According to KFF.org, an independent source for health policy research, polling, and news: Health and health care disparities refer to differences in health and health care between groups that stem from broader inequities. Furthermore, health equity generally refers to individuals achieving their highest level of health through the elimination of disparities in health and health care.
The COVID-19 pandemic and a nationwide racial justice movement over the past half-decade or so have highlighted the focus on health disparities and inequities in the US.
What Drives Disparities?
Social and economic inequities are a major part of what drives disparities in health and health care. Problems in and around the healthcare system drive inequities, specifically:
- Employment Income
- Medical Bills
- Other Financial Support
Neighborhood & Physical Support
- Playgrounds Walkability
- Zip Code/Specific Location
- Early Childhood Education
- Vocational Training
- Higher Education
- Food Security
- Access to Healthy Food Options
Community Safety & Social Context
- Social Integration
- Support Systems
- Community Engagement
- Exposure to Violence & Trauma
- Policing & Justice Policies
- Health Coverage
- Pharmacy Availability
- Access to Linguistic & Cultural Appropriate Care
- Quality Level of Care
Race and ethnicity play a huge role in these health disparities; however, you can see from above the broad range of dimensions where disparities occur. Federal programs are geared toward underserved communities. Those programs tend not to work as designed, unfortunately.
According to this NCBI study for racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease and premature death than among whites. Additionally, according to KFF, 20% of Black people reported experiencing race-based discrimination in the past year, especially during the COVID pandemic, and this doesn’t stop when entering the healthcare system. For instance, this study shows that people living in “Black” zip codes were 67% more likely to experience a shortage of primary care physicians.
Perhaps the most poignant evidence of health inequity is in our nation’s capital, in the cities of Friendship Heights and Barry Farm. They are approximately 10 miles apart. However, the life expectancy differs by 32.9 years between the two. Citizens in Barry Farm, a predominately Black area, have almost 33 years less to live than residents in the predominately white area of Friendship Heights.
Furthermore, Black people experienced more significant declines in life expectancy than white people between 2019 and 2021, reflecting the impacts of COVID-19.
Why It’s Important
It’s important to address health inequities because it boosts the entire nation’s health while reducing spending. Not addressing these issues decreases productivity due to missed time at work and or death. Another point is that people of color are projected to represent 52% of the country’s population by 2050.
Texas’s population increased by just over 16% between 2010 and 2020; people of color make up 95% of that increase. A recent study in San Antonio’s Bexar County shows “some glimpses of improvement” regarding healthcare disparities. Still, social determinants such as race and ethnicity, poverty, lack of education, and housing insecurity strongly correlate to poor health outcomes.
Best Path Forward
Now that we’re coming out of the COVID-19 pandemic, and so many health inequities have been put at the forefront, it’s time to make a change. It’s time to utilize the federal systems already put in place more effectively. It’s time to take the advantages we’re lucky enough to have in this country, as a whole, and find a way for every citizen, no matter what their racial background is, to get the proper healthcare needed.
How Do We Do That?
Unfortunately, the Office of Minority Health Statistics and Engagement in Texas was defunded in 2017. However, in 2021, now former state Rep. Garnet Coleman, D-Houston, tried to create a new office this year. House Bill 4139 is Coleman’s proposal for the Office of Health Equity, which would report to the Texas Health and Human Services Commission. Employees would centralize information about health disparities, handle funding and grants, and work with existing local and federal offices to promote access to care. Nevertheless, the bill passed in the House but failed in the Senate.
Moving forward and coming out of COVID policies, here’s what can be done to improve or close the gap on health inequities and disparities:
- DEI & Student Education
- Root Cause
- Concrete Combat
- More Outreach
Diversity, equity and inclusion training (DEI) is a must. Prospective healthcare practitioners should be encouraged to choose schools with high-quality DEI. States should incentivize these particular schools to boost enrollment and, therefore, awareness in the field.
Using a hardline approach to figuring out the root cause of problems. Leaving out political agendas and posturing is paramount as well.
We need a concrete plan to combat health disparities, which needs to be followed through.
There is community outreach for these issues already happening. However, it’s not working. Most communities with health inequities have little or no trust in the system. But with proper community outreach and information, that can change. There needs to be a localized plan for outreach and education since each community has its own set of disparities. A problem we as a society have run into in the past is the “blanket fix” for these issues, and that hasn’t been the answer.
Diving deeper into steps that can or need to be taken, we should look at these points:
- Pandemic Interventions
- Downstream not Upstream
- Expand Insurance Coverage
As mentioned above, the pandemic taught us so much and brought health inequities and disparities front and center. We can use pandemic interventions that work moving forward. At a time when many COVID policies are ending or losing funds, we need lawmakers to pledge to keep in place what proved successful.
We need to move downstream, not upstream. In regard to this, “downstream” means looking outside of healthcare. A prime example is the Department of Housing and Urban Development’s Moving to Opportunity for Fair Housing, which provided vouchers for low-income families to move into neighborhoods with less poverty during the pandemic. The move improved social and health outcomes.
Since Obamacare, or the Affordable Care Act (ACA), was enacted, there are fewer uninsured citizens nationwide. However, disparities still remain; disparities in coverage, and millions of people still don’t have health insurance. But the ACA has made it so there are fewer financial barriers for Blacks and other minorities to receive healthcare. Expanding Medicaid under the ACA has also reduced gaps in insurance coverage between Blacks and whites.
Although the gaps in disparities are closing, there’s still much to do. New laws need to be passed, and current programs that work need to be followed through to reduce disparities in health and health care for minorities.