Health inequities are neither natural nor inevitable.
Your ZIP code may be more important than your genetic code for health.
The choices we make are shaped by the choices we have.
Structural racism acts as a force in the distribution of opportunities for health.
All policy is health policy.
Health equity and social justice are values that imply a pledge to eliminate health inequities and its causes, most of which are rooted in the structural determinants of health. From this perspective, the pursue of health equity and social justice are associated with ethics and human rights. Achieving health equity and social justice occur when all individuals and groups have the opportunity to attain their full health potential regardless of their social position or other socially determined circumstance (Arcaya et al., 2015).
Health Status and Healthcare Vary
Health status and healthcare vary among individuals and groups of people within the same community. Differences in health status among groups within a community are most often related to economic status, race and ethnicity, gender, education, disability, geographic location, or sexual orientation . Although genes, behavior, and medical care play a role in how well we feel and how long we live, the social conditions in which we are born, live, and work have the most significant impact on health and longevity. Similarly, the way we organize our communities, the “social structure,” affects how we feel about ourselves and the role we play in the society. These social conditions that impact an individual’s health status are known collectively as the social determinants of health, and they include the human and social capital as well as opportunities for equality in individual development and participation in community life.
Poverty
Living in poverty is a main factor associated with poorer health status as well as lack of access to healthcare. Poverty thresholds are determined by the U.S. government, and vary according to the size of a family and the ages of its members. In 2021, the poverty threshold, or poverty line, for one individual was $12,784; for a family of four it was $25,701. In 2021, 38.1 million people lived in poverty in the United States. This is almost 12 percent of the total population. Poverty disproportionally affects women, single-parent families, and people living with a disability. In 2021, 11.9 million children (1 in every 6 children) and more than 14 percent of seniors lived in poverty. Regarding race/ethnicity (Figure 2.2), Native Americans had the highest poverty rate (25.4 percent), followed by Blacks (20.8 percent) and Hispanics (of any race) (17.6 percent). Whites and Asians had a poverty rate of 10.1 percent (Poverty USA, 2021).
Figure 2.2 Poverty by Race/Ethnicity
Source: PovertyUSA.org, 2020. Poverty Facts. The Population of Poverty USA. PovertyUSA.org. © 2019 United States Conference of Catholic Bishops, Washington, D.C.
Poverty has significant implications on whether people are able to meet basic needs, like food and housing. For example, the Department of Agriculture estimated that 11 percent of U.S. households were food insecure in 2018 (Figure 2.3). This means that approximately 14.3 million households had difficulty providing enough food for all their members due to a lack of resources. More than 35 percent of households with incomes below the Federal poverty line were food insecure (Mentzer Morrison, 2020).
Figure 2.3 Food Insecurity Note: Food-insecure households include those with low food security and very low food security.
Sources: USDA; Economic Research Service using data from the 2018 Current Population Survey Food Security supplement; U.S .Census Bureau.
Housing is key to reducing intergenerational poverty and increasing economic mobility. Even in the United States, increasing access to affordable housing is the most cost-effective strategy for reducing childhood poverty and increasing economic mobility. However, 75 percent of all extremely low-income families spend more than half their income on rent. Similarly, losing housing has a ripple effect on obtaining basic necessities such as food and medicines, leads to depression and child abuse, and compromises education (Cunningham, 2016). Despite this, over half a million Americans go homeless on a single night in the United States (The Council of Economic Advisors, 2019).
Race, Ethnicity, and Healthcare
Since 2003, the Agency for Healthcare Research and Quality (AHRQ) has produced an annual report entitled the National Healthcare Disparities Report (NHDR), which examines disparities in healthcare received by racial and ethnic minorities, low-income populations, and people with special healthcare needs. These reports measure trends in effectiveness of care, patient safety, timeliness of care, and efficiency of care, tracking more than 200 healthcare process, outcome, and access measures, and covering a wide variety of conditions and settings. Disparities in quality of care are common among Blacks and Hispanics, who received worse care than Whites for about 40 percent of quality of care measures, while American Indians/Alaska Natives received worse care than Whites for one-third of quality measures. African Americans and American Indians/Alaska Natives also experience worse access to care than Whites for about 40 percent of access measures, while Hispanics had worse access to care than Whites for about 60 percent of measures (Figure 2.4).
Figure 2.4 Racial and Ethnic Health Disparities among Communities of Color Compared to Non-Hispanic Whites
Source: Our nation’s health depends on fixing persistent health disparities, by Families USA, 2014. © 2014, Families USA.
Education
A persistent inequity in the United States is the gap between minority and White students, which has been proven to be difficult to close. Prevalent ethnic and racial inequities in education follow a pattern in which African Americans, American Indians, and Latinos systematically underperform academically, compared to Caucasians and Asian Americans. Educational inequities are evident in markers of low academic performance and graduation rates. In 2016–17, the Adjusted Cohort Graduation Rates (ACGRs) for minority public high school students were below the United States average of 85 percent: American Indian/Alaska Native 72 percent, Black 78 percent, and Hispanic 80 percent (National Center for Education Statistics, 2018).See Figure 2.5.
Figure 2.5 Adjusted Cohort Graduation Rate (ACGR) for Public High School Students, by Race/Ethnicity: 2016–17
Source: Public High School Graduation Rates, U.S. Department of Education, 2018.
An overarching goal of Healthy People 2030 is to “eliminate health