Key Concepts of Health Equity: Understanding Health Disparities and Social Determinants of Health

Understanding the key concepts of health equity: health disparities and social determinants of health

Countless factors play a role in determining how healthy (or unhealthy) a person is. Some of these factors, which we’ll dive into more below, are completely out of that person’s control, yet they have just as much of an impact on a person’s overall health. That’s where health equity comes into the conversation.

So, what is health equity? 

Health equity is the practice of ensuring everyone has a fair shot at being as healthy as possible, no matter what challenges life throws at them. The key to achieving true health equity is recognizing the threats to it—such as health disparities—and figuring out the best way to overcome them.

What are health disparities?

The Centers for Disease Control and Prevention (CDC) defines health disparities as “preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.”

In other words, health disparities are the unequal and often unjust differences in healthcare access and health outcomes that exist among different groups of people. 

Health disparities can manifest as variations in illness rates, life expectancy, and quality of healthcare received (e.g., different rates of complications). To achieve true health equity, we must figure out how to reduce and ultimately eliminate these health disparities to ensure everyone has an equal opportunity to live their healthiest life.

A health disparity can often be attributed to what are known as social determinants of health, or the non-medical factors and conditions in people’s lives that can significantly impact their health and overall well-being.

What are the social determinants of health (SDOH)?

Social determinants of health include but aren’t limited to factors such as socioeconomic status, education, employment, housing, access to healthcare, social support networks, and community environments. They play a crucial role in shaping an individual’s health, and addressing these factors is the first step in reducing health disparities and achieving greater health equity.

Social determinants of health can be split into five overarching categories:

Economic stability

As anyone who lives in the United States knows, good healthcare is not cheap. Low-income individuals can find it difficult to afford healthcare services, healthy foods, and housing, all of which can then lead to poor health outcomes.

In a recent article, USA Today reported that the average single person will pay more than $100 per month to supplement employer-sponsored health insurance, and more than $400 per month for a marketplace plan—and that’s not factoring in the copayments or coinsurance they’ll have to pay when they do seek care.

These fees can be extremely difficult for someone to cover, especially someone who’s living paycheck to paycheck. They may decide to skip out on medical treatment or health insurance completely in order to avoid the expense.

Education access and quality

Students can have a tough time in school for any number of reasons; as a result, some may drop out of school or fail to earn the grades needed to pursue further education. For others, college may never have even been an option—maybe they don’t have help filling out financial aid applications, or they need to work full-time to help support themselves and their families.

Unfortunately, studies have shown people with lower education levels tend to also have lower health literacy, which can have a significant and detrimental impact on their health outcomes. In addition, those with lower levels of education can often have lower earning potential; as we mentioned above, lower incomes can be a huge barrier to accessing healthcare services.

Healthcare access and quality

About one out of 10 people in the United States don’t have health insurance—as a result, they also don’t have a primary care provider. This means they’re likely not getting basic health services like annual checkups, cancer screenings, or other preventative care services, which can have long-term effects on their health status.

Those who live in a healthcare desert—geographical areas with few-to-no pharmacies, primary care providers, hospitals, trauma centers, low-cost health clinics, or centers of excellence—are also unable to get the high-quality care they need.

Over 80% of U.S. counties are experiencing some type of healthcare shortage, with over 40% lacking a nearby pharmacy, 20% without a local hospital, and more than 9% with no primary care provider.

At Carrum Health, we’re actively combating this. Nearly 100% of the population is within driving distance of one of the surgical centers of excellence in our network. We also provide virtual cancer guidance options—in addition to our cancer treatment bundles—through our partnerships with AccessHope and MSK Direct. Of course, this doesn’t make up for a lack of access to other types of care, but it’s a huge step in the right direction. 

Neighborhood and built environment

Where a person lives and works can have major effects on their health.

In the U.S., some neighborhoods face problems like violence, polluted air, and dirty water. If a neighborhood’s infrastructure is in disrepair, it can make it difficult for people to safely enjoy the space and fit physical activity into their day. For example, sidewalks with severe cracks—or a lack of sidewalks altogether—could lead to people falling, choosing to walk on the road, where it’s more dangerous, or opting to remain inside.

In addition, some jobs can be bad for employees’ health if there’s a high chance of being injured while working (e.g., construction, firefighting, installing power lines) or if they’re exposed to things like cigarette smoke, chemicals, or exceedingly loud noises.

Social and community context

Having strong relationships and feeling like part of a community can impact people’s health. For instance, a sense of belonging and having close confidantes—whether schoolmates, coworkers, members of the same congregation, and so forth—can greatly improve one’s mental health.

Research has also shown that having deep, rich connections with others can positively impact other areas of a person’s health, including, but not limited to, their cardiovascular and immune systems.

Not everyone is fortunate enough to have strong social and familial connections; if there isn’t a way to provide that support and belonging for them, their health could ultimately suffer.

Given the many obstacles some groups face in obtaining high-quality care and how glaring some health disparities are in our country, health equity might seem like a lofty idea—but in reality, it’s a fundamental (and achievable) necessity. It’s our collective responsibility to ensure everyone has the same tools to achieve optimal health levels, regardless of their background or current circumstances.