Essay On Social Inequalities
As is the case with most public health dilemmas, there is no black and white solution to the issue of health inequalities. Health inequalities do persist in part because of economic disparities, but the issue cannot justly be reduced to an ideological debate. The examination of the social determinants of health paints a compelling picture to the contrary. The boundaries between the effects of race, gender and class are blurry at best. Such factors as education, social context, economic status, and access to services are deeply intertwined – further muddying the waters. Yet, we are compelled to study address determinants and factors because they seem to bear heavily on the quality of societal health. Race, class – both social and economic – and gender each play significant roles in
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determining health. The evidence is clear: rigid patterns of social stratification that are deeply connected to health outcomes and thus health inequalities persist.
Racial discrimination is deep-seated in this country’s history and unfortunately continues to be a particular strong contributor to health inequalities (Dubowitz, Bates, & Garcia, 2010; Jackson & Williams, 2006; LaVeist & Isaac, 2012; Takeuchi, Walton, & Leung, 2010). African-Americans experience significantly greater total mortality, infant mortality, and morbidity from stroke, heart disease, cancer and HIV than their white counterparts (Takeuchi et al., 2010; LaVeist & Isaac, 2012). Disparities exist between other ethnic and racial groups as well with most minority groups fairing worse than whites.
Race is a unique health determinant in that it is strongly associated with segregation (Takeuchi et al., 2010). Segregation in turn has severe effects on infrastructure and access to resources – both positive and negative. Segregated minority communities often lack adequate emergency and medical services, grocery stores that sell healthy food, quality housing, and safe recreational opportunities (Takeuchi et al., 2010). Conversely, some groups may benefit from segregation. Highly educated immigrants, for instance may choose segregated communities that result in “concentrate[d] structural resources like supplemental education institutions that likely exert a positive effect on health status” (Takeuchi et al., 2010, p. 97). These issues clearly transcend the simplistic categories of poor and not poor.
In addition to structural differences, socioeconomic disparities often also ensue as a result of racial and social segregation. Poor education opportunities are a common characteristic of segregated and lower social class communities and lead to lower employability and income, resulting in decreased potential for social mobility (Ross & Mirowski, 2010; Takeuchi et al., 2010). Although often occurring in conjunction with segregation, discrimination is an independent factor affecting health outcomes regardless of economic status (Jackson & Williams, 2006). These factors have significant health implications, including leading to chronic stress which contributes to a host of other health problems (Adelman, 2008; Jackson & Williams, 2006; Takeuchi et al., 2010).
The social environment aspect of a community can also be very influential on its member’s health. Generally, the stress associated with living in lower socioeconomic class communities can lead to poor social networks and support (Takeuchi et al., 2010) - . Further complications are created when neighborhoods are dangerous, adding stress and preventing healthy behaviors such as exercise (Takeuchi et al., 2010). Although the social conditions in segregated neighborhoods are usually poor, there are exceptions. Many Latinos have better health than we would expect based on their socioeconomic status and segregated living conditions (Dubowitz et al., 2010). This is likely due to strong social networks and cultural practices related to healthy behaviors, factors that are probably strengthened through segregation (Dubowitz et al., 2010).
The causes of these disparities cannot be attributed to one determinant alone, but race is playing an important role. Race, along with gender and class, heavily influence socioeconomic context. Many of the factors associated with each determinant are similar or intertwined; but each one also contributes to health in unique ways. Black men for instance, have different health outcomes across socioeconomic strata, leading one to believe it is class and not race that cause health disparities (Jackson & Williams, 2006). Interestingly though, health disparities among minority groups persist even when socioeconomic status is controlled for (Jackson & Williams, 2006). Additional individual effects can be seen in the Latino paradox described earlier and in obesity trends. Racial trends in obesity persist throughout socioeconomic status indicating a racial effect to be present (LaVeist & Isaac, 2012).
The uniqueness of each social determinant of health warrants individual as well as combined attention – proof that a purely ideological stance is misinformed. In regards to race, the literature clearly shows that race is significantly and uniquely associated with health disparities. The key manifestation of racial inequality that affects health is segregation. Segregation has the potential to severely diminish the quality of infrastructure, socioeconomic attainment, and social environment.
Women still face discrimination in the professional realm and in wages earned. Women earned only 80% of what men earned in 2014 (U.S. Bureau of Labor Statistics, 2014).
