Health Inequities and the Negative Impacts of Social Determinants of Health

Editor’s note: Consultant Nikita Arora, Associate Consultant Adilene Gavina and Associate Consultant Rheanna Henson also contributed to this post.

Buzzwords are common in health care, and over the past year, social determinants of health (SDOH) and health equity have taken center stage. To better understand how SDOH impact patient outcomes, we need to better understand them. According to the World Health Organization, SDOH are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Studies have indicated that medical outcomes account for about 10–20% of a patient’s health outcomes, whereas things like economic stability, education, housing and access to health care comprise the other 80–90%.

The negative impacts of SDOH can contribute to undesirable health outcomes and lead to significant health disparities. For example, the influence of discrimination, or “embodied inequality,” includes dynamics of social injustice that lead to poor health outcomes and impact generations to come. Read on below to learn more about health inequities in our current health care landscape, and stay tuned for the second blog post in our health equity series on how Sg2 and Vizient are working toward bridging the gap within these disparities.

Environmental Pollution and Low-Income Communities

One example of health inequities within our current populations can be found in a recent Medical News Today article that investigates the connection between many low-income communities and an increased exposure to toxic pollution and chemicals. Research shows that thousands of toxic chemicals and pesticides have been released into the environment during the past couple hundred years, but many of these chemicals had not undergone proper safety testing to study long-term impacts. Although anyone can be impacted by environmental pollution, marginalized populations are disproportionately affected. Researchers have found that environmental pollution has a direct effect on human health and is a leading factor contributing to premature mortality for people living in lower-income communities (94% of attributed deaths occur in low- and middle-income counties). Previous research has established a connection between poverty and racial and ethnic identity; for example, African Americans make up a higher share of the poor population than their share of the general population.

According to the article, marginalized populations have increased exposure to toxins due to centuries of structural racism and colonization that have impacted where they live, work and play—the aftermath of which can still be seen today. Previously, colonizers and those with power created institutions and policies that dictated who had access to certain resources vs those who did not or who was able to own property vs those who were considered property. Oftentimes informal settlements and lower-income communities are established near large roads, waste dump sites, or polluting factories and facilities, as the land value is less desirable. Researchers found that potentially polluting firms were more likely to build their facilities in poorer areas where the risk of litigation following the release of the pollutants would be lower than in higher-income areas. The article also discusses methods and suggestions for citizens to take local action: either through negotiations with the polluting organizations, lobbying the local government and/or instilling community-based monitoring systems.

Despite the recognition of health inequality issues like these, a recent New York Times review of nearly 850 studies focusing on health equity, published by The Journal of the American Medical Association, highlights how much work is still ahead of us before we can truly claim health equity as a pillar of our nation’s health care delivery foundation. As of today, the divide between those who can benefit from the scientific advancements our country has made in health care delivery depends on race and ethnicity to variable degrees—despite the Affordable Care Act’s intent to bridge this gap. The traditional way care is sought between white and non-white communities itself is extremely glaring. Typical patterns of care indicate white Americans more often seek primary care and specialist visits, as opposed to hospital or emergency room visits when compared to minority groups. This disparity remained relevant independent of factors such as insurance coverage status, income, education and age. Minority groups have also been found to have lower vaccination rates and higher incidence of influenza and pneumonia. These patterns have only been further exacerbated considering the COVID-19 pandemic. More often than not, providers are not practicing in marginalized areas with lower-income status and minority neighborhoods, consequently increasing difficulty in accessing essential care.

How Your Organization Can Help Combat Health Inequities

Access to primary care is a key entry point to disease management, specifically for the very same chronic conditions our Sg2 2021 Impact of Change® Forecast indicates will be driving up utilization rates throughout the decade. The longer the delay in visiting a primary care provider, the greater the probability for increased complexity of downstream care for these conditions. The concept of health equity goes beyond just providing access to care. Its roots extend deeper and intertwine with structural racism, poverty, geography and education. It is about rebuilding trust and faith in our health care system, ensuring that all voices will be heard, and all symptoms will be taken seriously, as well as about breaking down barriers to food and proper nutrition while promoting prevention and wellness. Focusing on building out community partnerships is one way organizations can begin to address the upstream social needs that influence downstream care utilization. An article from PatientEngagementHIT provides insight into key steps to follow for building such partnerships to promote health equity.

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