HealthMarch 17, 2020

What are health disparities in the United States? An introduction

By: Ogie M. Ezeoke, MD

In the ultimate goal of providing excellent care to patients, health disparities act as a roadblock, impeding both the delivery of equitable care and the achievement of good health outcomes. They create a complex problem that must first be fully understood before it can be solved.

What are health disparities?

Health disparities are preventable variations in the achievement of full health potential, often measured by the unequal burden across population groups of mortality and morbidity associated with disease and disability.

Health disparities in outcomes, overall wellness and receipt of medical care exist across racial, class and state lines. As the U.S. Office of Disease Prevention and Health Promotion's Healthy People 2020 notes, these disparities are "closely linked with social, economic, and/or environmental disadvantage" and "adversely affect groups of people who have systematically experienced greater obstacles to health" based on those disadvantages.

What leads to health disparities?

The Centers for Disease Control and Prevention (CDC) list a number of systemic factors that can lead to unequal health and healthcare. These factors include:

  • Poverty, which can limit access to preventive services, insurance and other cost-management measures
  • Environmental issues, including air and water quality, that make it harder to stay healthy
  • Access to healthcare, which may be prevented by income levels or geography
  • Behavioral factors that hold individuals back from optimal health outcomes
  • Educational inequalities, which the CDC notes are associated with health risks

It's clear from this list that the contributors to health disparities overlap in complex ways. For example, lower education levels may mean reduced income or employment opportunities, which can make budgeting for healthcare harder as well as limiting access to health insurance.

In addition, Healthy People 2020 cites specific social determinants of health like the availability of nutritious food, safe housing, affordable public transportation and culturally aware healthcare providers.

Why location matters in health disparities

Location seems to play an outsize determining role in the factors mentioned above — for example, those who live in food deserts have a harder time accessing healthy food. Environmental risks and inadequacies in built environments may also be associated with where a person lives, as is their ability to get to both jobs and healthcare facilities.

In medical school, the burden of addressing health disparities is often placed on future physicians, who would theoretically relieve the physician shortage and provide care to populations facing unequal access. According to the American Association of Medical Colleges, the United States will expect a shortage of almost 122,000 physicians by 2032.

This shortage is most extreme in areas that lack academic or community health centers. In rural areas, the ratio of primary care providers to patients is 39.8 per 100,000 compared to 53.3 in cities, STAT reports. This shortage, which is a major barrier to health maintenance and treatment for residents of those areas, is one of the reasons for loan forgiveness incentive programs for physicians serving in rural areas.

Where cultural awareness matters in health disparities

With the growing diversity of the U.S. population comes increasing pressure for physicians to meet patients' language and cultural needs. In hospitals around the country, growing understanding of health disparities is leading to culturally aware physicians who encourage patient honesty, engender patient trust and are able to deliver appropriate medical advice that fits the patients' particular needs and resources.

In fact, the authors of a paper published in Plastic and Reconstructive Surgery claim that "[m]easures to improve cultural competence and ethnic diversity will help alleviate healthcare disparities and improve healthcare outcomes in these patient populations." Accordingly, cultural awareness is increasingly being taught and encouraged in medical schools and residencies. That said, ensuring equitable healthcare delivery and reduce health disparities remain works in progress.

Making progress on health disparities

Health disparities across the United States are bound up in many complex issues that plague the medical system, including patients lacking access to medical care facilities, medical insurance and culturally appropriate care. In tackling these problems, it's important to take a broad view that considers both the burden that these disparities place on the health of communities across the country and the need for universal support within the healthcare system for addressing them.

According to Health Affairs, evidence has shown that community-level interventions in addressing health disparities can improve overall population health. Some of the policies that can make a difference target education, including early childhood; urban planning, community development and housing; and income and employment support. Challenges that hold these interventions back include the difficulties of securing full-scale funding and effectively harnessing community planning resources.

On an individual level, physicians can play a role in addressing disparities by providing preventive care in clinics to support improvement in health outcomes, widening access to care in rural areas via telemedicine and supporting cultural awareness training in medical education. As physicians, we must be the proponents of system-wide changes in hospital policy and in legislation.

Ogie M. Ezeoke, MD
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