Additionally, many of the human rights enjoyed by democratic societies were only realized when the health of the society allowed its members to cease fighting for their existence and begin pursuing other less fundamental goals (Saussy, 2010, p. 20). The right to health can be thought of as “the right to claim rights” (Saussy, 2010, p. 20), because without it all other rights are secondary. It is clear that health disparities exist both globally and locally and are due largely to social inequalities (CDC, 2009, p. 6). Groups that are poor, marginalized, discriminated against, and lack quality education, are the unhealthiest people. By treating health as a social justice issue, the prevention and treatment of disease will be thought of as a universal necessity just as freedom from slavery is. It will no longer be only for those who currently enjoy financial and social privilege. Health will become valued for more than its economic implications (Commission on the Social Determinants of Health, 2008, p. 181). It will be esteemed because it is inherent to and essential to human life. Advocating for health in this way requires a holistic approach – one that addresses the root inequities behind the social determinants of health as well as the determinants themselves (CDC, 2009, p.
6). The role of the public health profession is to advocate for policy change that recognizes the impact that social inequality has on health and that poor health has on perpetuating the cycle of inequality (CDC, 2009, p. 6).
Although expensive, many innovations did greatly improve quality of care. Unfortunately, improving quality for some often came at the cost of reducing access for others. It was and still is the case that higher socioeconomic classes often benefit most from such innovations, which increases disparities (Link & Phelan, 2010, p. 7).
Presently, individuals over age 65 are almost universally insured, while children and adults between 18 and 65 still suffer from high uninsured rates (7.6% and 19.9%, respectively; Smith & Medalia, 2014). Whites have the lowest uninsured rate at 9.8%, followed by Blacks at 15.9%, and Hispanics at 24.3% (Smith & Medalia, 2014). Additionally, lower household income is associated with lower rates of insurance coverage (Smith & Medalia,
2014). In the grand scheme of health care in the United States, it is clear that there is still much progress to be made. The overall rate of people without access to health care is falling, but disparities remain. Certain policies have been implemented through the Affordable Care Act with the aim of creating more equity in terms of access, including cost and quality of care. Much has been done, but much needs yet to be done before the United States health care system is equally available to all.
U.S. Bureau of Labor Statistics. (2014). Highlight of women’s earnings. Retrieved from http://www.dol.gov/equalpay/regions/2014/national.pdf
Smith J., Medalia, C. (2014). Health insurance coverage in the United States: 2013. Washington, DC: U.S. Government Printing Office.
Link, P., Phelan, J. (2010). Social conditions as fundamental causes of health inequalities. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Ed.), Handbook of medical sociology (6th ed., pp. 3-17). Nashville, TN: Vanderbilt University Press.
Centers for Disease Control and Prevention. (2009). Report of the national expert panel on social determinants of health equity: Recommendations for advancing efforts to achieve health equity. Atlanta, GA.
Commission on the Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, CH.
Office of the High Commissioner for Human Rights. (n.d.). What are human rights. Retrieved June 12, 2015, from http://www.ohchr.org/EN/Issues/Pages/WhatareHumanRights.aspx
Saussy, H. (2010). Introduction: The right to claim rights. In H. Saussy (Ed.), Partner to the poor: A Paul Farmer reader. Berkley, CA: University of California Press.
United Nation General Assembly. (1948). Universal declaration of human rights: United Nations. Retrieved from http://www.un.org/en/documents/udhr/
Adelman, L. (Producer). (2008). Unnatural Causes: Is inequality making us sick? (Documentary on DVD) United States: California Newsreel.
Dubowitz, T., Bates, L., Garcia, D. (2010). The Latino health paradox. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 106–123). Nashville, TN: Vanderbilt University Press.
Jackson, P., Williams, D. (2006). The intersection of race, gender and SES: Health paradoxes. In L. Schultz, J., Mullings (Eds.), Gender, race, class, and health: Intersectional approaches (pp. 131–155). San Francisco, CA: Jossey-Bass.
LaVeist, T., Isaac, L. (2012). Defining health and health care disparities and examining disparities across the lifespan. In Race, ethnicity, and health: A public health reader (2nd ed., pp. 11–27). San Francisco, CA: Jossey-Bass.
Rieker, P., Bird, C., Lang, M. (2010). Understanding gender and health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 52–74). Nashville, TN: Vanderbilt University Press.
Ross, C., Mirowsky, J. (2010). Why education is the key to socioeconomic differentials in health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 33–51). Nashville, TN: Vanderbilt University Press.
