🚑Contemporary Health Issues Unit 7 – Health Disparities & Social Determinants

Key Concepts & Definitions

• Health disparities refer to preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations
• Social determinants of health encompass the conditions in which people are born, grow, live, work and age that shape health
  • Includes factors such as socioeconomic status, education, neighborhood and physical environment, employment, and social support networks
• Health equity is the principle underlying a commitment to reduce and ultimately eliminate disparities in health and its determinants
• Vulnerable populations are groups at increased risk for poor physical, psychological, and social health outcomes and inadequate health care (racial/ethnic minorities, low-income, elderly)
• Upstream factors influence the fundamental causes of health disparities and operate at the societal level (policies, social norms, institutional practices)
• Downstream factors directly influence individual behaviors and health outcomes (access to healthcare, health literacy, individual lifestyle choices)
• Social gradient in health describes the stepwise fashion health outcomes improve as socioeconomic position improves

Historical Context

• Health disparities have persisted throughout history and are rooted in social, economic, and environmental disadvantages
• Racial and ethnic minorities have experienced a long history of discrimination, segregation, and unequal treatment in the United States (slavery, Jim Crow laws, redlining)
  • These historical injustices have contributed to persistent disparities in wealth, education, housing, and access to healthcare
• The Civil Rights Movement of the 1960s brought attention to racial inequalities and led to legislation aimed at reducing discrimination (Civil Rights Act of 1964, Voting Rights Act of 1965)
• The Heckler Report, released in 1985 by the U.S. Department of Health and Human Services, was a landmark document that highlighted significant health disparities among racial and ethnic minorities
• Healthy People 2000, released in 1990, was the first national health promotion and disease prevention agenda to include a focus on reducing health disparities
• The Institute of Medicine's 2003 report "Unequal Treatment" provided evidence of racial and ethnic disparities in healthcare and recommended strategies for eliminating them

Major Health Disparities

• Racial and ethnic minorities experience higher rates of chronic diseases compared to non-Hispanic whites (diabetes, hypertension, obesity)
• African Americans have a lower life expectancy and higher rates of infant mortality compared to non-Hispanic whites
  • In 2018, the infant mortality rate for African Americans was 10.8 per 1,000 live births compared to 4.6 for non-Hispanic whites
• Hispanics and Native Americans have higher rates of uninsured status and limited access to healthcare services
• Low-income populations experience higher rates of preventable hospitalizations and emergency department visits for ambulatory care sensitive conditions
• Rural populations face challenges accessing healthcare due to geographic isolation, provider shortages, and limited transportation options
• Sexual and gender minorities experience higher rates of mental health disorders, substance abuse, and suicide compared to heterosexual and cisgender populations
• Individuals with disabilities have higher rates of obesity, smoking, and physical inactivity compared to those without disabilities

Social Determinants of Health

• Economic stability influences health through factors such as income, employment, food security, and housing stability
  • Poverty is associated with increased risk of chronic diseases, mental health disorders, and premature death
• Education impacts health by shaping job opportunities, income potential, health literacy, and health behaviors
  • Individuals with higher levels of education tend to have better health outcomes and longer life expectancies
• Neighborhood and built environment affect health through factors such as access to healthy food, quality housing, transportation, and exposure to environmental hazards (air pollution, lead)
• Social and community context encompasses the relationships and interactions that individuals have with family, friends, co-workers, and community members
  • Social support networks can buffer the negative effects of stress and promote healthy behaviors
• Health and healthcare include access to and quality of healthcare services, health insurance coverage, and health literacy
  • Lack of access to preventive services and timely treatment can lead to worse health outcomes and increased healthcare costs

Vulnerable Populations

• Racial and ethnic minorities face barriers to accessing healthcare due to factors such as language, cultural differences, and mistrust of the healthcare system
• Low-income populations may forgo necessary medical care due to cost, even if they have health insurance
  • Medical debt is a significant financial burden for many low-income families
• Elderly populations are more likely to have multiple chronic conditions and functional limitations that require complex care coordination
• Individuals experiencing homelessness have higher rates of mental health disorders, substance abuse, and infectious diseases (HIV, tuberculosis)
  • Lack of stable housing makes it difficult to manage chronic conditions and adhere to treatment plans
• Immigrants and refugees may face language barriers, cultural differences, and fear of deportation that prevent them from seeking healthcare
• Incarcerated populations have higher rates of chronic diseases, mental health disorders, and infectious diseases compared to the general population
  • Access to healthcare in correctional facilities is often inadequate and inconsistent

Health Equity Strategies

• Increasing access to affordable, quality healthcare services through expansion of insurance coverage and community health centers
• Addressing social determinants of health through cross-sector collaborations and partnerships (housing, transportation, education)
  • Place-based initiatives target resources and interventions to specific communities with high levels of health disparities
• Implementing culturally and linguistically appropriate healthcare services to improve patient-provider communication and trust
• Diversifying the healthcare workforce to better reflect the communities served and reduce implicit bias
  • Increasing recruitment and retention of underrepresented minorities in health professions
• Engaging communities in the planning, implementation, and evaluation of health equity interventions
  • Community-based participatory research involves community members as equal partners in the research process
• Collecting and disaggregating data by race, ethnicity, and other social determinants to identify and monitor health disparities
  • Using data to inform targeted interventions and allocate resources to communities with the greatest needs

Current Policies & Interventions

• The Affordable Care Act (ACA) expanded insurance coverage and included provisions to reduce health disparities (essential health benefits, preventive services without cost-sharing)
• The National Partnership for Action to End Health Disparities, established in 2011, is a national framework for collaboration and action to eliminate health disparities
  • Includes goals and strategies for addressing social determinants of health and promoting health equity
• The Centers for Disease Control and Prevention (CDC) funds programs and initiatives aimed at reducing health disparities (Racial and Ethnic Approaches to Community Health, REACH)
• The National Institutes of Health (NIH) supports research on health disparities and funds training programs for underrepresented minorities in biomedical research
• State and local health departments implement targeted interventions and policies to address health disparities in their communities (tobacco cessation programs, healthy food access initiatives)
• Healthcare organizations are implementing diversity, equity, and inclusion initiatives to reduce implicit bias and improve cultural competence among healthcare providers

Future Challenges & Opportunities

• Addressing the root causes of health disparities will require sustained, multi-sectoral efforts to improve social and economic conditions
  • This includes policies and investments in education, housing, transportation, and environmental justice
• Ensuring equitable access to and uptake of new health technologies and treatments (precision medicine, gene therapies)
  • Ensuring that research and clinical trials include diverse populations to ensure generalizability of findings
• Preparing for the health impacts of climate change, which are expected to disproportionately affect vulnerable populations (heat waves, natural disasters)
• Leveraging technology and data to identify and address health disparities in real-time (electronic health records, mobile health apps)
  • Using artificial intelligence and machine learning to identify patterns and predict health outcomes
• Building a more diverse and inclusive healthcare workforce through pipeline programs, mentorship, and leadership development
  • Addressing systemic barriers to advancement and promotion for underrepresented minorities in healthcare
• Strengthening partnerships between healthcare organizations, public health agencies, and community-based organizations to address social determinants of health
  • Developing innovative payment models that incentivize prevention and health promotion activities