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Despite consistent attention and resources devoted to the subject, disparities in mental health and mental health care have persisted over time. The complexity of this issue requires a deeper consideration of the structural context that has led to these inequities. This article redefines the issue, addresses new trends in research in the field, and offers innovative solutions that providers and policymakers can adopt to reduce mental health disparities and inequities.
Defining Disparities and Inequities
The gold-standard definition of “disparities” comes from the 2003 Institute of Medicine report, which defines disparities in health care as “racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention.”1 However, the majority of contributors to differences in health status among populations actually occur outside of the health care system, which only accounts for 10% of early mortality in the United States.2 Thus, in defining these differences, one must consider a definition that also encompasses the impact of genetic, community, environmental, and societal influences on health status. The National Institutes of Health defines health disparities as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”3 It should be noted that there is no value or judgment placed on these differences; they are just differences observed, but not necessarily inspiring or compelling action. In contrast, the World Health Organization (WHO) defines health inequities as “avoidable inequalities in health between groups of people within countries and between countries,” and notes that health inequities are driven by “the way society…organizes its affairs, giving rise to forms of social position and hierarchy, whereby populations are organized according to income, education, occupation, gender, race/ethnicity, and other factors.”4 The WHO places a distinct value judgment on this definition, along with the clear understanding that the inequities that we see in health status are preventable and the result of power and resource differentials between groups. Such hierarchies create systemic policy issues and structures (ie, housing, education, and the criminal justice system) that exclude and disenfranchise certain population groups from the opportunities for optimal health and positive health behaviors. For example, America's persistent phenomenon of racially hyper-segregated areas of...