Determinants of Health Disparities anD Health inequities
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Social determinants of health are the structural and economic conditions in which people are born, live, work, and age (World Health Organization, 2013). These conditions are also responsible for health inequities and are shaped locally, nationally, and globally by economic distribution, social policies, and politics. In other words, money, power, and resources are responsible for the major inequities in health. Health inequities are avoidable inequalities in health between groups of persons that arise from social and economic conditions which increase their risks for illness and access to health promoting and preventive services. Health equity—the absence of disparities in health across populations, genders, and geo- graphic areas—can be achieved by empowering individuals and communities to challenge and change the distribution of social resources and advocate for social policies for equal access for all.
Inequities in health are well documented and are considered to be the result of complex interactions among multiple factors:
• Biologicalvariations
• Healthcareaccess
• Personalhealthbehaviors
• Socialandeconomicresources
• Culture
One way to view health disparities is by examining the range of risk factors that increase the potential for inequalities (Table 12–1). The risk factors include personal health behaviors, popu- lation characteristics, health care characteristics, the social and physical environments, and the types of diseases that are disproportionately diagnosed in vulnerable groups (Koh, Oppenheimer, Massin-Short, Emmons, Geller, & Viswanath, 2010).
Potential Risk Factor
Personal Health Behaviors Population Characteristics Health Care Characteristics Residential Physical Environment
Social Residential Environment Diseases
Examples
Tobacco use, illicit drug use, personal hygiene, dietary habits, physical inactivity, unsafe sexual practices.
Race, ethnicity, immigration status, education, social position, occupation, employment, income, age, sexual orientation, health literacy.
Insurance, access to health care services, access to prevention and screening services, regular physician, medication affordability.
Housing density, housing quality, traffic density, air pollutants, hazardous wastes, drinking water quality, urban or rural, zoning policies, proximity to health care services, and proximity to quality food.
Civic engagement, crime rate, isolation, neighborhood cohesion, neighborhood social capital.
Obesity, hypertension, cardiovascular diseases, diabetes, mental illness, HIV/AIDS, cancer, respiratory illnesses, foodborne and waterborne illnesses.
The most important social determinants of health inequities are considered to be structural influences, or factors that generate and reinforce social stratification and social class divisions in a society and define one’s socioeconomic position (Solar & Irwin, 2010). Socioeconomic position provides access to power, prestige, and resources and is based on a person’s income, education, and occupation. Other important structural determinants include gender, social class, and race/ ethnicity. These determinants are shown in the model in Figure 12–1 that describes the social determinants of health. This model was first drafted at the World Health Organization (WHO) Commission on Social Determinants of Health Meeting in 2005 (Solar & Irwin, 2010). The model depicts how governance structures or the sociopolitical context influences one’s socioeconomic position through the distribution of resources. Socioeconomic position shapes intermediate health determinants. Intermediary determinants that are determined by socioeconomic position include the following:
· Material characteristics: neighborhood, housing, physical working conditions, buying potential
· Behavioralfactors:nutrition,physicalactivity,tobaccouse,alcoholuse
· Psychosocial factors: stressful living conditions and relationships, social supports, coping
resources
Intermediary determinants are reflective of an individual’s place in the social hierarchy, which results in differential exposure and vulnerability to health-compromising conditions (Solar & Irwin, 2010). All of these factors determine one’s health status and well-being.