Where Health Disparities Begin: The Role Of Social And Economic Determinants—And Why Current Policies May Make Matters Worse

Abstract

Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities-can harm health through complex pathways. Meaningful progress in narrowing health disparities is unlikely without addressing these root causes. Policies on education, child care, jobs, community and economic revitalization, housing, transportation, and land use bear on these root causes and have implications for health and medical spending. A shortsighted political focus on reducing spending in these areas could actually increase medical costs by magnifying disease burden and widening health disparities.

Chronic Psychological Stress and Racial Disparities in Body Mass Index Change Between Black and White Girls Aged 10–19

“…Hypothesized sources range from macro factors, such as neighborhood environment [8] or differential access to healthcare [9], to individual-level factors, such as inequalities in educational attainment [10], metabolic pathways [11,12], and differences in health behaviors [13]. Many researchers in behavioral medicine focus on a biopsychosocial pathway, testing whether exposure to psychological stress and its resulting physiological response might cause or moderate these disparities [14].…”

Gene–environment interactions and health inequalities: views of underserved communities

“…Participants across all focus groups suggested that both social and environmental factors affected the phenotypic expression of their genetic makeup, which resulted in poorer health. These perspectives are clearly in line with the increased focus on multiple determinants of health within the larger public health community, particularly regarding health inequalities Diez Roux 2012;Krieger 2011;Woolf and Braveman 2011).…”

Inpatient Hospital Charge Variability of U.S. Hospitals

“…This could happen both through higher hospital charges to cross-subsidize uncompensated care or the known adverse health consequences of poverty, unemployment, lower educational attainment, crime, and poor social support. [8][9][10][11] To measure socioeconomic status, we used the percent of individuals who are uninsured, percent of a 9th grade cohort that graduates from high school in four years, percent of adults aged 25-44 years with some college education, prevalence of unemployment, percent of children living in poverty, percent of adults with inadequate social support, percent of children living in single-parent homes, and violent crime rate per 100,000 population.…”