There are many different forms of of disparities that exist in the United States’ health system. Social determinants like race or ethnicity, sex, sexual identity, age, education, and socioeconomic status can greatly impact health outcomes in specific risk populations. Healthy People of 2020 defined a health disparity as a “particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” (Disparities, 2018). In 2008, 33% of the U.S. population identified themselves as belonging to a racial or ethnic minority population and 23% of the population lived in rural areas (Disparities, 2018). Over the years, efforts have been made in order to eliminate such disparities in order to achieve health equity. Not only have efforts been made to eliminate disparities in disease and illness, but also in other aspects that contribute to good health.
Race & Ethnicity
Racial and ethnic inequality refers to advantages and disadvantages that different groups face and how these socially constructed categories have an impact on individuals. Health disparities are differences that exist among different populations and they can have an effect on the health potential of individuals. Health disparities that involve race and ethnicity have remained a significant public health issue in the United States despite improvements in access to healthcare, education, and social mobility. Racial and ethnic disparities are still prevalent and have even seen an increase in certain areas.
Racial and ethnic disparities in health care contribute to higher morbidity and mortality rates in these groups. Health disparities can be linked to social, economic, and environmental disadvantages that are implemented by the conditions that surround us (A Nation Free of Disparities in Health and Healthcare, 2018). One of the most prominent chronic diseases in the United States, cardiovascular disease, accounts for the largest proportion of inequality in life expectancy between African Americans and non-Hispanic Whites, also affecting rates of diabetes (A Nation Free of Disparities in Health and Healthcare, 2018). Examining and addressing these health disparities at the national level is vital in reducing them. An underlying cause of disparities are socioeconomic policies, health access, and lack of health education issues among minority groups that Caucasian individuals are as likely to encounter. For example, Caucasian women are more likely to become diagnosed with breast cancer, however African-American women are more likely to die from breast cancer (Racial and Ethnic Health Care Disparities, 2015).
High prices of health care can also have an impact on health disparities. The cost of healthcare in America also is a contributing factor to health disparities. Whether it’s a life-saving surgery or blood pressure medication, many Americans do not have access to sufficient health insurance to cover steep costs, and end up having to pay out of pocket. In 2007, 62% of people that applied for bankruptcy had to do so in order to cover medical costs they could not afford (Racial and Ethnic Health Care Disparities, 2015). Providing affordable and accessible universal healthcare is an important in addressing the issue of high medical and hospital costs. According to the Institute of Medicine, over 50% of uninsured minorities did not have access to healthcare and 18,000 lives are prematurely lost each year due to lack of medical insurance (Chen, Vargas-Bustamante, Mortensen & Ortega, 2016). Barriers to healthcare access often deter people from receiving the medical attention that they need. Minorities generally face more difficult barriers than white people when it comes to access. Black and Hispanic adults are less likely to have a consistent source of healthcare than white adults, and are more likely to delay receiving care (Orgera & Artiga, 2018) . Having access to care does not necessarily mean that the care being received is high quality. Often minority patients are not receiving equal quality care due to under resourced facilities and providers with a high volume of patients (Chen, Vargas-Bustamante, Mortensen & Ortega, 2016). The Affordable Care Act (ACA) was implemented in 2014 with the goal to increase health coverage. Application of the ACA resulted in around 16.9 million people gaining insurance allowing them to have access to health care and coverage that they can utilize (Sealy-Jefferson, Vickers, Elam & Wilson, 2015). Although this has been far from a solution, steps in the right direction are being addressed to improve public health.
Sex
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Differences in health outcomes and disparities can also be affected by a person’s gender. In most countries, women tend to have a longer life expectancy than men. In the United States, the difference is not significant, with male life expectancy being 75 on average and female being 80 (Yin, 2007). Factors that contribute to this difference can be biological, environmental, and cultural. All of these factors combine to create differences in gender behaviors. In developed countries like the United States, risky unhealthy behaviors are a major factor that contribute to the lessened life expectancy in men. Men tend to have higher rates of smoking, drinking, gun use, hazardous occupations, and are more likely to participate in potentially dangerous behaviors (Yin, 2007). Testosterone in men has been shown to influence physical activity and aggressiveness which can lead to higher death rates from injuries, accidents, and homicides (Yin, 2007). Even though women have lower mortality rates and are less likely to engage in risky behaviors than men, they still see many physical and mental health inequalities (Sagynbekov, 2017). Women often are shown to have higher rates of pain and respiratory conditions that are not related to smoking, and are more likely to suffer from reproductive cancers and depression (Yin, 2007).
