Inequities: Causes & Solutions

Solving Health Inequities in 2022: Enduring Big Questions

Why is addressing medical racism and cultural competency adequate but not sufficient to address health inequities?  In the U.S. for years now we have identified, tracked, reported, and attempted to treat higher rates of disease, hospitalization, and death among groups from historically marginalized racial/ethnic groups.  It took the U.S. a while, going back to 2008 when the World Health Organization organized study groups around the social determinants of health (SDOH), but we seem to have acknowledged that these non-medical factors  can contravene health-care efforts to improve population health (2007, Bonnefoy, Morgan et al. 2007).

So. let’s just say that overall, health practitioners, academic medicine, and healthcare systems (including the healthcare insurance industry) currently give a nod to the problems with non-medical determinants of health.  But exactly how to address these factors remains at odds satisfied with strategies and efforts that fail to reflect the origins of the inequities or the “causes of the causes”(Krieger 1994, Krieger 2001, Krieger 2008, Krieger 2011).

For example, previous attempts to understand the factors associated with inequitable distribution of COVID-19 deaths and the rate of disease, testing, and vaccine uptake across groups have uncovered a multi-layered lack of resources and opportunities for these groups tied to historical oppression operating across time and geographies.  In fact, in some US regions, testing and vaccine resources are disproportionately allocated to more affluent and predominately White communities(Dennis-Heyward and Shah 2021). There is also some evidence to suggest that the testing and vaccine gap is further widened by concerns among racial/ethnic groups because of risk of employment loss, concerns about costs, and clinic hours and locations(Webb Hooper, Nápoles et al. 2020, Dennis-Heyward and Shah 2021, Ezell, Griswold et al. 2021, Tai, Shah et al. 2021).

What this adds up to is a strong association between health inequities and the inequitable allocation of opportunities and resources stemming from historical oppression and marginalization.   Further, this justifies the need for analysis of how the inequitable distribution of resources works to contravene healthcare and public health strategies that focus on behavioralist interventions and the delivery of more health care.

The pathway model discussed here considers current health efforts alongside more intentional, upstream policy-based initiatives to address health inequities.  The claim being made is that in addition to efforts that address medical racism or cultural competency, the most effective way to decrease social and health inequities would be achieved via changes in policies, rules, regulations, and programs that distribute resources and opportunities to groups based on notions of historical and present-day oppression, justice, fairness, and privilege. This kind of change occurs around the upper middle of the pathway model in the boxes to left and right labeled “Institutions & Systems” and “Policies, Rules and Regulations”.

References

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