Addressing Health Disparities in Public Health

Achieving good health is critical to everyone, but not everyone has the same opportunities to reach that goal. The U.S. population faces numerous health disparities, and those disparities are profound. A study conducted by nonprofit health policy organization KFF found in 2021:

• White people had a longer life expectancy (76.4 years) than people who were American Indian and Alaska Native (65.2 years) or Black (70.8 years).
• Among the non-elderly population, 7 percent of white people had no health insurance, while 21 percent of American Indian and Alaska Native people had no health insurance and 19 percent of Hispanic people had no health insurance.
• Among the population of individuals who needed mental health services, 52 percent of white people received the services they needed — however, only 39 percent of Black people, 36 percent of Hispanic people and 25 percent of Asian people received the services they needed.

But health disparities extend beyond characteristics such as race and ethnicity. Factors such as socioeconomic status, geographic location and gender also contribute to inequities that make it difficult for individuals to achieve good health.

Addressing disparities in health is an important part of working in public health. Those who are considering pursuing a career in public health can benefit from learning about disparities in health and their connection to public health.

What Are Health Disparities?

Understanding what health disparities are is important to grasping their significance and how they affect a population. Broadly speaking, a health disparity is any type of difference in health that has a close association with a disadvantage that is environmental, social or economic in nature.

Health disparities arise when people face obstacles to achieving good health, and many of these obstacles have connections to historical discrimination or exclusion. The U.S. Office of Disease Prevention and Health Promotion cites the following as examples of characteristics that can create obstacles to health.

• Age
• Disability (cognitive, sensory or physical)
• Gender
• Geographic location
• Mental health
• Racial or ethnic group
• Religion
• Socioeconomic status
• Sexual orientation or gender identity

How Social Determinants of Health Affect Health Disparities

Factors referred to as social determinants of health have a significant influence on health disparities. Although these determinants are non-medical, they can influence health outcomes because they affect living conditions and daily life. Social determinants of health include:

• The degree of economic stability in the places where people live
• People’s educational levels
• The social and community contexts in which people live
• People’s access to health care and the quality of the health care they receive
• The neighborhoods and environments where people live

Variations in these determinants can alter the opportunities people have to maintain their health and, therefore, can lead to health disparities.

The Economic Costs Associated with Health Disparities Are Significant

In addition to impairing quality of life, health disparities can result in significant economic costs. In 2022, professional services firm Deloitte published an analysis that indicated:

• Health inequities resulted in about $320 billion in annual health care expenditures, and that cost could grow to $1 trillion by 2040.
• Health disparities resulted in about $42 billion in lost productivity annually.

The COVID-19 Pandemic Exacerbated Health Disparities

Health disparities existed long before the COVID-19 pandemic, but the pandemic emphasized and widened these disparities. A 2021 study published in the journal Seminars in Vascular Surgery concluded the COVID-19 pandemic made health disparities prior to the pandemic even worse for:

• Black people, indigenous people and people of color
• People in rural areas
• The LGBTQ+ community
• People who were incarcerated or detained

The study noted the people in these groups were already vulnerable to poor health outcomes due to health disparities. Unfortunately, the pandemic made their barriers to achieving good health even more prominent.

What Do Health Disparities Have to Do with Public Health?

To understand how health disparities relate to public health, it’s important to consider what public health services entail. The U.S. Centers for Disease Control and Prevention (CDC) has identified 10 public health services that it considers essential. Those services include:

• Building partnerships within communities to address health issues
• Conducting research to identify new solutions to health issues
• Connecting people with health services they need
• Devising policies related to community health
• Diagnosing and researching a community’s health issues and hazards
• Educating and empowering individuals regarding issues related to health
• Enforcing laws to protect health
• Ensuring communities have competent health care professionals
• Evaluating health services at the individual and population levels
• Performing monitoring to recognize and address health issues in a community

While it might be natural to think of public health agencies as the sole players in public health, other organizations also play significant roles. For example, health care providers, public safety organizations, charities, human services organizations and environmental agencies carry out responsibilities that make them valuable participants in promoting and ensuring public health.

The Connection Between Public Health and Health Disparities

The organizations involved in public health can make significant contributions to reducing disparities in health through a range of approaches, such as:

• Implementing programs for the purpose of reducing health disparities. Public health organizations can design programs to address specific groups of people who are affected by health disparities. For example, a public health organization might implement a tobacco prevention program for a specific population or create a dental care program for children who live in poverty.
• Interpreting and sharing information. Public health organizations can analyze and interpret data in areas such as patient race and ethnicity and share their insights with health care providers. This can assist the providers in promoting better health equity; for instance, enabling them to know when to launch health-related campaigns for specific populations.
• Performing analyses to reduce racism in health care. Public health professionals have expertise that enables them to identify inherent racism in things such as clinical algorithms that can result in health disparities. Coordinating with health care organizations on issues of this nature can help them improve their approaches to health care and reduce the racism that may be built into their processes.
• Engaging with communities and community leaders. In promoting engagement in the communities they serve, public health organizations can better gauge and identify health disparities in their communities. Engagement also helps to build trust with a community and buy-in for the programs public health organizations implement to address disparities in health.
• Allocating funding with an eye toward addressing health disparities. How public health organizations allocate financial resources across programs can have a significant effect on addressing health disparities. For example, factoring information about social determinants of health into funding decisions can enable a public health organization to distribute funds in a manner that helps reduce health disparities.
• Employing staff from diverse backgrounds. Public health organizations can work to ensure their employees represent a broad range of backgrounds. This enables those employees to bring their experiences to the table and reflect the communities those organizations serve.

Examples of Health Disparities

Exploring specific examples of health disparities can illustrate their extensive range. The examples below are just a few of the disparities that individuals can face.

Racial and Ethnic Health Disparities

The Kaiser Family Foundation, an independent health data provider, put forth a study of racial and ethnic health disparities in 2021. The report concluded people who were Black, Hispanic and American Indian and Alaska Native fared worse than white people in most of the health areas the study analyzed. The study attributed these health disparities largely to racism and discrimination.

Specific examples of racial and ethnic health disparities the study highlighted include the following.

• Percentages of children categorized as food insecure were:
  • 4 percent of white children
  • 13 percent of Black children
  • 11 percent of Hispanic children
• Percentages of non-elderly adults who did not have a personal health care provider were:
  • 16 percent of white non-elderly adults
  • 34 percent of Hispanic non-elderly adults
  • 24 percent for American Indian and Alaska Native non-elderly adults
• Percent of adults who viewed their health as poor or fair were:
  • 14 percent for white adults
  • 25 percent for American Indian and Alaska Native adults
  • 21 percent for Hispanic adults

Geographic Health Disparities

Health disparities that are related to where people live also are significant. For example, according to the CDC, residents of rural areas typically are more sick than individuals who reside in urban locations. When compared with people who live in urban areas, individuals living in rural areas also are more likely to die prematurely from the following five top causes of death.

• Cancer
• Chronic lower respiratory disease
• Heart disease
• Stroke
• Unintentional injury

Additionally, children who live in rural areas and suffer from behavioral and developmental disorders confront more challenges in addressing these issues than do children with the same disorders who reside in urban areas.

According to the U.S. Department of Health and Human Services, examples of the causes of health disparities in rural areas include:

• Geographical isolation
• Relatively lower socioeconomic status
• Relatively higher rates of risky health behaviors
• Limited access to health care specialists

Disparities in Maternal Health

Disparities in maternal health also are concerning. The CDC has reported the rate of death from a cause related to pregnancy is three times higher for Black women in the U.S. when compared to white women. The CDC attributed this disparity to factors such as variations in the quality of health care, chronic conditions, implicit bias and structural racism.

The maternal mortality rate in the U.S. as a whole also is worse than maternal mortality rates in other high-income countries. According to a report from the Commonwealth Fund, in 2020, the U.S. maternal mortality rate was 24 deaths per 100,000 live births. That rate was more than three times higher than in the majority of other high-income countries. In discussing this disparity, the report noted that unlike in other high-income countries, the U.S. does not have universal health care. The report also cited deficiencies in U.S. women’s access to comprehensive postpartum health care.

Health Disparities Related to Level of Education

Research shows the less education people have, the more likely they are to experience health challenges. For example, people who have less education are more likely to suffer from health issues such as obesity, injury or substance abuse.

A variety of factors affect health disparities related to education. For example, the U.S. Office of Disease Prevention and Health Promotion has reported the following.

• People with higher education levels are more likely to work in jobs that pose fewer hazards to their physical safety.
• When people pursue higher education, they have opportunities for employment with salaries that enable them to have better housing and other psychosocial resources that can improve their health.
• People with higher levels of education are more likely to obtain preventive health care, exercise and consume less alcohol — all of which can improve their health.

Potential Solutions to Health Disparities

A wide range of solutions to health disparities can reduce differences in health that stem from the disadvantages people face. In the state of Georgia, for example:

• Research efforts are helping to refine public health policy. Researchers from Augusta University headed a team to explore health disparities in rural and urban areas. This research provided valuable insight into the particular vulnerabilities of people living in rural areas, as well as health disparities in countries that do not have a national health care system. The results of this research have the potential to inform public health policy and, ultimately, reduce disparities in health.
• The use of telemedicine is addressing health disparities in rural areas. Augusta University also partnered with a telemedicine company to offer telemedicine emergency services. Available at several hospitals in rural areas of Georgia, the program improves access to care in rural areas, enhances continuity of care for rural patients, and helps rural hospitals strengthen their financial positions.