Societal and cultural differences in men and women contribute to differences in life expectancy and health outcomes. Men are more likely than women to have jobs in the labor force, which can come with physical hazards that impact how quickly their health declines. As societal and cultural differences in men and women continue to decrease, women will become increasingly exposed to the similar rates of risky health behaviors as men (Yin, 2007). Overall, women tend to rate their health worse and visit hospitals more frequently than men from an early age on, however, they are less likely to die (Yin, 2007). Smoking related conditions significantly affect males more than females. In two years, men with smoking related conditions are significantly more likely to die than women with the same conditions (Yin, 2007). Men who are diagnosed with cardiovascular disease, bronchitis, and respiratory cancer have higher mortality rates than women who are exposed to the same diseases, which implies that men may experience more serious forms of these same conditions (Yin, 2007). Addressing the factors that contribute to health disparities in gender is important in providing effective interventions specific to the needs of each group.
Sexual Identity
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An individual’s sexual identity is strongly associated with some of the major health disparities seen in the United States, As of May 2018, 11 million U.S adults (or 4.5%) identify as lesbian, gay, bisexual or transgender (LGBT). This number has increased over the years, suggesting that it will continue to rise in the years to come. As a result of this, it is imperative that public health officials and others in the medical field focus their attention on how to better serve this population and decrease any current barriers to health that this group may experience.
The LGBT community in the United States has significantly different health outcomes and trends than their heterosexual counterparts. Sexual minorities in the United States experience more health disparities, discrimination, stigma, stress, and are overall at a higher risk for poor health outcomes and health behaviors (Jackson, et al., 2016). For example, one study examined certain health characteristics seen in lesbians and gay men and compared these results to those of hetersexuals, Of the 69,270 participants, it was found that lesbians had a 20% higher risk of obesity and a 96% higher chance of a stroke than their heterosexual females (Jackson, et al., 2016).. In addition, gay men were 21% more likely to have hypertension and 39% more likely to have heart disease. Bisexual men and women were also more likely to report that they drink more than 5 drinks in one sitting, These results are alarming as they demonstrate the inequalities that are seen in this population.
In addition to understanding what health disparities are seen in this group, health officials should also understand possible reasons as to why this inequality is seen. There are many structural barriers to health in the LGBT population, including a lack of culturally competent providers who are trained to deal with the health needs of this community. This has a direct effect on health as bisexual adults are seen to have higher rates of delaying care for non-cost reasons (Dahlhamerm 2016). Also, gay men have higher odds of reporting that they had trouble finding a provider that they can trust. Another barrier to receiving health care involves lesbian women who underestimate their risk at sexually transmitted disease. They tend to distance themselves from getting STI testing because they believe they consider themselves to be a low risk group (Baptise-Roberts, 2017). They believe that STIs are mostly a problem seen in MSM and heterosexual relationships. However, they are vulnerable to a host of diseases including chlamydia, trichomonas vaginalis, treponema (syphilis) and many others.
In order to better treat the LGBT population, it is important to know the demographics surrounding them that are seen in the United States. However, sexual orientation and gender identity questions are not asked on many national and state surveys. This makes it very difficult to get a better understanding of how to specifically treat the health disparities of the LGBT community. In response to this, Healthy People 2020 have included increasing the number of population-based data systems used to monitor and collect data for lesbian, gay, and bisexual populations (Healthy People, 2018). With better monitoring, public health officials can learn how to better treat members of the LGBT community.
Disability
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Disability is described as any condition of the body or mind that can make it harder for the individual to do everyday tasks and interact with the world around them (CDC, 2018). Disability can be applied to not only to physical symptoms, but also mental. Examples of disabilities include movement, thinking, learning, communicating, mental health, social relationships, vision, and remembering. An individual can be born with a condition (such as down syndrome), or they can get it in the beginning (autism) or later on (dementia) in their life. It can be from a chronic disease (such as losing a limb from diabetes), or through an injury. Considering that people with disability account for 12% of the U.S. population, it is very important to make sure that the needs of this population are being met. In regards to health and health care, people with disabilities fall behind their peers.
Individuals who have some form of disability report worse health problems than their healthy counterparts. For example, they report higher rates of obesity, lack of physical activity, and smoking (Krahn et al., 2015). They also have higher rates of newly diagnosed cases of diabetes and heart disease. The reasons behind these health inequalities stems from a variety of barriers. This includes their access to health care. While there has been a lot of progress in spreading Medicare to people with disabilities, 28% are still uninsured. There are some gaps in the system and the group that usually falls prey are those with emotional disabilities. Since these are hard to diagnose, many people are left without the insurance needed to afford the very expensive care that they need. In addition to having gaps in the system, many people living with disabilities cannot afford the rising costs of health insurance, Adults with disabilities are 2.5 times more likely to report skipping or delaying health care because of the cost. Lastly, people with disabilities do not feel like health care professionals are trained with the correct skills and knowledge to treat them in the ways they need (Sharby et al., 2015). They require care in a different manner than those who are not disabled and many doctors are not taught to treat them properly.
