Health equity arises from the ability to access the social determinants of health, specifically from wealth, power and prestige.
Individuals consistently been deprived of these three determinants are significantly disadvantaged from experiencing health inequities.
Such people face worse health outcomes than those who are able to access such resources.
Health equity is not simply providing every individual with the same resources, that is equality.
Health equity, implies resources are allocated based on an individual need-based principle.
Health is a state of complete physical, mental, social and spiritual well-being and not merely the absence of disease or infirmity.
Evaluating the quality of health and how health is distributed among economic and social status in a society provides insight into the level of development within that society.
Health is a basic human right and human need, and are interconnected to other human rights
Health equity refers to the absence of disparities in controllable or remediable aspects of health.
Inequity implies some kinds of social injustice.
If a population dies younger than another because of genetic differences, which is a non-remediable factor, there is a health inequality.
If a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity.
Health inequities may include differences in the presence of disease, health outcomes, or access to health care, between populations with a different race, ethnicity, gender, sexual orientation, disability, or socioeconomic status.
Having equality in health is essential to begin achieving health equity.
Socioeconomic status is both a strong predictor of health, and a key factor underlying health inequities across populations.
Poor socioeconomic status limits the capabilities of an individual or population, manifesting through deficiencies in both financial and social capital.
Income is an important determinant of access to healthcare resources.
A job or career is a primary conduit for both financial and social assets.
Unequal income distribution itself can be a cause of poorer health for a society: an underinvestment in social goods, public education and health care.
The role of socioeconomic status in health equity extends beyond monetary restrictions or an individual’s purchasing power.
People who are better connected to the resources provided by the individuals and communities around them, that is, those with more social capital live longer lives.
The segregation of communities on the basis of income occurs worldwide.
Community segregation of the basis of income, has a significant impact on quality of health as a result of a decrease in social capital for those trapped in poor neighborhoods.
Social interventions can improve
healthcare by enhancing the social resources of a community.
Wealth drives health affording choice and stability in housing, education, and nutrition, all of which are social determinants of health.
Greater wealth is independently associated with reduced premature mortality, lower rates of chronic diseases such as hypertension, and improved functional status throughout the course of life.
Among people 54 to 64 years of age, those in the lower wealth quintile have a 17% risk of death and 48% risk of disability over 10 years, as compared with 5% and 15% risk, respectively, among those in the top wealth quintile.uiiii
Such community healthcare approaches fare better than individual approaches in the prevention of heart disease mortality.
Cash transfers for reducing poverty used by some in the developing world appear to lead to a reduction in the likelihood of being sick.
Children of low socioeconomic status are the most susceptible to health inequities: children in poor families under 5 years of age are likely to face health disparities because the quality of their health depends on others providing for them, and young children are not capable of maintaining good health on their own.
Children of low socioeconomic status
Have higher mortality rates than those in richer families due to malnutrition.
Children in poor families are less likely to receive health care in general, and if they have access to care, it is likely that the quality of that care is insufficient.
Education is an important factor in healthcare utilization, and it is closely intertwined with economic status. status.
Education also has a significant impact on the quality of prenatal and maternal healthcare.
There is evidence for a correlation between socioeconomic status and health literacy.
Education inequities are also closely associated with health inequities.
Individuals with lower levels of education are more likely to incur greater health risks such as substance abuse, obesity, and injuries both intentional and unintentional.
Education is associated with greater comprehension of health information and services necessary to make the right health decisions.
Education is associated with a longer lifespan.
Individuals with better grades have better levels of protective health behavior and lower levels of risky health behaviors than their less academically achieved counterparts.
Poor nutrition, inadequate physical activity, physical and emotional abuse, and teenage pregnancy all impact on students’ academic performance and these factors are more frequent in lower-income individuals.
In 2019, the federal government identified nearly 80 percent of rural America as medically underserved: lacking in skilled nursing facilities, as well as rehabilitation, psychiatric and intensive care units.
In rural areas, there are approximately 68 primary care doctors per 100,000 people, whereas there are 84 doctors per 100,000 in urban centers.
Rural communities face lower life expectancies and increased rates of diabetes, chronic disease, and obesity.
Due to a lack of affordable health care, the African American death rate reveals that African Americans have a higher rate of dying from treatable or preventable causes.
1999 through 2020 the black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the white population: the differences between the black population and the white population healthcare disparities nave recently increased.
Such disparities also prevalent in indigenous communities.
There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities.
