Closing the Disparity Gap Requires an Integrated Response from Policy, Research, and Programs

Progress in reducing and eliminating discrimination and health disparities is slow: competing domestic, defense, and foreign-policy priorities, uncertainties of the national economy, and polarized partisan policy environment present challenges to social and health policy advances.Enacted in 1965 before the Social Security Act amendments established Medicare and Medicaid, the Older Americans Act (OAA) declared national rights-based commitment to the inherent dignity of older Americans. Title I of the OAA calls upon federal, state, and local governments and tribes to enable good quality of life for older persons in their later years (AOA, n.d.). To realize its vision, the OAA relies upon the ingenuity and resourcefulness of the nationwide aging network.Initial OAA provisions did not address the differential treatment and social exclusion of underserved racial or ethnic minority elders, nor did they acknowledge the vulnerabilities of older women or sexual minorities. These were ideas whose time had not yet come.Women's Stalled RevolutionWarner (2014) assesses the slow ascension of women in the United States to leadership roles as indicative of a stalled revolution despite some gains in gender equality. The United States lags behind the world community on several dimensions of gender equity, which the Organisation for Economic Co-operation and Development (OECD) judges moral imperative (OECD, 2012; Economist.com, 2013).From the 1938 Fair Labor Standards Act to the 2009 Lilly Ledbetter Fair Pay Act, number of laws provide the legal basis for pay equity for women. Sex (gender) was added to race, color, religion, and national origin in the anti-discrimination provisions of President Lyndon B. Johnson's 1967 Executive Order 11375. The 1978 Pregnancy Discrimination Act, amending Title VII of the Civil Rights Act, and the 1993 Family and Medical Leave Act help to protect and ease work-life dilemmas faced by mothers. Yet, the data are undeniable. Women in the United States do not enjoy pay equity, they struggle to manage work and motherhood, and they find their resources inadequate in old age. When compared with other OECD nations, the U.S. record related to several gender equity indicators is poor, bearing ramifications for women in their older years (OECD, 2012; Economist.com, 2013).The World Economic Forum's (WEF) The Global Gender Gap Report 2014 offers 136nation gender equity analysis. Overall, the United States ranks twentieth out of 142 nations. It ranks sixty-second for health and survival, sixty-fifth for gender wage gap, and forty-seventh for female labor force participation (WEF, 2014).While on average, U.S. female labor force participation may not be as high as in other OECD countries, workforce participation by women ages 55 to 64 rose from 41.3 percent to 59.4 percent between 1980 and 2012. One-third of older women expect to be in the workforce in 2020 (U.S. Department of Labor, Women's Bureau, n.d.), likely because their pensions and savings will be insufficient given the extending arc of human longevity (Social Security Administration, 2013; Women's Institute for Secure Retirement [WISER], 2014). Particularly at risk are women who are single, of color, and living alone in old age.The OECD did not analyze indicators for eldercare, or for caring for people with disabilities. Nonetheless, the United States ranks last among developed OECD nations on paid maternity leave provisions and, unlike thirteen European Union nations and Canada, lacks universal or nearly universal childcare for young children. These issues have long histories of support by influential advocates, unlike those of paid eldercare leave and comprehensive long-termcare reform, which do not have comparable foothold on national and state policy agendas.As Hooyman (2014) notes (see article on page 25), older age and disability, along with gender, race, immigrant status, and social class, all contribute to the compounded likelihood of marginalization. …

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