The additional examples of initiatives discussed below hold the promise of improving equity in health.

Diversifying the Health Care Workforce

Improving diversity in the health care workforce can help reduce racial and ethnic disparities in health. For example, a more diversified health care workforce can:

• Enhance the cultural competence of health care professionals and enable them to better respond to the needs of underserved populations
• Expand access to care for populations that are underserved
• Increase the levels of preventive care that underserved populations receive
• Increase patient satisfaction rates among underserved populations
• Lead to greater representation of underserved populations in health care policy and research
• Strengthen the quality of health care that underserved populations receive

A 2023 report published in the journal JAMA Network Open demonstrated how a diverse health care workforce can address health disparities. Specifically, researchers found that a 10 percent increase in Black representation at the county level among primary care physicians was associated with an average of an additional 31 days of life expectancy among Black individuals.

Improving Outreach in Locations with Geographic Health Disparities

In places such as rural areas that face geographic health disparities, several initiatives can strengthen outreach and reduce the disparities people in these areas face. These initiatives can focus on elements such as:

• Education. For example, communities that experience geographic health disparities have employed community health workers to better educate people about preventing or living with chronic disease.
• Residency programs for medical students. Specifically, some medical schools have offered rural residency programs to their students to enable them to experience providing care in these locations.
• Remote health care. In some rural areas, health care providers have begun monitoring their patients’ health remotely by providing patients with technology to participate in telehealth.
• Addressing specific needs of a population. For example, communities have implemented programs to address specific health care needs of their populations, such as a need for prenatal care or a need for more healthy foods.
• Transportation. Some communities have launched medical transportation programs to enable patients in rural areas to visit health care providers.

Strengthening Access to Maternal Health Care

A number of community-based initiatives focus on strengthening women’s access to maternal health care. For example, communities have launched programs that:

• Expand postpartum health care insurance coverage
• Give health care providers training to reduce provider bias in maternal health
• Help patients find assistance in obtaining housing, food and other needed resources
• Increase patients’ access to telemedicine to address health issues such as gestational diabetes and to improve healthy behaviors such as quitting smoking
• Offer patients prenatal care in group settings, home visits from providers, and care coordination and case management services
• Provide patients with access to doulas, midwives and community health care workers who can help address patients’ health care needs

Promoting Educational Achievement to Reduce Health Disparities

Many strategies to reduce health disparities related to educational levels are aimed at improving students’ health, keeping kids in school and ultimately, promoting educational achievement. For example, to reduce health disparities related to education, communities have:

• Expanded opportunities for students to receive the mental health care and counseling services they need
• Implemented school-based health centers to offer health care services and boost educational outcomes
• Introduced family engagement programs to involve families in ensuring students receive the health care they need
• Offered students resources such as food pantries and dental care to promote student wellness
• Provided students with laptops and other technology to enable them to participate in distance learning

How Public Health Professionals Research and Address Health Disparities

The expertise and skills of public health professionals can serve them well in conducting research that addresses health disparities. The following are examples of research public health professionals can perform to contribute to reducing disparities in health.

• Researchers in public health can develop overarching frameworks for public health professionals to follow when they develop programs to promote health equity. These frameworks can help ensure public health professionals consider relevant influences on health equity, as well as how these influences can be interconnected.
• Public health professionals who work in health informatics careers can analyze a population’s health data to both identify health disparities and provide information for developing programs to reduce health disparities.
• Environmental scientists can conduct research on how issues such as pollution, exposure to environmental contaminants or poor water quality contribute to health disparities. The results of this research can inform policy-making.
• Individuals who may be weighing the merits of biostatistics vs. epidemiology careers should know that having expertise in either field can contribute to reducing health disparities. For example, biostatisticians can identify patterns in a community’s health data that can inform new approaches to reducing health disparities. Individuals who work in epidemiology can conduct research to document and confirm health disparities and create interventions based on that research.

Public Health Expertise: A Powerful Tool in Addressing Health Disparities

Addressing disparities in health is a challenge that public health professionals can help address through education, experience, skill, research, advocacy and beyond. People who have expertise in public health can play a significant role in strengthening equity in health.

Individuals who are interested in working in public health would do well to explore the Augusta University Online Master of Public Health degree program. Offering concentrations in health informatics, health management, and social and behavioral sciences, the program is designed to establish a foundation for a rewarding career.

Start your journey to a fulfilling future in public health today.

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Augusta University Health, Virtual Critical Care: A Lifeline for Rural Hospitals and Patients
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The Commonwealth Fund, “Policies for Reducing Maternal Morbidity and Mortality and Enhancing Equity in Maternal Health”
The Commonwealth Fund, “The U.S. Maternal Mortality Crisis Continues to Worsen: An International Comparison”
Deloitte, “U.S. Health Care Can’t Afford Health Inequities”
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