue Brief No. 34 by the Center for Studying Health System Change (HSC), January 2001. HSC was a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

Racial and Ethnic Differences in Preventive Care: Progress and Persistent Gaps

Three years after the Clinton administration launched multiple efforts to identify and eliminate health disparities among racial and ethnic groups, data from HSC's Community Tracking Study Household Survey showed mixed progress. Between 1997 and 1999, the share of white and African American adults receiving key preventive services -- including mammography screening for women and physician counseling for cigarette smokers to quit -- increased. But comparable gains were not recorded for Hispanic populations, suggesting that outreach and intervention strategies were not reaching all communities equally.

Where Progress Was Evident

The survey found measurable improvements in several preventive care measures for both white and African American respondents. Mammography screening rates rose among women in both groups over the two-year study period, and physicians reported counseling a higher share of patients who smoked to quit. These gains likely reflected a combination of public awareness campaigns, provider education initiatives, and expanded insurance coverage for preventive services. For African Americans, the improvements were particularly noteworthy because this group had historically lagged behind whites on many preventive care measures. Narrowing the gap, even modestly, suggested that targeted outreach and improved access were having some effect.

Hispanic Populations Left Behind

The most troubling finding was the lack of improvement in preventive care for Hispanics. While white and African American adults showed gains across multiple measures, Hispanic respondents reported no statistically significant increases in mammography, smoking cessation counseling, or other key preventive services. Several factors likely contributed to this gap. Hispanic adults were substantially more likely to be uninsured, which limited their access to routine physician visits where preventive care is typically delivered. Language barriers and cultural factors may have reduced the effectiveness of health education campaigns designed primarily for English-speaking audiences. Additionally, the health care system's safety net in communities with large Hispanic populations was often stretched thin and underfunded relative to demand.

Policy Implications for Reducing Disparities

The findings underscored that eliminating health disparities would require strategies tailored to the distinct barriers faced by different racial and ethnic groups. Expanding insurance coverage was a necessary but insufficient step -- Hispanic communities also needed culturally competent care, bilingual providers and health education materials, and community-based outreach that met people where they lived and worked. The research suggested that policymakers aiming to close the preventive care gap should invest in community health centers serving Hispanic populations, support training programs for bilingual health professionals, and ensure that public health campaigns were designed and delivered in ways that reached non-English-speaking communities. Without such targeted efforts, the broad-based improvements observed for other groups were unlikely to extend to Hispanic Americans.

Sources and Further Reading

This Issue Brief was based on data from the Community Tracking Study Household Survey, conducted in 1996-97 and 1998-99 by the Center for Studying Health System Change. The survey collected information from a nationally representative sample of households in 60 communities across the United States. The research was supported by the Robert Wood Johnson Foundation.