Racial and Ethnic Health Disparities
Although health disparities have been documented in many populations and communities (i.e., gender, age, ethnicity and race, education, income, social class, disability, geographic location, or sexual orientation), The Health Trust has chosen to focus particularly on reducing racial and ethnic health disparities. Without dismissing the importance of addressing the social, economic and institutional factors that trigger health disparities in all population groups, THT recognizes that because of the intersection of race and class in the US, people of color are disproportionately impacted by the multiple root causes of health disparities. By choosing to commit to improving the health of the racial and ethnic populations that experience health disparities in Santa Clara County, THT hopes to impact the root causes that affect all populations and improve the conditions for health equity for all.  Disparities in access to care and quality of care based on race and ethnicity are well-documented in the 2003 report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” authored by the Institute of Medicine and the Board on Health Sciences Policy.ⁱ In this report, the Institute of Medicine reports that “despite steady improvement in the overall health of the U.S. population, racial and ethnic minorities, with few exceptions, experience higher rates of morbidity and mortality than non-minorities.” Healthy People 2010, the compendium used to set the nation’s health priorities each decade, also acknowledges “compelling evidence indicate that race and ethnicity correlate with persistent, and often increasing, health disparities among U.S. populations… and [demand] national attention.” ⁱⁱ

Root Causes of Health Disparities
An important feature of health disparities as it is defined in the context of health equity and social justice is that these differences in health that certain populations experience are due to factors beyond individual control. The root causes of health disparities are systemic, institutionalized, and many decades or even centuries in the making. The relationships among the root causes of health disparities are multi-directional and cyclical, exacerbating one another and calling for intervention at every level.

Health Disparity Data
A local look at disparity data shows health disparities particularly affecting high proportions of Latino and Asian populations.

1. Type 2 Diabetes. In SCC, incidence rates for both Latinos and Asians are high: about 8% for each group, compared with incidence among whites (less than 6%). ⁱⁱⁱ
2. Cancers. Cervical and liver cancers have higher incidence rates among Latino and Asian populations than whites and African Americans in SCC. Cervical cancer incidence rates in the county as high as 13.9 per 100,000 for Latina women and 12.7 for Asian women compared with 6.4 for white women and 5.7 for African American women. Latinos are up to twice as likely and Asians are between 2 and 5 times as likely to get and die from liver and stomach cancer than whites.
3. HIV/AIDS. In Santa Clara County, Latinos are 20% more likely than whites to be infected with HIV/AIDS. ^iv
4. Oral Health. In Santa Clara County, Latino and Asian children are 35% and 25% more likely than whites to have experience with dental caries. Latino children are also about 15% more likely than white children to have no dental insurance. ^v

Health Professions Workforce Diversity
The changing demographics of the region suggest that there will continue to be a great unmet need for physicians able to provide linguistically and culturally appropriate care. As a rural area, San Benito County already experiences a shortage of physicians and difficulty recruiting providers. In Santa Clara County there was a clear lack of Latino physicians and surgeons.  The Center for Health Professions projects that by 2020 there will be an overall shortage in the RN workforce in ten Bay Area counties, including Santa Clara County.  Diversity in the health professions has the dual potential of improving the health status of people of color by increasing the educational, employment and socioeconomic prospects of the individuals who become health professionals, while improving the ability of health care organizations and systems to address the needs of diverse communities by increasing at all levels their internal diversity, cultural competency, and understanding of the communities they serve.

Access to Health Care Coverage and Services
Lack of access to quality care contributes to health disparities. Healthcare coverage is only the first step to accessing quality care. Many of the root causes of health disparities act as barriers to utilizing healthcare services even after insurance coverage becomes available. Patient navigation services and promoting cultural competency at many levels are additional steps to ensuring access for all.

Access to Prevention, Screening and Treatment for Chronic Diseases
According to the CDC, seven of ten Americans die each year from a chronic disease. Chronic diseases are among the most common and costly health problems, but they are also among the most preventable. For those members of the SCC who are fortunate to have affordable HC coverage; prevention, screening, and self-management services are often readily available and affordable.  However, for those with limited resources such as adequate health care coverage, financial resources, or who may be new to this country, opportunities to access such services are greatly limited.  The profound racial and ethnic disparities in the prevalence, morbidity and mortality related to diabetes, cancer and HIV/AIDS make these chronic disease areas high priorities for our health disparities work.  Despite the fact that chronic diseases are both highly costly and highly preventable, there is a lack of chronic disease prevention resources in the community.

Oral Health
Oral health problems can cause pain, difficulty in speaking, chewing, swallowing, and eating healthy.  Oral health is dependent upon access to appropriate dental care. On a national^vi and county^vii level, racial and ethnic minority children in the third grade are more likely to have experience with dental caries than white children. Asset mapping projects in Silicon Valley have shown that a shrinking number of dental care providers are accepting insurance such as Denti-Cal, Healthy Kids and Healthy Families, reducing access for children who rely on these types of coverage. This shortage of providers for uninsured or underinsured children, and a lack of a State Oral Health Plan in California, creates a clear need for an oral health clinic focusing on underinsured children.

Places of employment can be an effective arena for promoting healthy behaviors and environments. Where effective worksite wellness programs have been operated, not only did companies save $3 for every $1 invested, but social norms actually within the organizations help to reinforce the desired healthy behaviors. However in businesses and organizations where health care coverage and employee wellness is either viewed as a non-essential luxury, or a complete impossibility because of the high cost, it is difficult at best to promote healthy workplaces.