Takeuchi, D., Walton, E., Leung, M. (2010). Race, social context, and health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 92–105). Nashville, TN: Vanderbilt University Press.
determining health. The evidence is clear: rigid patterns of social stratification that are deeply connected to health outcomes and thus health inequalities persist.
Racial discrimination is deep-seated in this country’s history and unfortunately continues to be a particular strong contributor to health inequalities (Dubowitz, Bates, & Garcia, 2010; Jackson & Williams, 2006; LaVeist & Isaac, 2012; Takeuchi, Walton, & Leung, 2010). African-Americans experience significantly greater total mortality, infant mortality, and morbidity from stroke, heart disease, cancer and HIV than their white counterparts (Takeuchi et al., 2010; LaVeist & Isaac, 2012). Disparities exist between other ethnic and racial groups as well with most minority groups fairing worse than whites.
Race is a unique health determinant in that it is strongly associated with segregation (Takeuchi et al., 2010). Segregation in turn has severe effects on infrastructure and access to resources – both positive and negative. Segregated minority communities often lack adequate emergency and medical services, grocery stores that sell healthy food, quality housing, and safe recreational opportunities (Takeuchi et al., 2010). Conversely, some groups may benefit from segregation. Highly educated immigrants, for instance may choose segregated communities that result in “concentrate[d] structural resources like supplemental education institutions that likely exert a positive effect on health status” (Takeuchi et al., 2010, p. 97). These issues clearly transcend the simplistic categories of poor and not poor.
In addition to structural differences, socioeconomic disparities often also ensue as a result of racial and social segregation. Poor education opportunities are a common characteristic of segregated and lower social class communities and lead to lower employability and income, resulting in decreased potential for social mobility (Ross & Mirowski, 2010; Takeuchi et al., 2010). Although often occurring in conjunction with segregation, discrimination is an independent factor affecting health outcomes regardless of economic status (Jackson & Williams, 2006). These factors have significant health implications, including leading to chronic stress which contributes to a host of other health problems (Adelman, 2008; Jackson & Williams, 2006; Takeuchi et al., 2010).
The social environment aspect of a community can also be very influential on its member’s health. Generally, the stress associated with living in lower socioeconomic class communities can lead to poor social networks and support (Takeuchi et al., 2010) - . Further complications are created when neighborhoods are dangerous, adding stress and preventing healthy behaviors such as exercise (Takeuchi et al., 2010). Although the social conditions in segregated neighborhoods are usually poor, there are exceptions. Many Latinos have better health than we would expect based on their socioeconomic status and segregated living conditions (Dubowitz et al., 2010). This is likely due to strong social networks and cultural practices related to healthy behaviors, factors that are probably strengthened through segregation (Dubowitz et al., 2010).
The causes of these disparities cannot be attributed to one determinant alone, but race is playing an important role. Race, along with gender and class, heavily influence socioeconomic context. Many of the factors associated with each determinant are similar or intertwined; but each one also contributes to health in unique ways. Black men for instance, have different health outcomes across socioeconomic strata, leading one to believe it is class and not race that cause health disparities (Jackson & Williams, 2006). Interestingly though, health disparities among minority groups persist even when socioeconomic status is controlled for (Jackson & Williams, 2006). Additional individual effects can be seen in the Latino paradox described earlier and in obesity trends. Racial trends in obesity persist throughout socioeconomic status indicating a racial effect to be present (LaVeist & Isaac, 2012).
The uniqueness of each social determinant of health warrants individual as well as combined attention – proof that a purely ideological stance is misinformed. In regards to race, the literature clearly shows that race is significantly and uniquely associated with health disparities. The key manifestation of racial inequality that affects health is segregation. Segregation has the potential to severely diminish the quality of infrastructure, socioeconomic attainment, and social environment.
Women still face discrimination in the professional realm and in wages earned. Women earned only 80% of what men earned in 2014 (U.S. Bureau of Labor Statistics, 2014).