The level of insurance coverage is directly correlated with access to healthcare.
Sexuality is a basis of health discrimination and inequity throughout the world.
LGBT populations face significant discrimination and barriers to care.
Seventeen European states mandate sterilization of individuals who seek recognition of a gender identity that diverges from their birth gender.
19% of individuals that are LGBT experienced a healthcare worker refusing care because of their gender, 28% faced harassment from a healthcare worker, 2% encountered violence, and 50% saw a doctor who was not able or qualified to provide transgender-sensitive care.
23% of LGBT individuals report not seeking necessary medical care out of fear of discrimination, and 33% of individuals who had been to a doctor within a year of taking the survey reported negative encounters with medical professionals related to their transgender status.
The LGBT community is at increased risk for psychosocial distress, mental health complications, suicidality, homelessness, and substance abuse, often complicated by access-based under-utilization or fear of health services.
Transgender and gender-variant individuals have been found to experience higher rates of mental health disparity than LGB individuals.
39% of transgender respondents report serious psychological distress, compared to 5% of the general population.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a disorder until 1973; transgender status was listed as a disorder until 2012.
In 2013 with DSM-5 when gender identity disorder was replaced with gender dysphoria, reflecting that simply identifying as transgender is not itself pathological and that the diagnosis is instead for the distress a transgender person may experience as a result of the discordance between assigned gender and gender identity.
Both gender and sex are significant factors that influence health.
Sex is characterized by female and male biological differences in regards to gene expression, hormonal concentration, and anatomical characteristics.
Gender is an expression of behavior and lifestyle choices.
Sex and gender interaction is complicated by the difficulty of distinguishing between sex and gender given their intertwined nature.
Sex modifies gender, and gender can modify sex, thereby impacting health.
Sex and gender can both be considered sources of health disparity; both contribute to men and women’s susceptibility to various health conditions, including cardiovascular disease and autoimmune disorders.
Males tend to have a health advantage over women due to gender discrimination, evidenced by infanticide, early marriage, and domestic abuse for females.
The mortality rate is higher for adult men than for adult women.
Adult men develop fatal illnesses with more frequency than females.
Male death rate is higher due to accidents, injuries, violence, and cardiovascular diseases.
Physicians tend to offer invasive procedures to male patients more often than to female patients.
Men are more likely to smoke than women and experience smoking-related health complications later in life as a result.
Similar trends exist for other substances: marijuana.
Men are also more likely to have severe chronic conditions and a lower life expectancy than women in the United States.
Women in developing nations experience greater mortality rates than men in developed nations.
Women in developing countries have a much higher risk of maternal death than those in developed countries.
The highest risk of dying during childbirth is 1 in 6 in Afghanistan and Sierra Leone, compared to nearly 1 in 30,000 in Sweden—a disparity that is much greater than that for neonatal or child mortality.
Women in the United States tend to live longer than men, they generally are of lower socioeconomic status and therefore have more barriers to accessing healthcare.
Having a lower socioeconomic status increased societal pressures, with higher rates of depression and chronic stress and, which negatively impact health.
Women are also more likely than men to suffer from sexual or intimate-partner violence both in the United States and worldwide.
In Europe, women with history of child poverty are more likely to have lower muscle strength and higher disability in old age.
Women’s pain tends to be treated less seriously and initially ignored by clinicians when compared to their treatment of men’s pain complaints.
An estimated 3 million girls are subjected to female genital mutilation each year potentially suffer both immediate and lifelong negative effects, excessive bleeding and urine retention, urinary tract infections, bacterial vaginosis, pain during intercourse, and difficulties in childbirth that include prolonged labor, vaginal tears, excessive bleeding, higher rates of post-traumatic stress disorder (PTSD) and herpes simplex virus 2 (HSV2) than women who have not.
Minority populations have increased exposure to environmental hazards that include lack of neighborhood resources, structural and community factors as well as residential segregation that result in a cycle of disease and stress.
Minority neighborhoods have more fast food chains and fewer grocery stores than predominantly white neighborhoods, affecting a family’s ability to have easy access to nutritious food.
The lack of nutritious food extends into the schools that have a variety of vending machines and deliver over processed foods.
These social ramifications is projected that the current generation will live shorter lives than their predecessors will.
Minority neighborhoods have health hazards that result from living close to highways and toxic waste factories or general dilapidated structures and streets.
Environmental conditions create health risk from noise pollution, carcinogenic toxic exposures from asbestos and radon that result in increase chronic disease, morbidity, and mortality.
