Clinically Speaking: Health Inequities and Social Determinants of Health

All too often, a person’s gender, race, education, income or zip code dictates how healthy they are. In our latest episode, we explore health inequity and disparity in the U.S. and the pathways to meaningful solutions.

The Facts

The World Health Organization defines health inequity as “systematic differences in the health status of different population groups.”

Said another way, this means that, all too often, a person’s gender, race, education, income or zip code dictates how healthy they are. In fact, according to County Health Rankings and Roadmaps, 80% of an individual’s health is determined by health behaviors, socioeconomic status and the environment in which they live, learn, work and play.

For instance, 13.4% of the U.S. population or approximately 42.5 million Americans are living in poverty across rural, urban and suburban areas. They are likely to have less access to education, healthy food, medical care and other necessities that impact their health. They may be missing doctor appointments because they don’t have transportation; suffering through symptoms because they don’t understand what to do; and skipping or rationing medication because they can’t afford it.

For millions of Americans, health inequities contribute to health disparities. In other words, living in socially disadvantaged circumstances can lead to meaningful and preventable differences in how often people get sick, go to the ER and stay in the hospital. It’s a snowball effect that can lead to higher rates of mental illness and lower life expectancy. 

COVID-19 and Health Disparities

The COVID-19 pandemic has exposed some health disparities. According to a 2020 report from The Commonwealth Fund, the greater likelihood that Black and Latino Americans reside in neighborhoods with overcrowding, air pollution, and inadequate access to care, means they experienced higher rates of sickness, hospitalizations and deaths related to the virus.

People of color also face higher rates of diabetes, obesity, stroke, heart disease and cancer. In the case of diabetes, the risk of being diagnosed is 77% higher for African Americans and 66% higher for Hispanics. Asian Americans, Native Hawaiians and Pacific Islanders are at twice the risk of developing diabetes than the population overall.

And a recent data analysis before the pandemic showed that people of color fared worse compared to their white counterparts across other health measures, such as infant mortality, pregnancy-related deaths, and overall physical and mental health status.

It’s important to note that while health disparities are often viewed through the lens of race, ethnicity and socioeconomic status, they occur across a wide range of factors, such as age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. 

Working Toward a Solution

If we can narrow health disparities by helping someone connect with a doctor, get the care they need, or afford their medication, we can improve our nation’s health and save lives.

Resolving health inequities and disparities will reduce the unnecessary health care costs that are negatively impacting the bottom line of every health plan and employer in the U.S.

The first step is to understand where social determinant challenges are greatest. From there, health plans, employers and health care providers can determine where there may be value in directed engagement strategies, like community referral services or targeted enrollment.

Sometimes, simple education of health care benefits or resources is enough. In other cases, a more robust approach is more appropriate. For example, a high prevalence of members with asthma and COPD could require devices or programs to address specific adherence issues.

Understanding health disparities can also influence benefit design decisions. For example, if a health plan or employer identifies members with diabetes in socially challenged areas, capping copays on insulin may make sense.

There is a lot of work to be done and millions of people to help. And when we do that, we’ll start to see a future of equal health opportunities for all.

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