Systemic inequities in the U.S. healthcare system have impeded many people’s ability to get essential medical care. Factors such as race, sexual identity, occupation, housing status, and education level can lessen the quality of care people receive. Government and medical organizations often perpetuate disparities due to historical and systemic discrimination.
Eliminating inequities in health care requires the removal of various barriers. According to the U.S. Department of Health and Human Services, “Achieving health equity involves examining the existence of and reduction of inequities in health, healthcare access, and use of quality health services.”
Those interested in promoting health equity need the right preparation. Tulane University’s Online Master of Public Health fosters the skills students need to understand what health equity is and effect meaningful change in the realm of public health.
Health equity means that every individual has an equal opportunity to live the healthiest life possible. People’s race, economic circumstances, sexual identity, or gender should not affect their access to such basics as healthy food or proper medical care, nor should anyone’s geographic region determine the level of health education available to them. However, today these factors influence our nation’s disease rates, life spans, disabilities, and mortality rates.
According to the National Vital Statistics System, life expectancy can vary by up to seven years between racial and ethnic populations. An unequal distribution of resources contributes to many such alarming disparities. While health differences will always exist, the American Public Health Association (APHA) explains that we can avoid those “linked with social, economic, and/or environmental disadvantage.”
Health equity matters because imbalances in health access lead to differences in life expectancy and quality of life; health disparities also weigh heavily on the economy. Inequities in health access cost the U.S. billions of dollars in lost productivity and excess medical expenses. Failing to address the urgent need to establish health equity hurts everyone.
The barriers to achieving health equity are great but not insurmountable. Public health professionals stand on the front lines of the fight. With ingenuity and tenacity, they can help eradicate unjust and unnecessary disparities. APHA describes the importance of health equity and outlines six strategies that should guide the work of public health professionals:
- Explicitly identify communities who suffer health disparities.
- Confront racial biases in policies and behaviors with training and education.
- Address how housing, employment, transportation, and other determinants affect health equity.
- Implement health equity goals into organizations while also ensuring internal organizational practices do not contribute to health disparities.
- Engage affected communities to actively participate in solving the problems they face.
- Assess the impact of initiatives meant to reduce health inequities.
To answer the question “What is health equity?” and develop a comprehensive understanding of how to achieve it, we can examine the major factors that create health disparities and prevent people from accessing care.
What we eat and the quality of our food directly impact both our physical and mental development. Poor nutrition can negatively affect growth and prevent us from reaching our full potential. Poor diets result in weakened immune systems, increasing susceptibility to communicable diseases, and poor diets contribute to noncommunicable diseases such as diabetes, stroke, and cancer. However, a proper diet can help stave off these unfortunate health outcomes.
What happens when a community lacks access to fresh and healthy food? According to the Centers for Disease Control and Prevention (CDC) poor access to nutritious foods leads to unhealthy diets.
Today, many rural, minority, and low-income communities in the U.S. are known as food deserts. Food deserts are areas with few local sources of fresh fruits, vegetables, and other whole foods. Instead, food stores in food deserts sell mostly high-fat, high-sugar, processed foods. People who live in food deserts find it more difficult to eat a healthy diet, which accounts for their higher rates of negative health outcomes.
For instance, living in economically disadvantaged neighborhoods has been associated with increased risk of cardiovascular problems. A study published in Circulation suggests food deserts might be to blame. According to the research, those living more than a mile from fresh food sources develop coronary calcium build up, a leading risk factor for heart disease, faster than those living outside of food deserts.
According to the United States Department of Agriculture (USDA), up to 17.4 percent of the population lives in food deserts. Public health professionals work to combat this situation by advocating for programs, such as the federal government’s Healthy Food Financing Initiative, that support fresh food sources like grocery stores and farmers markets within food deserts.
Equitable access to good nutrition also involves increasing awareness about healthy food choices. Public health advocates play a key role in helping communities gain healthier nutrition habits. In addition, public health advocates promote government programs that help low-income communities afford the cost of healthy foods.