Damaged housing residential environment increases the risk of adverse birth outcomes, through exposure to lead in paint and lead contaminated soil as well as indoor air pollutants such as second-hand smoke and fine particulate matter.
Adverse housing conditions can create varying health risks that lead to complications of birth and long-term consequences in the aging population.
Occupational hazards can add to the detrimental effects of poor housing conditions, as greater number of minorities work in jobs that have higher rates of exposure to toxic chemical, dust and fumes.
Latino farmworkers are exposed to high levels of particulate matter and pesticides on the job, which contribute to increased cancer rates, lung conditions, and birth defects in their communities.
Residential segregation is noted in all minority groups, but blacks tend to be segregated regardless of income level when compared to Latinos and Asians.
Segregation results in minorities clustering in poor neighborhoods that have limited employment, medical care, and educational resources, which is associated with high rates of criminal behavior.
Such segregation affects health because the environment is not conducive to physical exercise due to unsafe neighborhoods that lack recreational facilities and have nonexistent park space.
Individuals who experience discrimination have an increased risk of hypertension and other physiological stress related affects.
Environmental, structural, and socioeconomic stressors leads to compromise on the psychological and physical wellbeing, which leads to poor health and disease.
Although 20 percent of the U.S. population lives in rural areas, only 9 percent of physicians practice in rural settings.
Rural areas individuals must travel longer distances, experience long waiting times, or are unable to obtain the necessary health care they need in a timely manner.
Rural areas characterized by a largely Hispanic population average 5.3 physicians per 10,000 residents compared with 8.7 physicians per 10,000 residents in nonrural areas.
Reasons for disparities in access to health care are many, but can include the following:
Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs.
Minority groups in the United States are more likely to use emergency rooms and clinics as their regular source of care.
Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs, poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person’s ability and willingness to obtain needed care, scarcity of providers.
In inner cities, rural areas, and communities with high concentrations of minority populations,
Scarcity of personnel in the medical laboratory with some geographical regions having significantly diminished access to advanced diagnostic methods and pathology care.
Minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.
Language differences restrict access to medical care for minorities in the United States who have limited English proficiency.
Poor health literacy, where patients have problems obtaining, processing, and understanding basic health information.
Lack of diversity in the health care workforce: Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups’ proportion of the United States population.
Age as a factor in health disparities: older Americans exist on fixed incomes which may make paying for health care expenses difficult.
Other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically.
They may not have the opportunity to access health information.
Mental illness accounts for about one-third of adult disability globally.
Health insurance increases the affordability of healthcare in the United States, but issues of access along with additional related issues act as barriers to health equity.
Without health insurance, patients are more likely to postpone medical care, go without needed medical care, go without prescription medicines, and be denied access to care.
Minority groups in the United States lack insurance coverage at higher rates than whites.
Dental access remains limited for marginalized groups such as the homeless, racial minorities, and those who are homebound or disabled.
Health disparities in the quality of care exist and are based on language and ethnicity/race. which includes:
Communication is critical for the delivery of appropriate and effective treatment and care, regardless of a patient’s race.
Miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care.
Minorities face greater difficulty in communicating with their physicians.
Hispanics have the largest problem communicating with their providers.
Communication is linked to health outcomes, as communication improves so does patient satisfaction which leads to improved compliance and then to improved health outcomes.
Quality of care is impacted as a result of an inability to communicate with health care providers.
The inability of providers to communicate with limited English proficient patients leads to more diagnostic procedures, more invasive procedures, and over prescribing of medications.
Language barriers hinder appointment scheduling, prescription filling, also is associated with health declines, which can be attributed to reduced compliance and delays in seeking care.
Evidence suggests that patients need to communicate with a language concordant physician and not simply an interpreter to receive the best medical care, bond and satisfaction with the care experience.
Communication problems can result from a decrease or lack of cultural understanding by providers of patients’ health beliefs and practices.
Understanding a patients’ views of health and disease is important for diagnosis, treatment to improve quality of care.
Patient’s health decisions can be influenced by religious beliefs, mistrust of medicine, and familial and hierarchical roles.
Communication problems are seen in LGBT health care.
Provider discrimination occurs when health care providers either unconsciously or consciously treat certain racial and ethnic patients differently from other patients.
This discrimination may occur regardless of consideration for education, income, and personality characteristics.
Stereotype discrimination may be automatic stereotypes or goal modified.