Socioeconomic Status
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The United States is considered to be one of the worlds’ more developed nations, with many opportunities for its citizens. However, unlike many other high income countries, it is severely lacking in health care for all. Instead, there is a clear difference in preventative and tertiary care in people from different socioeconomic statuses (SES). SES is the sociologic and economic circumstances that can affect a person’s way of life. This can include income, education, class, and access to resources. In 2016, 12.7% of citizens were living at or below the poverty line (Census, 2017). In addition, 88% of adults had at least a high school diploma or GED and only 33% held a bachelor’s degree or higher. People who were raised with higher SES usually have more care services and, as a result, will experience a life of better health.
Education is a big marker for certain health habits of people. For example, high school dropouts are 3.7 times more likely to smoke and 4.9 times more likely to not exercise than college graduates (Pampel et al., 2011). In addition, these same trends of unhealthy habits are seen in people who rent rather than own their home and for people who are unemployed, People from higher SES are given the education they need to learn about the importance of engaging in healthy habits and avoiding those that can cause them harm. In addition, they have the economic advantage of having the money to attend higher level education that allows them to afford the ever increasing costs of healthcare. Also, it is increasingly more difficult for people with SES to receive the primary care they need. In one study, telephone calls were made to family physicians and general practices either acting like they come from areas of high or low SES. Approximately 22% of people who presented themselves like they were of high SES received an appointment compared to only 14% (Olah et al., 2013). Again, this enforces the fact that people of low SES have less access to care than other people in the nation. To better serve the people in this country, public health leaders and other officials should focus on ways to reduce the gap between the different statuses.
Geographic Area and Health Disparities
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Zip code is a better predictor of health than genetic code. Quality of healthcare, quality of education, and even quality of the house one lives in all depends on the neighborhood. There are many factors in how a neighborhood can affect health. The type of neighborhood, such as rural, suburban and urban, can affect health. In predominantly communities of color, health care quality has also shown to be lower. Finally, neighborhood income, which is also related to ethnicity and neighborhood-type, can have an effect on health outcomes. All of these factors play a role in perpetuating health disparities within a geographic area.
The type of neighborhood can have an effect on one’s health. Rural, suburban, and urban all have their pros and cons to residing there. Urban communities can have many more amenities in closer proximity than suburban or rural. Suburban communities can have larger houses and backyards than urban living. Rural communities can have more access to nature and fresh air. However, it has been found that rates of child and young adult death, motor vehicle accidents, and male suicides are higher in rural areas across the United States (Institute of Medicine, 2002). Life in a rural community can pose more dangers, as police and fire stations are farther from houses. There are also less job opportunities which can contribute to higher suicide rates.
In communities with a predominantly minority population, health disparities are apparent. Ethnicity and race have been linked to many social issues such as educational opportunity, income, and incarceration rates. It has been found that black adults tend to live in lower socioeconomic neighborhoods and have worse health overall than white adults (Yao & Robert, 2008). It becomes apparent that race, income, and health are all interconnected in our society.
Finally, neighborhood income has also been linked to health disparities. It goes without saying that poorer neighborhoods do not have access to the same services as more affluent neighborhoods do. Access to quality food, access to quality healthcare, and access to quality education are all difficult to find in lower-income neighborhoods. It has been shown that due to hazardous conditions and unequal access to care, people who live in lower-income neighborhoods report more physical and mental health problems (Ailshire & Garcia, 2018). Most of the hardships that face those who live in low-income neighborhoods are not experienced by those who live in higher-income neighborhoods, resulting in the health disparity.
Why Are These Areas Disadvantaged?
Now that we know what types of situations health disparities can arise in, it poses the question: how? How do health disparities arise? Do they develop gradually or in a short amount of time? There are many facets in our society that can cause the development of a health disparity. Some factors that can contribute to health disparities can include historical treatment of certain populations and strategic zoning of residential neighborhoods.
You cannot explain the history of America without acknowledging its participation in the slave trade. The treatment of African slaves were abysmal. When slaves were allowed to integrate into society as “freemen”, their conditions hadn’t improved. Freed slaves were thrown into extreme poverty and manipulative practices such as sharecropping, on top of receiving inadequate health care. Historically, African-Americans have been used as subjects of inhumane medical experiments. The neglect and abuse of African-Americans in the healthcare system has carried on into modern healthcare where African-Americans suffer the effects of prejudices held by physicians (Feagin & Bennefield, 2014). This unequal treatment of African-American patients results in health disparities in that population.
As mentioned in the previous section, health is linked to place of residence. More affluent neighborhoods have better health while poorer neighborhoods have worse overall health. This brings up the question of why neighborhoods end up in their economic state. A huge contributor of health disparities within a neighborhood is zoning. Zoning is when a government entity marks off areas that are designated for certain types of buildings, such as residential or industrial. It has been found that neighborhoods with a higher population of African Americans and immigrants were more likely to be zoned for industrial use (Shertzer, Twinam & Walsh, 2016). When living near industrial plants, one is exposed more to the waste products that said plants excrete. Air quality and overall beauty of the neighborhood can also be diminished. If quality of life is lower when living closer to industrial plants, it can explain the health disparities seen in certain populations.
