Social determinants of health — the conditions in which people live, work, and play — can affect an individual’s well-being. For example, where someone lives can influence their access to fresh, healthy food. In low-income neighborhoods or isolated rural communities, markets selling fresh fruits, vegetables, and other nutritious foods may be few and far between, creating what’s known as a food desert. The U.S. Department of Agriculture identifies more than 6,500 food deserts in the United States, based on how close people live to supermarkets, supercenters, and grocery stores. This limited access to healthy food has far-reaching consequences. In fact, studies have shown that neighborhoods designated as food deserts often report high childhood obesity rates and other diet-related health issues that can have lifelong negative impacts.
Economic stability — which encompasses elements such as socioeconomic status, income, and cost of living — is another important social determinant of health. Economic factors impact health outcomes because they influence the kind of health care people can access and how often they can use these services. Health insurance can command high deductibles, requiring people to shoulder a hefty share of the expense for health treatment. If individuals cannot afford to pay steep medical bills, they might postpone or completely abandon efforts to get the health care they need.
Dr. Thomas LaVeist, dean of the Tulane University School of Public Health and Tropical Medicine, is a passionate proponent of public health equity. He sees the issue of affordable insurance coverage as central. “We’re the only industrialized country that doesn’t provide access to health care to all,” Dean LaVeist explains. “We tie access to health insurance to employment. This is not the way it’s done anywhere else in the world, and that is not the most efficient or effective way — it leaves millions of people out.”
Social determinants, such as income or access to good food, have the power to tip the scales of public health in favor of certain communities. In order to change these trends and successfully promote health equity, public health professionals need to understand the unique challenges individuals and communities face. “While we all live in the same country, we’re experiencing the country in very different ways,” Dean LaVeist says. “As a result, we have differential access to resources.”
Health equity requires holistic improvements to all community resources. According to Communities in Action, Pathways to Health Equity, communities striving to improve health outcomes for all members should consider:
- Income and wealth
- Health systems and services
- Public safety
- Social environment
By bolstering social resources, communities can affect real change. Here’s how two communities, one rural and one urban, have addressed the issue of public health equity:
The Delta Health Center (DHC) serves individuals and families in five rural counties in the Mississippi Delta. It aims to make big changes in how the community organizes its healthcare delivery to improve health outcomes for all residents, many of them lower income. Focusing on a community-oriented primary care model, the center provides comprehensive services, from dental care to diabetes clinics to women’s health care.
Mississippi is among the 14 states (as of January 2020) that opted not to take advantage of expanded Medicaid coverage offered in 2012. Consequently, thousands of Mississippians who have no other options for health insurance coverage do not qualify for Medicaid. In the Mississippi Delta, DHC helps families who have fallen into the so-called insurance gap by offering sliding-scale fees and prescription assistance.
In addition to providing income-based solutions, DHC has adapted to align with the community’s social environment. To address residents’ historic mistrust of medical institutions, for example, the DHC staff is transparent about following HIPAA privacy rules and helps foster positive relationships by interacting with the community through health fairs and school programs.
In the 1990s, West Oakland, California, was a vibrant, middle-class community. But when the historically African-American community’s prosperity began to decline — largely due to discriminatory housing policies and residents’ losing homes to redevelopment — the area faced challenges to health equity.
To help address the growing health disparities, community organizers created the Mandela Marketplace. Still active today, the initiative provides employment opportunities and offers health and nutrition education through Mandela Foods Cooperative, a grocery store stocking fresh produce, much of it sustainable and sourced from local farmers of color.
Community-focused efforts can help our entire nation achieve health equity, but these grass-roots programs need the partnership of public health professionals who truly represent their communities. “Public health leaders need to be culturally competent,” Dean LaVeist says. “Without a nuanced understanding of the people they are trying to help, they’re going to be less effective.”
Dean LaVeist also emphasizes the importance of working directly with community members. “It’s helpful to have people from the community you are serving be part of the process of developing solutions,” he says. “Engaging community members as knowledge creators is necessary for creating solutions that work.”
Public health leaders need to be well versed in a community’s specific nuances in order to support that community’s health effectively. Programs such as the Online Master of Public Health at Tulane University promote the importance of cultural understanding in professional public health leaders.
The Tulane University Online Master of Public Health (MPH) faculty is passionate about rebalancing the scales of health equity, advocating for public health by fostering the growth of culturally competent professionals. MPH students benefit from a flexible online program taught by active public health researchers and are supported by access to the School of Public Health and Tropical Medicine’s rich history and innovative thought leadership. Explore how you can join a diverse group of students who are dedicated to giving a voice to those in need and creating healthier communities and a healthier nation.