STUCTURAL DETERMINANTS SOCIAL DETERMINANTS OF HEALTH INEQUITIES
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INTERMEDIARY DETERMINANTS SOCIAL DETERMINANTS OF HEALTH
fiGure 12–1 WHO Framework Describing Structural Determinants of Health Source: Solar, O., & Irwin, A. (2010). A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice). Accessed at http://www.who.int/ sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf
socioeconomic Determinants
The key components of socioeconomic position depicted have been substantiated to be the root of health inequities, measured at the population level (Solar & Irwin, 2010). Low economic status is the most consistent predictor of life expectancy, morbidity and mortality, and health status (Braverman, Cubbin, Egerter, Williams, & Pamuk, 2010). Although there is great diversity among minority populations, overall, minorities have substantially lower incomes and educational levels than do whites. Income is a powerful variable that explains health status. Low income and educa- tion result in economic hardship, such as the inability to meet one’s living expenses, while higher incomes and educational levels facilitate access to care, better housing in safer neighborhoods, increased opportunities for healthy food purchases, and access to club memberships and health- promotion programs. In addition, low-status occupations expose individuals to physical health hazards. Educational attainment also is lower in minority groups. High-risk behaviors have been correlated with lower educational levels. More-highly educated persons are also more likely to obtain health-related information at understandable levels.
A socioeconomic gradient exists for almost every health indicator for every racial and ethnic group (Braverman, Egerter, & Mockenhaupt, 2011). The effects of low socioeconomic status are long lasting. Low socioeconomic status in childhood has been associated with poorer health in adulthood. The cumulative wear and tear of the adverse experiences of living in poverty, with its multiple challenges, results in chronic illnesses. Families who have been poor over several generations and suffer ongoing discrimination and frustration without substantial upward movement develop feelings of powerlessness and perceive their condi- tions differently than do recently arrived immigrants who are poor, but are hopeful about their future.
Access to care can be measured by the proportion of a population that has health insurance. Because of their socioeconomic situation, racial and ethnic minorities are much more likely to be underinsured or to lack health insurance. When they do have insurance, it is likely to be public insurance, primarily Medicaid. Health insurance contributes to the amount and type of health services obtained. Lack of health insurance has important implications for health promo- tion and prevention efforts, such as screening and access to wellness programs. Insurance status has also been correlated with self-reported health status. Those who rate their health as fair or poor are more likely to be uninsured than are those who rate their health as good or excellent. Poor individuals also experience greater barriers in accessing care, have more difficulty getting an appointment, and wait longer during health care visits. These factors are compounded by the fact that many communities of poverty mistrust the government and government-controlled programs. Socioeconomic barriers to accessing care exist for vulnerable populations. These barriers have been repeatedly documented and need to be addressed to improve access to quality health care.