Researchers, health professionals and advocates routinely use these phrases above to talk about differences in health, but what do they really mean? As we look at the health of our nation’s people, it is apparent that people who belong to certain groups are more at risk for illness, disease, and death than members of other groups are. The poor and members of racial and ethnic minorities are the groups at greatest risk. These health inequalities are the frame of reference for health disparities, social determinants of health, and health equity. The terms are different ways of explaining why health inequalities exist, what should be done about them, and who should be involved.
The entry point for health disparities work is the most superficial level – which is not to underestimate the difficulty of the task. These programs typically work with individuals, hoping to alter disease and death trends. They generally do not address the larger factors that give rise to disease. At the other end of the spectrum, health equity work focuses on groups rather than individuals, and addresses conditions like poverty and discrimination that are known to be the fundamental causes of health and disease.
Efforts to reduce disparities in health status and health care typically focus on primary prevention, improvements in the delivery of health care, and use of data to track trends and outcomes. The focus of intervention is usually individuals. Examples include – community programs to improve the health status of at-risk populations (such as screenings and health education; – programs to improve care in clinical settings (such as cultural competency training, workforce diversity), and – data collection to build the evidence base.
SOCIAL DETERMINANTS OF HEALTH
In comparison to the narrower focus of the health disparities approach, the social determinants framework provides a more comprehensive understanding of the reasons why low-income communities and communities of color experience disproportionately higher rates of disease and death. From this perspective, what puts people at risk for or protects them against disease is the environment in which they are born, grow, live, and work. These conditions shape people’s options, choices, and behavior. Consequently, polluted environments, inadequate housing, lack of educational and employment opportunities, and unsafe working conditions are understood to damage the physical and mental health and well-being of low-income communities and communities of color.
The strength of the social determinants approach is its comprehensiveness and action on the social determinants of health requires a broad range of funding resources and willingness to fund outside of traditional health arenas. . Examples include – reducing the levels of poverty in the population; – reducing intervening factors between socioeconomic status and health, and, – increasing awareness of non-health policies that can have decisive consequences for the health of economically vulnerable populations.
The push to achieve health is committed not just to identifying the social determinants of health that create health disparities, but also to taking action to change them. Driven by values of social justice, there is a focus on outcomes (achieving equity) rather than problems (ending disparities), a focus on population health rather than individuals, and a focus on structural and institutional change to address the conditions that produce illness and disease.
There is ample evidence that people of color (including Asian Americans) and those in low-income areas don’t have the same access to quality health care as others. It’s only sensible, fair and right that we find solutions that offer quality of care to everyone. Examples of initiatives under the rubric of health equity that focus primarily on health status and health services include efforts to:
- improve access to health care
- increase risk reduction and disease prevention
- increase minority participation in the health professions
- integrate health literacy, disparities reduction, and quality improvement.