🧑‍⚕️Public Health Social Sciences Unit 4 – Health Disparities and Equity in Public Health

Key Concepts and Definitions

• Health disparities refer to preventable differences in health outcomes and access to healthcare services between different population groups
• Health equity means everyone has a fair and just opportunity to be as healthy as possible, requiring removing obstacles to health such as poverty and discrimination
• Social determinants of health encompass the conditions in which people are born, grow, live, work, and age that shape health outcomes (education, income, housing, etc.)
• Health inequities are systematic, unfair, and avoidable differences in health status between different population groups
  • Result from social, economic, and environmental disadvantages faced by certain groups
• Vulnerable populations experience greater risk of poor health due to social, economic, and environmental factors (low-income, racial/ethnic minorities, LGBTQ+, etc.)
• Health equity interventions aim to reduce disparities by addressing social determinants of health and ensuring equitable access to resources and opportunities
• Health in All Policies (HiAP) is an approach that systematically considers the health implications of policy decisions across sectors to improve population health and equity

Historical Context of Health Disparities

• Health disparities have persisted throughout history, often rooted in systemic racism, discrimination, and social inequality
• Slavery, segregation, and discriminatory policies in the U.S. have contributed to long-standing health disparities among racial and ethnic minority groups
  • Tuskegee Syphilis Study is an infamous example of unethical medical experimentation on African American men
• Colonialism and forced displacement of indigenous populations have led to persistent health inequities globally
• Eugenics movement in the early 20th century promoted pseudoscientific theories of racial superiority and influenced discriminatory health policies
• Civil rights movement and social justice activism have played a crucial role in advocating for health equity and addressing disparities
• Healthy People initiative, launched in 1979, sets national objectives for improving health and reducing disparities in the U.S. every decade
• Affordable Care Act (2010) aimed to expand access to healthcare and reduce disparities, but challenges and inequities persist

Social Determinants of Health

• Social determinants of health are the conditions in which people are born, grow, live, work, and age that shape health outcomes
• Economic stability factors such as income, employment, and food security greatly influence health
  • Poverty is associated with higher rates of chronic diseases, mental health issues, and mortality
• Education access and quality impact health literacy, health behaviors, and employment opportunities
• Neighborhood and built environment, including housing quality, safety, and access to healthy food and green spaces, affect physical and mental health
• Social and community context, such as discrimination, social cohesion, and civic participation, influence health and well-being
• Healthcare access and quality are important determinants, encompassing insurance coverage, provider availability, and culturally competent care
• These determinants interact and accumulate over the life course, contributing to health disparities
• Addressing social determinants requires collaboration across sectors (healthcare, education, housing, transportation, etc.) and community engagement

Measuring and Analyzing Health Inequities

• Measuring health disparities involves comparing health outcomes and determinants between different population groups
• Common measures include morbidity (disease prevalence), mortality (death rates), life expectancy, and health-related quality of life
• Disparities can be assessed by various factors such as race/ethnicity, socioeconomic status, gender, sexual orientation, and geographic location
• Absolute and relative measures are used to quantify disparities
  • Absolute measures look at the difference between rates, while relative measures compare the ratio of rates between groups
• Epidemiological studies, such as cross-sectional, cohort, and case-control designs, are used to investigate health disparities
• Analyzing health inequities requires disaggregating data by relevant subgroups to identify patterns and trends
• Geographic information systems (GIS) and spatial analysis techniques can map and visualize disparities across communities
• Community-based participatory research (CBPR) engages community members as partners in the research process to address health inequities
• Intersectionality framework examines how multiple social identities (race, class, gender, etc.) intersect to shape health experiences and outcomes

Vulnerable Populations and Health Risks

• Vulnerable populations are groups at increased risk of poor health due to social, economic, and environmental disadvantages
• Racial and ethnic minorities often experience worse health outcomes compared to the majority population
  • African Americans have higher rates of chronic diseases, infant mortality, and premature death
  • Hispanics/Latinos face barriers to healthcare access and have higher rates of obesity and diabetes
• Low-income populations are more likely to live in unhealthy conditions, have limited access to healthcare, and experience stress-related health issues
• LGBTQ+ individuals face discrimination, stigma, and barriers to healthcare, leading to higher rates of mental health problems and substance abuse
• Immigrants and refugees may encounter language barriers, cultural differences, and limited access to resources, affecting their health outcomes
• Older adults are at increased risk of chronic diseases, cognitive decline, and functional limitations
• Individuals with disabilities face physical, social, and attitudinal barriers that impact their health and well-being
• Rural populations often have limited access to healthcare services, leading to higher rates of chronic diseases and mortality
• These vulnerable populations often experience multiple, intersecting forms of disadvantage that compound health risks

Policy and Interventions for Health Equity

• Policies and interventions at various levels are necessary to address health disparities and promote health equity
• Expanding access to affordable, quality healthcare is crucial, such as through Medicaid expansion and community health centers
• Addressing social determinants of health requires cross-sectoral collaboration and policies that improve living conditions, education, and economic opportunities
• Community-based interventions engage local stakeholders to identify and address health inequities
  • Examples include community health workers, school-based health programs, and faith-based initiatives
• Cultural competency training for healthcare providers can improve the quality of care for diverse populations
• Health impact assessments (HIAs) evaluate the potential health consequences of policies and projects across sectors
• Place-based initiatives target resources and interventions to specific communities with high levels of health disparities
• Health equity impact assessments (HEIAs) systematically assess the potential impacts of policies on health equity
• Participatory budgeting allows community members to have a say in allocating resources to address health priorities
• Evaluation and monitoring are essential to assess the effectiveness of interventions and make improvements over time

Ethical Considerations in Addressing Disparities

• Addressing health disparities raises important ethical considerations around justice, equity, and human rights
• The principle of distributive justice requires the fair allocation of health resources and opportunities across society
• Equity involves recognizing and addressing the unique needs and barriers faced by disadvantaged populations
• Respect for autonomy means empowering individuals and communities to make informed decisions about their health
• Beneficence requires that interventions and policies aim to maximize benefits and minimize harm for all groups
• Non-maleficence means avoiding interventions that may unintentionally widen disparities or cause harm to vulnerable populations
• Solidarity involves fostering a sense of shared responsibility and collective action to promote health equity
• Participatory approaches that engage communities in decision-making processes are essential for ethical and effective interventions
• Balancing individual and population-level interests can be challenging, requiring transparent and inclusive deliberation
• Ethical considerations should be integrated throughout the research, policy, and practice continuum to ensure equitable outcomes

Future Directions and Challenges

• Despite progress, significant health disparities persist, requiring ongoing efforts to achieve health equity
• Advancing health equity requires addressing the root causes of disparities, including systemic racism, discrimination, and social inequality
• Strengthening the evidence base on effective interventions and policies is crucial for guiding future efforts
  • More research is needed on the mechanisms linking social determinants to health outcomes and the long-term impacts of interventions
• Implementing policies and interventions at scale remains a challenge, requiring sustained political will, resources, and community engagement
• Improving data collection and disaggregation is necessary to better understand and monitor disparities across subpopulations
• Enhancing multisectoral collaboration and coordination is essential for addressing the complex, interconnected determinants of health
• Building a diverse and culturally competent healthcare workforce is critical for providing equitable care to diverse populations
• Addressing the digital divide and ensuring equitable access to health information and technologies is an emerging challenge
• Climate change and environmental justice are increasingly recognized as key issues for health equity, requiring urgent action
• Promoting health equity globally requires addressing disparities within and between countries and strengthening global health governance