Understanding Health Disparities

Race and socioeconomic status (SES) health disparities imply massive impact in terms of unequal suffering and dramatic social and economic costs. It is clear that status differences in the availability, use, and effectiveness of medical care and in a variety of health behaviors are implicated in these disparities. However, it is equally clear that adjustments for these differences leave the majority of race and SES health disparities unexplained. Despite wide acceptance of the idea that differences in stress exposure may contribute importantly to such disparities, it is contended that the stress hypothesis has never been effectively tested because of misclassification in the distinction between the disordered and the well and the inadequate estimation of differences in exposure to social stressors. This article reviews the empirical basis for this contention and describes an ongoing community study designed to more effectively evaluate the hypothesis that lifetime stress exposure represents a fundamental factor in observed race and SES health disparities. It is suggested that the application of aspects of the approach described may advance the capacity of future research to fully evaluate the mental health significance of the stress process.