Additionally, many of the human rights enjoyed by democratic societies were only realized when the health of the society allowed its members to cease fighting for their existence and begin pursuing other less fundamental goals (Saussy, 2010, p. 20). The right to health can be thought of as “the right to claim rights” (Saussy, 2010, p. 20), because without it all other rights are secondary. It is clear that health disparities exist both globally and locally and are due largely to social inequalities (CDC, 2009, p. 6). Groups that are poor, marginalized, discriminated against, and lack quality education, are the unhealthiest people. By treating health as a social justice issue, the prevention and treatment of disease will be thought of as a universal necessity just as freedom from slavery is. It will no longer be only for those who currently enjoy financial and social privilege. Health will become valued for more than its economic implications (Commission on the Social Determinants of Health, 2008, p. 181). It will be esteemed because it is inherent to and essential to human life. Advocating for health in this way requires a holistic approach – one that addresses the root inequities behind the social determinants of health as well as the determinants themselves (CDC, 2009, p.
6). The role of the public health profession is to advocate for policy change that recognizes the impact that social inequality has on health and that poor health has on perpetuating the cycle of inequality (CDC, 2009, p. 6).
Although expensive, many innovations did greatly improve quality of care. Unfortunately, improving quality for some often came at the cost of reducing access for others. It was and still is the case that higher socioeconomic classes often benefit most from such innovations, which increases disparities (Link & Phelan, 2010, p. 7).
Presently, individuals over age 65 are almost universally insured, while children and adults between 18 and 65 still suffer from high uninsured rates (7.6% and 19.9%, respectively; Smith & Medalia, 2014). Whites have the lowest uninsured rate at 9.8%, followed by Blacks at 15.9%, and Hispanics at 24.3% (Smith & Medalia, 2014). Additionally, lower household income is associated with lower rates of insurance coverage (Smith & Medalia,
2014). In the grand scheme of health care in the United States, it is clear that there is still much progress to be made. The overall rate of people without access to health care is falling, but disparities remain. Certain policies have been implemented through the Affordable Care Act with the aim of creating more equity in terms of access, including cost and quality of care. Much has been done, but much needs yet to be done before the United States health care system is equally available to all.
U.S. Bureau of Labor Statistics. (2014). Highlight of women’s earnings. Retrieved from http://www.dol.gov/equalpay/regions/2014/national.pdf
Smith J., Medalia, C. (2014). Health insurance coverage in the United States: 2013. Washington, DC: U.S. Government Printing Office.
Link, P., Phelan, J. (2010). Social conditions as fundamental causes of health inequalities. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Ed.), Handbook of medical sociology (6th ed., pp. 3-17). Nashville, TN: Vanderbilt University Press.
Centers for Disease Control and Prevention. (2009). Report of the national expert panel on social determinants of health equity: Recommendations for advancing efforts to achieve health equity. Atlanta, GA.
Commission on the Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva, CH.
Office of the High Commissioner for Human Rights. (n.d.). What are human rights. Retrieved June 12, 2015, from http://www.ohchr.org/EN/Issues/Pages/WhatareHumanRights.aspx
Saussy, H. (2010). Introduction: The right to claim rights. In H. Saussy (Ed.), Partner to the poor: A Paul Farmer reader. Berkley, CA: University of California Press.
United Nation General Assembly. (1948). Universal declaration of human rights: United Nations. Retrieved from http://www.un.org/en/documents/udhr/
Adelman, L. (Producer). (2008). Unnatural Causes: Is inequality making us sick? (Documentary on DVD) United States: California Newsreel.
Dubowitz, T., Bates, L., Garcia, D. (2010). The Latino health paradox. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 106–123). Nashville, TN: Vanderbilt University Press.
Jackson, P., Williams, D. (2006). The intersection of race, gender and SES: Health paradoxes. In L. Schultz, J., Mullings (Eds.), Gender, race, class, and health: Intersectional approaches (pp. 131–155). San Francisco, CA: Jossey-Bass.
LaVeist, T., Isaac, L. (2012). Defining health and health care disparities and examining disparities across the lifespan. In Race, ethnicity, and health: A public health reader (2nd ed., pp. 11–27). San Francisco, CA: Jossey-Bass.
Rieker, P., Bird, C., Lang, M. (2010). Understanding gender and health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 52–74). Nashville, TN: Vanderbilt University Press.
Ross, C., Mirowsky, J. (2010). Why education is the key to socioeconomic differentials in health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 33–51). Nashville, TN: Vanderbilt University Press.
Takeuchi, D., Walton, E., Leung, M. (2010). Race, social context, and health. In S. Bird, C., Conrad, P., Fremont, A., Timmermans (Eds.), Handbook of medical sociology (6th ed., pp. 92–105). Nashville, TN: Vanderbilt University Press.