Social determinants of health, part 1

This post is the first in a three-part series on social determinants of health, collaboratively written by KHA staff members Lisa Gary, Khadija Jahfiya and Jasmine Hall Ratliff. A new post will be published each Tuesday in June.

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Health disparities continue to be a major public health issue in the United States. Various definitions for the concept of health disparities exist. As noted by the CDC, “health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”

This definition is commonly cited. The first unique feature of this definition is the notion that the differences are preventable. The second interesting feature of this definition is the proposition that the populations affected by disparities are socially disadvantaged. This disadvantage may mean that certain populations are differentially affected with poor health or they have a higher likelihood of experiencing poor health. By definition, for example, if a health outcome is seen to a greater or lesser extent between populations, there is a potential disparity.

As we continue to think about definitions of disparities, we should note that the term “disparities” is often construed to mean racial or ethnic disparities. However, many different types of population groups experience health disparities in the United States.

As noted earlier, a simple difference becomes a disparity when it is differentially experienced by socially disadvantaged groups. As a result, we can observe differences for various subpopulations defined by age, gender, race or ethnicity, disability status, chronic illness status, geographic location, socioeconomic status or sexual identity. In addition to the variety of population groups that experience disparities there is also diversity in the types of health-related disparities.

For example, many socially disadvantaged populations experience disparities in health care treatment or quality of healthcare services, health care access, and health outcomes like higher mortality and morbidity rates.

The documentation of health disparities is longstanding in the fields of medicine and public health. In 2003, the Institute of Medicine released a landmark report on racial and ethnic disparities in the United States. The report cataloged disparities in health outcomes and health care treatment and presented important methodological insights on measuring disparities. Federal agencies such as the Agency for Healthcare Research and Quality (AHRQ), produce the National Healthcare Quality and Disparities Reports which has garnered significant attention by public health practitioners and health care providers in the past.

Finally, the Office of Disease Prevention and Health Promotion (ODPHP) within the U.S. Department of Health and Human Services has continued its Healthy People initiative to track the overall well-being of Americans during 10-year increments of time. The current initiative is called Healthy People 2030 and the ODPHP will measure the progress on various goals and objectives for reducing preventable illness among all Americans. Regular reports will be generated.

For readers who are interested in learning more about the methodological issues with measuring health disparities, we have listed some references.

References

Smedley B, Stith A, Nelson A. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, D.C: The National Academies Press; 2003.

Keppel K, Pamuk E, Lynch J, et al. Methodological issues in measuring health disparities. National Center for Health Statistics. Vital Health Stat 2(141). 2005. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681823/

National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; September 2018. AHRQ Pub. No. 18-0033-1-EF. http://www.ahrq.gov/research/findings/nhqrdr/nhqdr17/index.html