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Healthcare disparities refer to the differences in health experienced by people who belong to traditionally underserved social groups. Although the experience of disparities in care is intersectional, persons are most likely prone to disparity due to their race/ethnicity, religion, socioeconomic status, age, location, gender, able-bodiedness, and sexual orientation. (Kaiser Family Foundation, 2018)
In order for practitioners and scholars to best serve healthcare needs, it's important to recognize healthcare disparities, how and why they happen, why they matter, and how they can be addressed.
A complex and interrelated set of individual, provider, health system, societal, and environmental factors contribute to disparities in health and health care. Factors include (but are not limited to):
Federal efforts to reduce disparities include a focus on designated priority populations who are particularly vulnerable to health and health care disparities. These priority populations include people of color, low-income groups, women, children, older adults, individuals with special health care needs, and individuals living in rural and inner-city areas. Again, these disparities do not occur in isolation; rather, they are intersectional, and prone to overlap.
Social determinants of health are the conditions of a place where a person lives, which affect health outcomes, risks, and proximity to various disparities. Everybody inhabits a select social space, but statistically, there are social spaces which have longer lasting, negative effects on health outcomes. For instance, a person who lives and grows up in 85121, the lowest income zip code in Arizona, does not have access to:
Additionally, someone who was born and raised in 85121, is more likely to have experienced adverse childhood experiences resulting from:
This is not to say that these experiences happen to all persons who live in 85121, or any other geographic location with a similar social structure. However, the likelihood of their occurring grows, along with the health and healthcare disparities that happen alongside them.
The following list details the range of social determinants that we all encounter:
Social determinants initiate and reproduce a cyclical relationship with health and healthcare disparities, one that is deeply entwined with systems of oppression and violence occurring at local, regional, national, and global levels. While there are many particulars of life which affect the social determinants that affect a person or community, many are perpetuated through the healthcare system itself. This is especially true in the United States, where healthcare and biomedicine are deeply entwined with the material history and cultural apparatuses that make up the US. In social terms, this series of networks can be called the Healthcare Industrial Complex. According to transformative justice and disability activist, Mia Mingus (2015), that complex is enormous, multi-pronged, and can be visualized as such:
Even though healthcare disparities are far-reaching, the American Medical Association insists that all providers should address disparities such that they ensure equitable, appropriate, effective, safe and high quality care for all, with no gaps in services based on any medically irrelevant factor (2007, p. 3). In short, providers should seek to end disparities rather than striving primarily to reduce them. The AMA has developed 10 guiding principles to assist providers in making evidence-based decisions to battle healthcare. Policies and actions should be:
relationship centered | supportive of the delivery of patient-centered, family-focused, community-oriented care to individuals throughout the life span
culturally and linguistically appropriate | strategies tailored to the unique needs of diverse patient populations
targeted | with a focus on recognized and demonstrated gaps in access to health prevention, health care, safety, and quality
data-driven | making use of both quantitative and qualitative information to inform
transparent, participatory and collaborative | designed in open processes with the input of all key stakeholders and interested constituency groups
both long and short-term | quick fixes are important, but solutions should also aim to resolve underlying causes of disparities and should create permanent structural and financial incentives to prevent the reemergence of disparities
comprehensive | because health care disparities are intersectional, a set of policies to eliminate disparities must be broad-based
judicious in the use of incentives and requirements | both incentives and mandates might have a role in ending disparities, but policy-makers should recognize a preference for incentives, since mandates often risk backlash and long-term failure
fiscally responsible and bi-partisan | eliminating health care disparities is a non-partisan goal that can be accomplished in fiscally responsible ways
monitor and revise | policies to end disparities should be tracked closely over time for both intended and unintended effects so that they can be revised in the future
Inherent in these guidelines are the core principles of evidence-based practice, in which providers should concern themselves with patient interactions by asking, aligning, acquiring, and appraising information while balancing their expertise with the level of knowledge conveyed in research, and the patients' values and circumstances. Arguably, providers should take particular care to their patients' values and circumstances, as these are both complexly associated with the disparities attributed to a patient's social grouping.
The NLM has dedicated resources to helping researchers and providers find information that can help them make informed decisions that best suit patients prone to inequity in treatment and health. The following search terms are recommended by NLM to assist in accessing information relevant to healthcare disparities research:
Collapsed into a search string, they appear as such: "Health disparities" OR "healthcare Disparities" OR "health Status disparities" OR inequalit* OR inequit* OR "socioeconomic factors" OR "Minority groups" OR "Social Determinants of Health" OR racism OR sexism OR ageism OR "Ethnic groups"
The NLM has also created a much more cohesive search strategy that includes MeSH, filters for title and abstract([TIAB]), major topics with no explosions (ie: [MAJR:noEXP]), and a more diverse array of search terms. The complete search strategy can be accessed here. Search results can be accessed by clicking here.
Current and emerging research supports the use of empathy and empathic thinking as an intervention to reduce bias in patient-provider interactions (Stewart, 1995; Stewart, et al., 2000; Reiss, 2015; Ariso, 2018). This is a fairly unsurprising idea, in general, but even as empathy is regarded as necessary to care, it is increasingly less likely to be taught in biomedical education. As a result, students are actually less empathetic after leaving medical school than entering it.
Students at the Phoenix Biomedical Campus are invited to integrate empathy more fully into their education and future practice. Through programs like University of Arizona's College of Narrative Medicine and Health Humanities, students from both NAU and UA learn to "promote compassionate clinical care and value for the patient’s story through narrative medicine methods." In other words, students are encouraged to build empathy, and in doing so, to acknowledge biases (Ross & Lypson, 2015). Cross-institutional opportunities include Celebrating the Humanities through Art (ChArt), a peer-reviewed literary journal published by the Phoenix Biomedical Campus community, and Stories in Medicine, a narrative medicine blog.
"Health literacy is an evolving concept" used to frame the ability of individuals and communities to inform their own health. (WHO, 2016) It is a key component to health disparities and social determinants of health in that health literacy tools and understandings can help to reduce the disparities experienced as a result of negative social determinants.
Health literacy interventions include:
Because there are so many components to health literacy, the term itself is often challenged, and has been described at times as critical health literacy, health education, and health information literacy. While all of these terms are useful, they are more appropriately categorized as parts of health literacy rather than the thing itself.
Providers, community organizers, policy makers, and information professionals can all seek to improve community health by bringing health literacy practices into their practice. The following links provide information about health literacy trends, health needs, health literacy programs and services, and health literacy integration.