Automated stereotyping is activated and influence judgments/behaviors occur outside of consciousness.
Goal modified stereotype is a more conscious process to make a complex decisions.
Physicians are unaware of their implicit biases.
Ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures: Critics question these finding.
Uninsured Americans are less likely to receive preventive services in health care: minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic populations.
The lack of public awareness is a key reason why there has not been significant gains in reducing health disparities in ethnic and minority populations.
Health inequities stem from lack of access to care due to poor economic status and an interaction among other social determinants of health.
The majority of high quality health services are distributed among the wealthy people in society.
To move towards achieving health equity, it is essential that health care increases in areas or neighborhoods consisting of low socioeconomic families and individuals.
Because of the challenges that arise from accessing health care with low economic status, many illnesses and injuries go untreated or are not given sufficient treatment.
There are higher rates of morbidity and mortality for lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder.
In Canada, the issue was brought to public attention by the LaLonde report.
Poor health outcomes appear to be an effect of economic inequality across a population.
Nations and regions with greater economic inequality show poorer outcomes in life expectancy.
There is a positive correlation between developed countries with high economic equality and longevity, unrelated to average income per capita in wealthy nations.
Economic gain only impacts life expectancy to a great degree in countries in which the mean per capita annual income is less than approximately $25,000.
The United States shows exceptionally low health outcomes for a developed country, despite having the highest national healthcare expenditure in the world.
The US ranks 31st in life expectancy.
Americans have a lower life expectancy than their European counterparts, even when factors such as race, income, diet, smoking, and education are controlled for.
High income individuals have a substantially better survival, and are more likely to receive life-saving revascularization after myocardial infarction and had shorter hospital length of stay and fewer readmissions across almost all countries: suggesting income-based disparities are present, even in countries with universal health insurance and robust social safety net systems.
Relative inequality negatively affects health on an international, national, and institutional levels.
The patterns seen internationally hold true between more and less economically equal states in the United States.
Members of lower status in institutions show increased mortality and morbidity on a sliding downward scale from their higher status counterparts.
When comparing the United States, a more unequal nation, to England, a less unequal nation, the US shows higher rates of diabetes, hypertension, cancer, lung disease, and heart disease across all income levels.
This is also true of the difference between mortality across all occupational classes in highly equal Sweden as compared to less-equal England.
Genomics applications continue to increase in clinical/medical applications, but there are disparities in the access to genetic counseling, inclusion of minority communities in original research, and access to genetic information to improve health.
Diagnostic inequity represents a lack of fair and just chance to have diagnostic excellence benefits.
Gaps in diagnostic excellence involves marginalized or otherwise at risk populations for diagnostic inequity.
Such populations include: racial and ethnic groups, residence location, rural versus urban, income levels, insurance status, age related, disability communities, linguistic communities, low literacy, sexual orientation and gender identity.
Women in the United States tend to live longer than men, and they generally are of lower socioeconomic status.
Their lower socioeconomic status has more barriers to accessing healthcare, increases societal pressures, which can lead to higher rates of depression and chronic stress and, in turn, negatively impact health.
Women are more likely than men to suffer from sexual or intimate-partner violence both in the United States and worldwide.
In Europe, women who grew up in poverty are more likely to have lower muscle strength and higher disability in old age.
Women in the US have higher access to healthcare than men.
Access to maternal obstetric care has decreased in rural communities due to the increase in both hospital closers and labor & delivery center closures that have placed an increased burden on families living in these areas.
Women living in rural areas in the United States are more at risk of having decreased access to maternal health care facilities if the community is low-income, and are more at risk of experiencing adverse maternal outcomes like a higher risk of having postpartum depression, having an out-of-hospital birth, and on the extreme end, maternal morbidity and mortality.
Women’s pain tends to be treated less seriously and initially ignored by clinicians when compared to their treatment of men’s pain complaints.
Historically, women have not been included in the design or practice of clinical trials.
Health disparities are due in part to cultural factors that involve practices based not only on sex, but also gender status.
In India, gender-based health inequities exist as many families provide better nutrition for boys in the interest of maximizing future productivity.
In India boys receive better care than girls and are hospitalized at a greater rate.
The magnitude of health disparities increases with the severity of poverty in a given population.
The practice of female genital mutilation (FGM) is known to impact women’s health, with an estimated 3 million girls who are subjected to FGM each year potentially suffer both immediate and lifelong negative effects.
