editor's choice

AMERICAN JOURNAL OF PUBLIC HEALTH

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EDITOR-IN-CHIEF DEPUTY EDITOR FEATURE EDITOR ASSOCIATE EDITORS

EDITOR’S CHOICE

Disentangling Health Disparities Through National Surveys The changing social and cultural dimensions of the US population have required innovative methodologies to fully understand the health of diverse communities. Whereas previous small and large-scale community surveys have contributed to our knowledge, national surveys provide novel opportunities to examine health disparities both in health and use of health services. The US Department of Health and Human Services (DHHS) has supported an agenda for health disparities research that examines differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions among specific populations in the United States. Ascertainment of the causes of disparities in mental health has been elusive and complex. Racial and ethnic bias, stigma, and other social and cultural factors contribute to the mental health of racial and ethnic minorities, compounding efforts to disentangle disparities. A 2001 report by the US surgeon general (Mental Health: Culture, Race, and Ethnicity—A Supplement to Mental Health. Rockville, Md: US DHHS; 2001), which reviewed disparities in mental health, concluded that culture, race, and ethnicity are vital considerations when assessing the prevalence of mental disorder, the burden of mental illness, psychiatric service use, and the unmet mental health needs of racial and ethnic minorities. Similarly, the 2003 report of the President’s New Freedom Commission on Mental Health (Available at: http://www.mentalhealthcommission.gov/) challenged the nation to transform the mental health system to eliminate disparities in mental health services. Unfortunately, data on mental health disparities, disability, and functioning from past psychiatric research studies have focused on narrow dimensions of race, ethnicity, geography, and age. The National Institute of Mental Health has provided primary support for emerging research through an innovative collaboration of psychiatric epidemiology surveys to improve data on racial

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and ethnic minorities through the Collaborative Psychiatric Epidemiological Survey program (Colpe L et al. Guest editorial. Int J Methods Psychiatr Res. 2004;13:193–195). Together, the National Comorbidity Survey Replication, National Survey of American Life (NSAL), and National Latino and Asian American Study provide rich and unprecedented information never afforded before on the mental health of African American, Latino, and Asian American racial and ethnic subgroups, including immigrant populations. Data on the mental health of US Caribbean Black populations had been sparse before the major information boost from the NSAL. Psychiatric research on Latinos and Asian Americans had suffered from inadequate statistical power to clarify processes and within-group differences. Common core data components across these national surveys have maximized the analytic capabilities of databases for subsequent analyses of health disparities among diverse populations. National surveys with the appropriate methodological processes and resources to consider mental health disparities provide crucial data that inform strategic public health efforts. The dissemination and translation of these findings hold promise for improving the health of racial and ethnic minority populations through the development of health policies and programs. Current ongoing National Center for Health Statistics and Centers for Disease Control and Prevention data collection efforts will permit the future monitoring of national trends in mental health disparities and health care to ascertain whether the promise of these rich data sources is being met. Cheryl A. Boyce, PhD, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services Virginia S. Cain, PhD, National Center for Health Statistics, Centers for Disease Control and Prevention, Department of Health and Human Services

Mary E. Northridge, PhD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Leslie Beitsch, MD, JD Felipe González Castro, PhD, MSW Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Mary Bassett, MD, MPH (Harare, Zimbabwe) Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Sydney, Australia) DEPARTMENT EDITORS John Colmers, MPH Government, Politics, and Law Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Bernard M. Dickens, PhD Health Policy and Ethics Forum Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Neil Hann, MPH, CHES (2007), Chair Hector Balcazar, PhD (2008) Bobbie Berkowitz, PhD, RN (2008) Bonnie Duran, DrPhH (2008) Vanessa Northington Gamble, MD, PhD (2009) Alice M. Horowitz, PhD, MA (2009) Cassandra L. Joubert, ScD (2009) Michael D. Kogan, PhD (2007) Marsha D. Lillie-Blanton, DrPH (2007) Christie Zunker Malpede, MA (2007) Allan Steckler, DrPH (2009) Henrie M. Treadwell, PhD (2008) Terrie F. Wetle, PhD (2007) Lynne S. Wilcox, MD, MPH (2009) Siu G. Wong, OD, MPH (2007) STAFF Georges C. Benjamin, MD, FACP Executive Director/Publisher Ellen T. Meyer, Director of Publications Nancy Johnson, MA, Executive Editor Brian Selzer, Journal Production Manager Alexandra T. Stupple, Assistant Production Editor Sarah Smith, Production Coordinator Ashell Alston, Director of Advertising Maya Ribault, Editorial Assistant Jennifer Strass, Graphic Designer Dana Jones, Reviews Coordinator Vivian Tinsley, Subscriptions Coordinator FREELANCE STAFF Janis Foster, Greg Edmondson, Michele Quirk, Jan Martin, Gretchen Becker, Alisa Guerzon, Alison Moore, John Alexander, Beth Staehle, Trish Weisman, Copyeditors Alison Moore, Chris Filiatreau, Chrysa Cullather, Alexe van Beuren, Proofreaders Vanessa Sifford, Michele Pryor, Graphic Designers Aleisha Kropf, Image Consultant

doi:10.2105/AJPH.2006.103960

American Journal of Public Health | January 2007, Vol 97, No. 1