There’s a complex set of social and economic inequities that drive health and health care disparities.
Disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by different populations, according to the Centers for Disease Control and Prevention.
Health care disparities (or inequities) refer to things like differences in access to care, insurance coverage and the quality of care that is delivered.
Social determinants of health are the environments where people born, live, learn, work, play, and worship that affect a wide range of health, functioning, and quality-of-life outcomes and risks. They can all be exacerbated by racial prejudices, discrimination and social injustices, and can disproportionally impact members of the African American/Black, Native American and Hispanic and Latino communities in Michigan; as well as rural community members, persons with disabilities and members of the LGBTQ+ community.
It’s estimated that up to 80% of a person’s health outcomes are influenced by these factors, rather than the medical care we receive.
Here are the six areas of social determinants of health that are the main drivers of health disparities and inequities:
1. Economic stability
This includes factors like employment, income and household expenses.
Poverty raises the risk for disease and premature death, according to Healthy People, noting “the risk for chronic conditions such as heart disease, diabetes and obesity is higher among those with the lowest income and education levels.” Poorer mental health outcomes are associated with poverty and it can increase risk for adverse childhood experiences, or ACEs, traumatic events that occur in childhood.
About 14% of Michiganders live below the poverty level.
Stretched household budgets contribute to many social determinants of health, including housing.
Research shows people facing housing insecurity are more likely to skip annual physicals and routine preventive care. This means their health conditions are often diagnosed at later stages, with more expensive treatment necessary. For children, housing insecurity has been tied to lower weight, developmental risks and mental health concerns.
Economic strain also affects food insecurity. Many inexpensive convenience foods are high in fat, sodium and sugar. While these foods meet a hunger need, when eaten frequently they can contribute to poor health outcomes, including diabetes, obesity and heart disease, which leads to higher health care costs.
2. Neighborhood and physical environment
This includes factors like housing, transportation and having parks or playgrounds in your community.
Environmental conditions at home have a significant impact on a person’s health.
Air quality in neighborhoods is one environmental factor. Environmental factors, when combined with other social determinants of health, like housing stability, job security, fresh food availability, transportation and education can have long-lasting impacts on a person’s health and wellbeing.
Other environmental factors at home can include exposure to lead – either through aging, flaking paint, or through drinking water in older homes that have lead service lines. Lead exposure can give children permanent damage to their brains and nervous systems.
This includes factors like level of reading ability, language and level of education.
According to Healthy People 2030, “people with higher levels of education are more likely to be healthier and live longer.” People who are unable to graduate from high school or go to college are “less likely to get safe, high-paying jobs and more likely to have health problems like heart disease, diabetes and depression.”
Many times, disparities in educational achievement are tied to disparities in the educational opportunities available to kids which disproportionately affects minority communities.
This includes food security and access to nutritious food.
Low-income and some urban and rural communities lack access to affordable, healthier foods – which makes eating a healthy diet difficult. Instead, people in these communities may have to settle for foods that are higher in calories but lower in nutritional value.
Many inexpensive convenience foods are high in fat, sodium and sugar. While these foods meet a hunger need, when eaten frequently they can contribute to poor health outcomes, including diabetes, obesity and heart disease, which leads to higher health care costs.
5. Community safety and social context
Factors here include network of social and support systems, stress, and exposure to violence and trauma.
Crime and violence in communities can have long-lasting impacts both in the lives of the perpetrators, victims, witnesses and those exposed to it through word-of-mouth. Injuries can be physical and mental. And the impacts of crime and violence can add to a compounding series of factors.
Violence can have a ripple effect on health in neighborhoods. If violence or crime are common in your community, you might not go outside for a walk as often or get much physical activity. You may feel like it’s safer to stay in your backyard, or on your porch.
6. Health care system and health literacy
This includes factors such as health literacy, health coverage, provider availability or quality of care.
The ability to access health services is linked to multiple social, economic and environmental circumstances, including race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, education, geographic location and cultural factors. Being uninsured or underinsured plays a big role in access to health care.
Not having health insurance means you’re less likely to have a primary care provider, which means you’re also less likely to get routine screenings that could catch things like cancer earlier. You’re also less likely to be able to access medications you might need.
Transportation is another barrier that can make it difficult to access care. Without a reliable way to get to appointments, you’re more likely to delay care or need to reschedule. It’s also likely harder to access necessary medications and it could be more difficult to manage complex health needs which might require frequent appointments in different locations. Living in a location with a shortage of health care providers can also act as a barrier to health care.
Health literacy is the ability of individuals to obtain, process and understand basic health information to make health decisions – like knowing how to read a prescription label or understanding a treatment plan. Low health literacy can mean an individual may have higher medical costs, increased visits to the emergency room and hospital admissions. The responsibility for addressing health literacy does not rest solely with the individual. The health care system is incredibly complex, as are health conditions. Health care organizations and businesses also can make significant changes in the way they communicate with patients – from prescription labels to informational materials provided at visits.
Our role in addressing social determinants of health
Blue Cross Blue Shield of Michigan and the Blue Cross Blue Shield of Michigan Foundation assess how social determinants of health affect the individuals in the communities we serve across the state. We provide grants and funding to organizations engaged in work on the ground that helps people bridge gaps and break down barriers when it comes to addressing household needs, taking care of their families and their health.
In Michigan, communities are struggling with the impacts of social determinants of health. Blue Cross works closely with community organizations to connect members and residents to resources and programs that make a difference.
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