Health equity, according to the Centers for Medicare and Medicaid Services, means the highest quality of health for all people, where everyone has a fair and just opportunity to be well and healthy. These opportunities span across three driving forces:
- Structural drivers of health
- Social drivers of health
- Ancestry-related biology
There is a significant body of research on what determines health equity. These are called the social determinants of health. The graphic below shows these determinants.
Unfortunately, in each of these 10 areas, there are those who are likely to have less health and wellness based on sex/gender, location, socioeconomic status, race/ethnicity, and so on. There are “holes” in our societal experience in which health is not sustained, and stressors can lessen protective factors inside group and individual experiences.
These factors can be sorted into the three driving forces of health equity. All of these factors can create social vulnerability, which leads to less-positive health outcomes. The determinants of health are linked together like a chain, and they tend to “bump into” each other in producing health and wellness or health vulnerability.
Structural drivers of health
Geographic location: Simply put, our health is determined more by our zip code than our genetic code. Access to quality and affordable healthcare is one of the areas that needs to be equitable for all. But this is not the only area that must be developed. “Food deserts” and the lack of affordable healthy food options is one of the geographic location factors, as well as is living in unsafe conditions, environments, and communities.
Digital literacy: This is the ability to have the knowledge and capacity to get online, research, learn, and connect. Digital literacy is one of the newest areas to be studied in determining protective factors to build better health.
Social drivers of health
The human experience is both individual and relational. We are each wonderfully unique, but we also relate to others. Anthropologists have studied the tribes or groups in which we belong and from which we came. We interact within and between these groups. These group experiences define the social drivers of health equity.
Race/ethnicity: Because of both historical and current bias and prejudice and distrust within societies, the experience of not being a part of the dominant culture results in worse health outcomes. An article titled “Emerging Health Disparities during the COVID-19 Pandemic” cites how the health outcomes of COVID-19 were much better for White people than for people of color. More Whites received the COVID-19 vaccine than did ethnic minorities. One does not have to look far to see that historical racism, prejudice, and bias have a deep impact on how we live, how we view healthcare, and how we are viewed by society.
Employment status: Black and Hispanic individuals were more likely to work and for a longer time in high-risk occupations specific to COVID-19. One of the first studies on determinants of health was the Whitehall study in the United Kingdom, which studied the health outcomes of government employees. The higher one’s status at work, the better the health outcomes were, even though all employees had the same level of health insurance. If you have voice and power at work and in your community, you have less stress than if you are always being told what to do by a superior.
Socioeconomic status: Bridges Out of Poverty assists in defining the experiences of living within poverty, middle class, wealth, and all experiences between. It is often said, “If you want to be healthy, be wealthy.” Research has determined that the stress of poverty is linked to overall less-positive health outcomes and that it affects our choices related to health. When we are stressed, it affects our mind and therefore our body, especially if that stress happens at a very young age. Not only that, but the structures of poverty limit access to quality healthcare. Your group can discuss how the experience of economic class can provide risks or protective factors that will impact stress levels and, therefore, health.
Age and medical ability: These are combined here because of the impact of both age and medical ability to provide adequate support systems, both physically and socially, to negotiate with healthcare systems and to have the physical strength and stamina to fight disease and build health. There are those who do it! But it is much more difficult than it is for younger persons and those more able in mind and body. Someone said that the minute she sat in a wheelchair, she became “invisible.” Many older patients complain that the healthcare system sets them aside because they are considered too old to be a candidate for strong health and wellness. How society views these physical aspects directly affects social vulnerability.
Sex/gender: The aforementioned article about health disparities cites how LGBTQ people have been defamed during past outbreaks of novel transmissible diseases such as HIV and other epidemics. This leads to discriminatory communication and inadequate COVID-19 treatment for these groups. This is a strong illustration of social vulnerability.
Political affiliation: The health disparities article shows the relationship between the political power of the US government in manufacturing face masks for the US population, but not for Latin America and Canada. And differing political views on vaccines and data created more distrust and conspiracy theories that are still with us today.
Immigration status: Migrant workers were in a very vulnerable position to being exposed to COVID-19 and to being locked out of medical treatment during the pandemic. Living and working conditions created layers of vulnerability for this group, who “were unable to adhere appropriately to social distancing, quarantine or lockdowns” and dealt with the “absence of food and medical aid,” putting them directly in the line of infection.
Ancestry-related biology: Your personal ancestry and genetic makeup has a significant impact on your health and personal vulnerability, as well as your resilience to certain diseases. It is included in the article as having significance, but it is not considered by most researchers to be a social determinant of health, such as economic class and its impact on education levels.
Ultimately, health equity can only be achieved through a broad strategy of individual, organizational, community, and policy change.
