This historic report, the first annual report on healthcare disparities, is intended to provide a balanced summary of the state of disparities in the United States. It will demonstrate that disparities exist for many Americans and improvement is possible. Rather than offer a series of snapshots of disparities from individual research studies, this report provides a comprehensive view of the scope and characteristics of differences in health care quality and access associated with patient race, ethnicity, income, education, and place of residence. To date, no report has provided extensive cross-group comparisons that could provide a national roadmap to focused efforts to reduce disparities. Demographic trends indicate that the number of Americans who are vulnerable to suffering the effects of heath care disparities will rise over the next half century. Current data show that some ethnic minorities, as well as low-income families of whatever race or ethnicity, tend to be in poorer health than other Americans. Additionally, some racial and ethnic minorities are growing at a much more rapid pace than the majority white population. Nearly 1 in 2 Americans will be a member of a racial or ethnic minority-i.e., black, Hispanic, Asian, or American Indian-by the year 2050. Clearly, these trends pose a daunting challenge for policymakers and the health care system. A vital step in the effort to eliminate health care disparities is the systematic collection and analysis of health care data. This will help policymakers and researchers discern the areas of greatest need, monitor trends over time, and identify successful programs for addressing those needs. This first NHDR builds on and seeks to complement existing work in the area of disparities, notably Healthy People 2010 and IOM's 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare Unequal Treatment. Yet those efforts differ from the NHDR in substantive ways. The elimination of disparities in health is a goal of Healthy People 2010. Since the extent to which disparities in health care contribute to overall disparities in health remains unknown, the NHDR complements HP 2010 by focusing on prevailing disparities in health care delivery. Disparities in health care can only be interpreted within the context of disparities in health. Eliminating disparities in health care is a logical method for eliminating associated disparities in health. Unequal Treatment extensively documents health care disparities in the United States by race and ethnicity. The IOM's examination finds that disparities in health care are substantial, even after accounting for characteristics typically associated with disparities, such as health insurance coverage and income. But while Unequal Treatment demonstrates definitively that racial and ethnic disparities in health care exist, it does not measure the magnitude of the problem from a national perspective. The NHDR examines national disparities in both the ability of Americans to access health care and in the quality of health care. It includes an analysis of disparities related to socioeconomic position as well as to race and ethnicity, and attempts to capture the relationship between race/ethnicity and socioeconomic position. The report provides baseline data from which we may be able to measure the effect of national initiatives to reduce disparities. The NHDR provides seven key findings to policymakers, clinicians, health system administrators, and community leaders who seek to use this information to improve health care services for all populations: 1) Inequality in quality persists; 2) Disparities come at a personal and societal price; 3) Differential access may lead to disparities in quality; 4) Opportunities to provide preventive care are frequently missed; 5) Knowledge of why disparities exist is limited; 6) Improvement is possible; 7) Data limitations hinder targeted improvement efforts.