The second goal of Healthy People 2000 is to reduce health disparities among Americans. The focus is on closing the gaps in health status and health outcomes between racial and ethnic minorities and the total population. Across many health measures--mortality, morbidity, and health services utilization--differences between whites and minorities continue to exist.
Years of potential life lost (YPLL) is a measure of premature death, or death that occurs before age 75_the average life span. Figures 1-4 show the years of potential life lost before age 75 (YPLL-75) per 100,000 State population under age 75 for selected racial and ethnic populations for the 3-year period 1990-92. In the calculation of YPLL-75, infants who die before their first birthday have 74.5 years of life lost; a person dying at 50 years has 25 years of life lost. Therefore, the younger the decedent the more years of potential life lost. To facilitate comparisons among States and racial/ethnic groups with different age compositions, the data have been age-adjusted to the 1940 U.S. standard population. Data are not shown for States in which the number of deaths was too small to compute a reliable rate. Data are also not shown for the five States (Connecticut, Louisiana, New Hampshire, New York, and Oklahoma) for which Hispanic origin data for 1990-92 were not available from the National Vital Statistics System.
For the United States as a whole, the 1990-92 age-adjusted YPLL-75 for all races was 8,384 per 100,000 (Figure 1. Years of Potential Life Lost [YPLL] Among All Races Before Age 75, by State, 1990-1992 [per 100,000]). For blacks and American Indians/Alaska Natives in Indian Health Service areas the rates are considerably higher, 15,468 and 11,875 respectively (Figures 2. Years of Potential Life Lost Among All Blacks Before Age 75, by State, 1990-1992 [per 100,000], and 4. Years of Potential Life Lost Among American Indians/Alaska Natives Before Age 75, by Indian Health Service Areas, 1990-1992 [per 100,000]). This reflects the higher mortality for blacks due to a number of factors that primarily affect younger people such as infant mortality, homicide, and HIV infection. Contributing to the disparity for American Indians/Alaska Natives are higher rates for infant mortality, unintentional injury death, homicide, and suicide. For Hispanics, YPLL-75 is 7,114 per 100,000 (Figure 3 Years of Potential Life Lost Among Hispanics Before Age 75, by state, 1990-1992 [per 100,000]).
Assessment of health disparities among Americans requires data systems to collect information on race, ethnicity, socioeconomic status, and disabilities. Such systems are addressed by Healthy People 2000 objective 22.4, which calls for development of a national process to identify gaps in the Nation's disease prevention and health promotion data for racial and ethnic minorities, people with low income, and people with disabilities, and to establish mechanisms to meet these data needs.
A note of caution should be expressed about the ability to identify health disparities. The lack of data about subgroups of the population and small geographic areas hampers the ability to quantify their health problems. In recent years, however, oversampling of blacks and Mexican Americans in national surveys has taken place, providing data that show disparities. These data have been used to establish new Healthy People 2000 population targets. But as the United States becomes more diverse, the challenge of identifying disparities as they emerge and addressing differences in health status and health outcomes will increase. Meeting the ambitious year 2000 targets set forth in Healthy People 2000 will require making improvements in the information available on minority health status, behaviors, and clinical preventive services utilization.
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Excerpted fromHealthy People 2000 Midcourse Review and 1995 Revisions.
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