Health Equity

Good health is a fundamental human right, and health equity efforts aim to ensure that this right is granted to every individual, despite systemic barriers to access. The resources necessary for good health include:

• Peace
• Shelter
• Education
• Food
• Income
• A stable ecosystem
• Sustainable resources
• Equity

Health equity is often measured by life expectancy, disease rates, and other factors. Research indicates that the U.S. has “higher mortality and inferior health” compared to other developed countries because of a fragmented healthcare system, high uninsured rate, and adverse social and economic determinants, among other issues. The U.S. is one of the only countries that spends more on healthcare but sees lower rates of life expectancy. For example, the U.S. has a life expectancy of 78.69 years, but spends more than $8,700 per capita on healthcare annually, while the United Kingdom spends approximately $3,700 and enjoys a life expectancy of almost 81 years old.

The U.S. continues to struggle with health disparities across class, race, and gender lines. Health disparities are differences in health that are closely related to economic, social, or environmental factors, while health equity is a commitment to address and end those disparities. With this distinction in mind, donors can support pathways to narrow health gaps while increasing access to high-quality healthcare in order to achieve health equity.

For those who are uninsured, high costs can plunge them deeper into cycles of poverty and poor health. Even for those who are insured, coverage may not be enough to lift them out of financial or medical hardship.

A 2019 study found that “29% of Americans failed to take their medications as prescribed because of the cost.” Meanwhile, dental care is crucial to health and wellbeing but not always accessible to low-income individuals. Consider that 40% of low-income and non-Hispanic Black adults have untreated tooth decay.

Approach your giving strategy with the social determinants of health (SDOH) in mind. SDOHs are grouped into five categories, and examples of social determinants include racism, safe housing, and literacy skills.

• Access to quality education and employment: Accessing education can lead to higher quality employment pipelines with healthcare benefits that are long-term and sustainable.
• Healthcare Access: 1 in 10 individuals living in America are not covered through health insurance. Not having a primary care provider can cause severe disease due to a lack of access to preventative treatment and services.
• Built environment: Built environment can impact the number of pollutants you are exposed to, sanitation concerns, and other environmental factors that impact your physical and mental health.
• Economic stability: Individuals experiencing poverty and less income have a lower life expectancy.
• Social Community and Context: The amount of social support that individuals experience or don’t experience can cause disparities in health. More specifically, experiences of discrimination, bias, and racism can cause adverse health outcomes.

People of Color

People of color are likely to make up the majority  of the U.S. population by 2050, but discrimination and bias deeply impact health outcomes and affect life trajectories. For example, racism contributes to residential segregation, and studies find that many Black and Hispanic neighborhoods are more likely to lack hospitals and offer low-quality care centers or limited primary care facilities that can help patients with preventative care.

A high level of distrust of the U.S. health care systems is another barrier facing many communities and can lead to poorer health outcomes. For Black Americans and other people of color, medical distrust stems from discrimination in healthcare and the legacy of mistreatment of Black patients within medical systems.

“Weathering” is the concept that chronic exposure to social and economic hardships can lead to deteriorating health patterns. Research shows that Black women experience this at higher rates compared to their white female counterparts. However, weathering is an experience for all communities of color as racism and bias exist in healthcare.

There is evidence to suggest that Black women’s stress and experiences of discrimination are factors in infant and maternal mortality.

Data also suggests that there are higher pregnancy-related mortality ratios among Black and American Indian/Alaska Native women compared to other ethnicities from 2007-2016.

Research shows that normalizing masculine behavior (such as hiding/withholding emotions) in American society can lead to an increase in medical distrust which is linked to fewer preventative screenings. Repressing anxiety, depression, and loneliness in order to appear more masculine also impacts men of color. Only 26.4% of Hispanic and non-Hispanic Black men who had daily feelings of anxiety or depression sought any treatment.

Asian Americans and sub-groups report poor quality of healthcare, communication difficulties with doctors, and less access to preventative services. Poor language training and lack of cultural sensitivity training in the healthcare field contribute to health inequity in Asian American communities. One study captures Asian-Americans’ healthcare experiences:

Asian Americans were less likely than whites to report that their doctors ever talked to them about lifestyle or mental health issues. They were more likely to report that their regular doctors did not understand their background and values. When asked about the last visit, they were more likely to report that their doctors did not listen, spend as much time, or involve them in decisions about care as much as they wanted.

