What are the 5 Main Causes of Health Inequities? 

by Amy Barczy

| 4 min read

There’s a complex set of social and economic inequities that drive health disparities.
Disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations, according to the Centers for Disease Control and Prevention.
It’s estimated that up to 80% of a person’s health outcomes are determined by these factors, which are called the social determinants of health, rather than the medical care we receive.
Social determinants of health can all be exacerbated by racial prejudices and discrimination, and disproportionally impact members of the African American/Black, Native American and Hispanic and Latino communities in Michigan. 
Here are the five areas of social determinants of health that are the main drivers of health disparities and inequities, according to the U.S. Department of Health and Human Services

1. Economic stability

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. Education access and quality

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.

3. Health care access and quality

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.

4. Neighborhood and built environment 

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.

5. Social and community context

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.

Our role in addressing social determinants of health 

Blue Cross Blue Shield of Michigan and the Blue Cross Blue Shield of Michigan Foundation closely track how social determinants of health affect the individuals in the communities we serve across the state. We target grants and funding to organizations engaged in work on the ground that helps people bridge gaps and break down barriers when it comes to taking care of themselves, their families and their health. In Michigan, both rural and urban communities are struggling with the impacts of social determinants of health.
Photo credit: Getty Images

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