Data and research from the CDC indicate that people who live in certain geographic areas — identified down to the zip code level — can have lower life expectancies than those of their immediate neighbors. Public health professionals address the following disadvantages:
People without cars need reliable, affordable public transportation to access employment, child care, and health care. Individuals whose access to transportation is problematic may miss out on opportunities and are challenged to meet basic health care and nutrition needs.
Crime affects low-income neighborhoods at high rates, and exposure to violence produces many health and behavioral issues. For example, children who live with the threat of violence experience increased levels of depression and anxiety and show increased aggression. Over time, they are often at greater risk for substance abuse and risky sexual behavior.
Those living in poverty face greater obstacles to accessing medical care and are less likely to be treated with newer drugs or advanced technologies. Higher stress environments may expose them to behavioral risk factors such as smoking, drinking, and obesity.
- Environmental hazards
Low-income individuals and minority communities often experience greater exposure to air pollution and lead-based paint. They are also more likely to live near toxic waste facilities and landfills and have reduced access to clean drinking water.
Our communities and cities are diverse, and all individuals face unique obstacles to leading healthy lives. Living a healthy life can mean something different to each community. Public health leaders must understand the needs of specific communities to ensure all individuals have equal opportunities to thrive.
Healthcare providers should be sensitive to social and cultural differences among their patients. People from different backgrounds may have perspectives about health unknown to their providers, or they may have different expectations that can affect how they follow medical advice. Research has repeatedly shown that good communication between patients and providers correlates with better health outcomes.
Achieving cultural humility requires clinicians to examine their biases, attitudes, and beliefs, all of which can potentially contribute to delivering inequitable care. Unconscious bias can also influence how healthcare providers diagnose and treat patients. Numerous studies have shown how preconceived notions about different groups result in inequitable treatment regimens and misdiagnoses.
A study published in the medical journal Pain Management notes that doctors prescribe less pain medication to non-white patients than to their white counterparts for the same conditions.
Another study published in JAMA Network Open found primary care doctors had different patterns when referring patients to specialists based on the patient’s race. Doctors referred fewer Black patients than white patients to specialists in cardiology, pulmonary disease, gastroenterology, orthopedic surgery, general surgery, and neurology even when the Black patients presented with the same symptoms as others who were referred to specialists. Confronting health disparities fosters cultural competence so such discrepancies can be eliminated.
Public health advocates ensure health equity by working with local agencies and programs, tackling the challenges of advancing health.
Organizations like the Louisiana Public Health Institute address health disparities through research, communication, partnership building, and program implementation. Through social media and marketing, they inspire collective action to improve community health. They gather and analyze data to help government agencies and community-based organizations and to make evidence-based decisions and policies. They also design health initiatives at the local, state, and national levels.
The Louisiana Public Health Institute works across different sectors to address issues that play into health disparities. They collaborate with urban housing planners, social service providers, regional and national partners, local residents, and others to improve behavioral and family health and to ensure better, more accessible health care to communities.
Innovating solutions to our nation’s health disparities takes commitment and knowledge. Tulane University’s Online Master of Public Health program helps develop the expertise to serve this greater good. By including courses on and elements of epidemiology, behavioral health, environmental health, biostatistics, and management, students gain tools for serving local communities.
The program cultivates respect for the inherent value of each individual, making health equity a priority. Through real-world research, students build their understanding of how to intervene on behalf of underserved communities. In addition, graduates are equipped to become public health advocates who use data to influence policies for advancing health.
Tulane University was also recently awarded $2.9 million towards a national learning collaborative for health equity, which aims to understand and address obstacles to health equity on a national scale. Thomas A. LaVeist, Dean of the TU School of Public Health and Tropical Medicine, Weatherhead Presidential Chair in Health Equity, and expert researcher of social determinants of health will lead the collaborative.
Explore Tulane University’s Online Master of Public Health program and join the mission to promote health equity and create a world of greater dignity for all.