Specific subcultures face varied and serious health challenges: U.S. Filipino individuals are more likely to be obese or overweight, causing high blood pressure and diabetes compared to non-Hispanic white individuals. Additionally, U.S.-born Vietnamese women are four times as likely to die of breast cancer than other Asian American women.

Immigrant communities experience lower rates of health insurance and receive lower quality care. Unauthorized immigrant populations also fear deportation, lowering their likelihood of seeking care, and are not eligible for U.S. health benefits. In California, ​​an estimated 51% of unauthorized immigrants are uninsured. Other factors such as socioeconomic background, English proficiency, residential location, and stigma all contribute to health disparities within immigrant populations.

Children Affected by At Least One Adverse Childhood Experience

People With Disabilities

More than one billion people worldwide are estimated to experience or live with a disability and face challenges trying to obtain high-quality healthcare. These include attitudinal barriers, physical barriers, communication, and financial barriers.

Many disabilities come with specific challenges.

• Adult individuals who are deaf or hard of hearing frequently report “fair or poor health” compared with those without hearing impairment. Deaf populations can have significant issues when trying to communicate with medical professionals (who don’t have ASL interpreters).
• Individuals who experience vision loss or impaired sight are more likely to have heart disease and  hypertension, experience a greater prevalence of obesity, and smoke more than the general population.
• Women with some sort of significant disability are less likely to get regular pap smears and mammograms compared to women without disabilities.

Furthermore, individuals with disabilities are less likely to receive preventative healthcare, less likely to have an annual dental visit, and are less likely to receive recommended cancer screenings than individuals without disabilities.

Communication and facility-based barriers add more complications. Hospitals don’t prioritize disability competency training for medical professionals and healthcare practitioners. At the policy level, there are issues that contribute to disability exclusion in hospitals: Hospitals don’t face financial repercussions for non-compliance, ADA compliance isn’t a focus for hospital accreditation, and there aren’t strict regulations against hospitals buying inaccessible medical equipment.

High Costs of Care and Lack of Supportive Public Health Policy

Public health policy or lack thereof can restrict access for individuals that need stable and consistent high-quality healthcare. People of color are more likely to be uninsured – several states with large Black populations have refused to expand Medicaid coverage.

If the remaining states implemented expansion, at least 4 million additional uninsured adults would become eligible for Medicaid coverage, likely more due to the recession. Of these, nearly 60 percent are people of color.

There is evidence that expanding Medicaid coverage can lead to improvements in access, financial security, and some measures of health status/outcomes.

Historically, strong public health policy can contribute to significant life changes and positive health outcomes, such as vaccinations for school children, safer workplaces, and improvements in reproductive services and family planning.

At the state level, policies can have a large impact on local populations, especially ones that are marginalized. In New York and Texas, health regulations mandated that private insurance must  cover 3-D mammograms with no out-of-pocket costs, helping increase access to breast cancer preventative care, which is significant for Black women, who are 43% more likely to die than white women. In Washington State, a 2021 bill prohibits health insurers from discriminating against policyholders based on gender expression and identity, which specifically strengthened protections for transgender patients seeking gender-affirming treatment.

State and federal health policy that makes healthcare affordable and accessible could help to improve disparities that many Americans face regarding their healthcare access and services.

Lack of Data and Research for Smaller Populations

National statistics do not include data on health disparities for smaller populations, such as American Indians and Alaska Natives or Native Hawaiian and other Pacific Islanders. Disaggregated data could help policymakers understand health disparities and tailor policies accordingly. Since there are several gaps within existing data sources to measure health disparities and inequities, some populations will be left out of policy aimed at creating equitable health outcomes. Additionally, the federal government data has minimal criteria or expectations for demographic data, making it difficult to access research that accurately reflects population health struggles and community needs.

Pushing to improve how we collect data, and improving processes for measuring and understanding different population needs across the social determinants of health can ultimately help create pathways for health equity.