Chairman Reynolds, Vice-Chairman Thernstrom, and other esteemed members of the Commission, thank you for the invitation to address you on the nature of health disparities.

My name is Sally Satel. I am a resident scholar at the American Enterprise Institute and a physician practicing part time at a local methadone clinic. At AEI, much of my work has focused on the interface of medicine and culture and the politicization of science. I have been particularly interested in the manifestation of identity politics within medicine. Until several years ago, the subject of health disparities has been an exceptionally rich example of this phenomenon.

Today I would like to present an overview of health disparities as a discrete topic within the domain of health policy. I will briefly trace the evolution of the conceptual underpinnings of the health disparities issue from its origins as a epidemiological phenomenon with no posited cause, to a civil rights problem presumably driven by bias among physicians, and then to a public health concern stemming from socio-economic factors. Unsurprising, as the causal orientation shifts from civil rights to public health, proposed remedies must realign as well. The themes in this statement are elaborated in greater depth in The Health Disparities Myth: Closing the Treatment Gap (AEI Press 2006) which has been distributed to all members of the Commission and is available online at: http://www.aei.org/docLib/20080630_HealthDisparitiesMyth.pdf.

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Sally Satel, M.D., is a resident scholar at AEI.