Eliminating racial disparities in health is a top priority public health goal. African Americans have worse health outcomes and receive worse quality of care for a wide range of diseases, but addressing all of these various disparities in health and health care is not feasible. Instead, we must make judicious use of limited resources and target those aspects of health care that will produce the greatest reduction in health disparities. In short, an evidence-based strategy for eliminating racial disparities in health is critically needed and should prioritize those aspects of care that will have the biggest impact on reducing the racial gap in life expectancy. The evidence base to support such a strategy is currently lacking, however.

We have previously found that, at the national level, the causes of death contributing most to the racial disparity in life expectancy are hypertension, HIV and homicide.(Wong et al, NEJM 2002) Substantial geographic variations in demographics and health behaviors exist in the U.S. Thus one might expect that the causes of death and risk factors contributing most to racial disparities in health would also vary substantially by geographic region and between metropolitan and rural areas. In fact, we have preliminary data suggesting that the causes of death contributing most to the racial gap in life expectancy differ greatly from state to state. Thus, developing a strategic approach at the state and local level must not only identify which risk factors and health problems to target, but must also identify the right targets for the right population.