What Are Health Disparities?
Health disparities are the “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health” and exist when different populations experience different health outcomes. Certain racial or ethnic groups, age groups, people of a particular sex or sexual identity, religious affiliation, disability status, socioeconomic class, or people living in certain locations often experience worse health outcomes than their more advantaged counterparts.
Examples of health disparities include:
- Mortality rates
- Life expectancy
- Burden of disease
- Untreated mental health conditions
- Uninsured or underinsured status
- Inability to access healthcare
Health equity, in contrast, refers to eliminating disparities in health and the level of healthcare received so that all people can experience their best health.
What Causes Health Disparities?
What exactly are health disparities? Often called social determinants of health, many nonmedical factors impact health outcomes and health disparities in the US, and they interact with each other to produce compounding effects on health.
These include:
- Economic stability
- Physical safety and physical environment
- Education
- Food security
- Healthcare access
Economic stability
In an emergency, could a patient afford a $1000 ER bill? This is the lower end of the average out-of-pocket cost to the patient for an emergency room visit. If they don't have the money, do they have a social network that can help them pay their medical bills? These represent social factors of economic stability.
Economic stability includes elements like:
- Employment
- Total income
- Expenses
- Debt
- Medical bills
- Social support
Patients’ economic stability affects whether they can afford their medications, healthy food, or a copay—even a small copay like $10—to see their doctor.
Physical safety and physical environment
When patients need to go to the doctor, can they simply get in their car and go? Is there a bus or train station near their house that’s easy to walk to? These are everyday situations in the physical environment that affect health disparities.
The physical environment includes elements like:
- Safe, adequate housing
- Access to transportation
- Safe access to the outdoors
- Clean water and non-polluted air
Where people live can determine what chemicals they are exposed to as part of their everyday life, the quality of the air they breathe, and the water they drink. Communities near landfills, for example, can continuously breathe in relatively large amounts of methane, causing nausea, fatigue, poor concentration, and a feeling of difficulty breathing.
Even the home itself, and the physical or financial ability to keep it up, can affect health. People living in houses with mold, lead paint, poor plumbing, or poor ventilation experience greater rates of asthma, respiratory problems, lead poisoning, and carbon monoxide poisoning.
Education
Were patients taught healthy nutrition and critical thinking or the skills and credentials they need for professional success? Education is linked with income, and many studies show that people in lower socioeconomic situations experience more obesity, asthma, diabetes, heart disease, and other health problems than people in better financial circumstances.
Educational factors in health disparities include:
- Literacy
- Language
- Early childhood education
- Higher education
- Job training
School is also an important environment in which children gain early social skills and learn to communicate and develop relationships, as well as how they can expect the world to work. Attending a school that is physically dangerous, or in which students are treated as though they are physically dangerous, can also lead to developmental learning that the environment is not safe, leading to diseases of stress.
Food security
Is someone concerned about whether they will have dinner today or breakfast tomorrow? The factor of food security is quite simply access to healthy food or any food at all. This can apply to the person or providing food for their family. Studies show that people who can’t buy enough food are more likely to experience chronic diseases, and be less able to control the chronic diseases they are living with, thus having more medical emergencies. Children who face food insecurity are also at increased risk for obesity, malnutrition, and developmental difficulties.
Community safety
Would the justice system assume your patients were victims or perpetrators? Can these patients squeeze in any time for social hobbies or volunteering out of the day? It isn’t just poverty-related factors that contribute to adverse health outcomes.
Community safety can include both social needs and physical safety, such as:
- Exposure to physical violence or physical or mental trauma
- Social integration
- Social support
- Encounters with law enforcement and the justice system
At its most easily observable, a dangerous community environment leads to people staying inside, making them less physically active. Studies find that people who feel unsafe in their neighborhoods experience higher levels of obesity, though there are many contributing factors. People who feel unsafe in their communities tend to be low-income and, therefore, food insecure, contributing to obesity. In addition to crime and violence producing physical pain and injury, people living in high-crime environments are more likely to experience depression, suicidal thoughts, and anxiety.
Studies show that policies resulting in disproportionate interactions with the criminal justice system also worsen mental health outcomes and contribute to health complications of chronic stress. For example, New York City’s stop-and-frisk policing, which involved aggressive detaining and searching of millions of mostly Hispanic and Black New Yorkers, resulted in greater levels of anxiety and depression in the local population, according to a recent study.
Healthcare access
Do patients have a primary care physician? Could they afford their copays if they had to see the doctor?
Healthcare access is perhaps the most visible contributor to health disparities, including factors like:
- Health coverage
- Availability of providers
- Access to pharmacies
- Culturally appropriate care
- Quality of care
Many elements can contribute to a lack of access to healthcare. People from historically marginalized racial or ethnic groups, low-income individuals, and people who live in rural areas often have more difficulty accessing healthcare. Low-income, rural areas often have fewer specialists, including mental health providers, and less well-equipped hospitals than urban areas of the United States. Telemedicine may somewhat improve healthcare access, but internet speeds are often also lower in rural areas, making telemedicine less available.
Promoting Health Equity
The need to focus on Health Equity in the United States has never been of more importance.
Activate Care is addressing that need with its proactive, whole population social care solution - Path Assist. Path Assist is delivered by a team of public health professionals and local Community Health Navigators who help engage, coach, empower, and change a person’s life course. With Pass Assist, Activate Care partners with managed care organizations, government agencies, and healthcare systems to promote health equity and augment current SDOH-care efforts proactively before costly, avoidable events.