Following FGM, girls commonly experience excessive bleeding and urine retention, and long-term consequences include urinary tract infections, bacterial vaginosis, pain during intercourse, and difficulties in childbirth that include prolonged labor, vaginal tears, and excessive bleeding.
FGM patients have higher rates of post-traumatic stress disorder (PTSD) and herpes simplex virus 2 (HSV2) than women who have not.
Minority populations have increased exposure to environmental hazards that include lack of neighborhood resources, residential segregation that results in a cycle of disease and stress, influencing individual behaviors and lead to poor health choices and outcomes.
Minority neighborhoods have more fast food chains and fewer grocery stores than predominantly white neighborhoods: food deserts affect a family’s ability for easy access to nutritious food.
This lack of nutritious food extends into the schools that have a variety of vending machines delivering over processed foods.
These environmental conditions have social ramifications and in the first time in US history is it projected that the current generation will live shorter lives than their predecessors will.
Minority neighborhoods have various health hazards that result from living close to highways and toxic waste factories or general dilapidated structures and streets: create varying degrees of health risk from noise pollution, to carcinogenic toxic exposures from asbestos and radon that result in increase chronic disease, morbidity, and mortality.
Damaged housing has been shown to increase the risk of adverse birth outcomes, which is reflective of a communities health: exposure to lead in paint and lead contaminated soil as well as indoor air pollutants such as second-hand smoke and fine particulate matter.
A greater number of minorities work in jobs that have higher rates of exposure to toxic chemical, dust and fumes: poor Latino farmworkers face in the United States, a high levels of particulate matter and pesticides on the job, which have contributed to increased cancer rates, lung conditions, and birth defects in their communities.
Racial segregation results in minorities clustering in poor neighborhoods that have limited employment, medical care, and educational resources, which is associated with high rates of criminal behavior.
Segregation affects the health of individual residents because the environment is not conducive to physical exercise due to unsafe neighborhoods that lack recreational facilities and have nonexistent park space.
Racial and ethnic discrimination adds to the environment that individuals have to interact with daily, and Individuals that report discrimination have an increase risk of hypertension in addition to other physiological stress related affects.
The presence of high magnitude environmental, structural, socioeconomic stressors leads to increased compromise on the psychological and physical being, which leads to poor health and disease.
Individuals living in rural areas, have access to fewer health care resources.
Although 20 percent of the U.S. population lives in rural areas, only 9 percent of physicians practice in rural settings.
Individuals in rural areas typically longer distances to receive care, experience long waiting times, and are unable to obtain the necessary health care they need in a timely manner.
Rural areas have an average 5.3 physicians per 10,000 residents compared with 8.7 physicians per 10,000 residents in nonrural areas.
Compared to whites, minority groups in the United States are less likely to have a regular doctor are more likely to use emergency rooms and clinics as their regular source of care.
The lack of financial resources is a barrier to health care access for many Americans, and the impact on access appears to be greater for minority populations.
Legal barriers to medical care by low-income immigrant minorities can to public insurance programs.
Structural barriers including poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person’s ability and willingness to obtain needed care.
In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities, and medical laboratories.
The health care financing system is a barrier to accessing care.
Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.
Language differences restrict access to medical care for minorities who have limited English proficiency.
Health literacy is important patients in obtaining, processing, and understanding basic health information.
Problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.
There is a correlation of maternal education and the antenatal visits for pregnancy.
Lack of diversity in the health care workforce is a major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients.
Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups’ proportion of the United States population.
Age is a factor in health disparities.
As many older Americans exist on fixed incomes, may have impaired mobility or lack of transportation which make accessing health care services challenging.
Many older Americans may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.
Health insurance increases the affordability of healthcare in the United States, issues of access along with additional related issues act as barriers to health equity.
Health Insurance Literacy: include premiums, deductibles, co-payments, coinsurance, coverage limits, in-network versus out-of-network providers, and prior authorization.
Only an approximate 9% of Americans understand health insurance terms.
Lack of universal health care or health insurance coverage:
Without health insurance, patients are more likely to postpone medical care, go without needed medical care, go without prescription medicines, and be denied access to care.
Minority groups in the United States lack insurance coverage at higher rates than whites.
This problem does not exist in countries with fully funded public health systems.
Underinsured or inefficient health insurance coverage leads to side effects that occur as a result of lack of care.
In many countries, dental healthcare is less accessible than other kinds of healthcare resulting in increased risk for oral and systemic diseases.
In Western countries, dental healthcare providers are present in private or public healthcare systems that typically facilitate access.