The Broken Approach to Health Disparities

I’ve experienced the reality of health disparities firsthand. Growing up in a low-income, predominantly Black neighborhood in Boston during the 60s and 70s, my family didn’t have access, or, frankly, the privilege, to tap into the depth and richness of Massachusetts’ healthcare system. We paid a price for it. My story isn’t rare; it’s one echoed by countless others.

Health disparities aren’t new, they’ve stretched across centuries. In my lifetime alone, we’ve seen wave after wave of efforts to tackle them: the creation of Federally Qualified Health Centers under the Economic Opportunity Act of 1964; the launch of Medicare and Medicaid in 1965; a surge of research studies in the 1970s; the establishment of the Office of Minority Health in 1986; the Disadvantaged Minority Health Act of 1990; the NIH Revitalization Act of 1993 and that’s just the short list. State, federal, and academic initiatives have poured time and resources into understanding and addressing these gaps. The persistence of these problems, and in some cases their worsening, isn’t for lack of trying.

So why haven’t we made real, lasting progress? Why can’t we get our arms around health disparities and squeeze them out of existence? There’s no single answer, but I’d argue three culprits stand out: we lack a common language, clear accountability, and defined metrics of success.

Let me paint a picture with a few examples. Back in the early 1930s, corporate America’s sloppy, inconsistent financial reporting was seen as a key trigger of the 1929 Stock Market crash and the Great Depression that followed. The American Institute of CPAs stepped in and created GAAP, a set of accounting standards that brought consistency, predictability, and transparency. Clear purpose, shared language, accountability, and measurable outcomes turned chaos into order.

In 1961, President Kennedy threw down a gauntlet: land a man on the moon by decade’s end to beat the Soviets in the space race. Skeptics called it a pipe dream, but that bold vision backed by a clear goal, a deadline, and relentless accountability, galvanized NASA and the nation. Neil Armstrong’s first steps in July 1969 proved it wasn’t fantasy; it was focus.

In 1964, the U.S. Surgeon General dropped a bombshell report linking smoking to serious health risks. Within a year, the Federal Cigarette Labeling and Advertising Act mandated warning labels on packs. What followed laws, taxes, regulations, and public campaigns, slashed smoking rates by about 75% in my lifetime. A straightforward goal, clear metrics, and a coordinated push delivered results.

And then there’s 1987, when President Reagan stood at the Brandenburg Gate and demanded, “Mr. Gorbachev, tear down this wall.” A crystal-clear objective, a defined outcome, and accountability that shook the world. Two years later, the Berlin Wall fell.

Now, some will say health disparities, rooted in centuries of inequity, are trickier than tidying up accounting rules, landing on the moon, or dismantling a Cold War relic. They’re not wrong. But complexity isn’t an excuse for stagnation.

Take Healthy People 2030, one of the Department of Health and Human Services’ roadmaps for improving health nationwide. It outlines five ambitious goals: ensuring thriving lives free of preventable diseases and premature death, eliminating disparities and achieving health equity, building environments that unlock everyone’s health potential, promoting well-being across all life stages, and rallying leaders and the public to take action. Noble goals, no doubt. But they’re followed by 358 objectives, some vague, some tangled, and some even clashing, with overlapping mandates from various HHS agencies. Good intentions often get lost in this sea of complexity.

To cut through the noise, we need an action plan. Take, for example, appointing a “Health Disparities Czar” to unify the nation’s efforts. One leader, one vision, a streamlined, cost-effective, and coordinated approach, rather than the fragmented mess we have now. From there, we can’t afford to tackle “health disparities” as a whole. It’s crucial to prioritize five to seven key disparities to address over the next decade. I’d start with maternal mortality rates, heart disease, diabetes, obesity, and a couple of other areas we can narrow down. The key is focus, less “boiling the ocean,” more targeting critical issues.

To make real progress, we must ditch vague platitudes and set SMART goals: specific, measurable, achievable, relevant, and time-bound. This isn’t about wishful thinking; it’s about concrete targets we can track and hit. I’m all for states doing their part to improve local health and well-being, but without a unified national framework, we’re just shouting into the wind. Look at past successes like GAAP, the moon landing, smoking reduction, and the fall of the Berlin Wall, each succeeded because clarity and accountability transformed ambition into action. Health disparities deserve the same. My story and millions like it show what’s at stake. We have the tools and the will; now it’s time to sharpen our aim and make it happen.

Photo: PeterPencil, Getty Images

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