Social inequities in health: Rochester, New York

This paper reports an investigation of social inequities in the distribution of low birth weight risks and mortality rates for Rochester, N.Y., a community reported to have relatively good access to medical care. The prevalence of low birth weight and no prenatal care were lower for each race/education group than those observed in comparable national data. Mortality rates were higher in the poorer areas for each sex, race, age group, and disease category. The excess mortality in the poorer areas declined significantly over the period studied for conditions amenable to medical care but not for conditions not amenable. In minorities, however, the excess mortality increased significantly for amenable conditions with no change for nonamenable conditions. The results are consistent with the hypothesis that the socially disadvantaged suffer an excess burden of morbidity and mortality. Access to medical care may make a significant contribution to reducing these inequities, but major barriers to equitable health and health care remain, particularly for minorities. This is an important but neglected area of concern for family medicine, and the implications are discussed.