Managing diversity to eliminate disparities: A framework for health

Michelle J Ko, Cary Sanders, Sarah De Guia, Riti Shimkhada, Ninez A. Ponce

Research output: Contribution to journalReview articlepeer-review


By 2044 there will be no single racial or ethnic majority group in the US, according to the Census Bureau. California experienced this shift in 2000, making the state a bellwether in its attempts to bring health equity to a highly diverse population.We used data from the California Health Interview Survey and the California Regional Health Care Cost and Quality Atlas to examine health, health care access, and quality of care by race/ethnicity, payer, and region. Evaluating insurance coverage and diabetes as a sentinel condition, we found that wealthy regions exhibited the widest disparities-with advantages among non-Latino whites and people with commercial coverage. Disparities were narrowest in rural and agricultural regions, but health and quality of care were lower overall in those regions. State initiatives to address health equity include requiring health plans to reduce disparities by language and race/ethnicity and investing carbon cap-and-trade revenues in disadvantaged communities. Prominent advocacy, community engagement, the systematic use of data, local flexibility, and mechanisms for stronger accountability are driving these initiatives. Evidence has yet to emerge on how effective these policies will be in reducing health disparities in the state.

Original languageEnglish (US)
Pages (from-to)1383-1393
Number of pages11
JournalHealth Affairs
Issue number9
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Health Policy


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