Health Disparities As One Of The Greatest Challenges Endured By Global Health

Imagine there's no countries. It isn't hard to do, nothing to kill or die for; and no religion too. Imagine all the people living life in peace, you. As the great John Lennon once wrote, the world is full of imbalances and differences. In the field of public health, it is even more apparent when studying the social factors that influence these disparities. Health disparities are defined by the CDC as the difference in health outcomes and their causes among groups of people. This variation of health is “closely linked with social or economic disadvantage”. Health disparities “adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion”.

Fortunately, because health disparities are rooted in social disadvantage they can be avoidable, but also difficult to manage. Historically, health differences are linked to discrimination. For example, women were not able to practice their reproductive rights until the creation of the birth control pill in 1960 with an immense amount of resistance, particularly from religious facilities. However, the latex condom which was first made in the early 1900’s was widely accepted. Along with health disparities, “health equity is the idea that everyone has the opportunity to be as healthy as possible”. According to Merson, et al, 2012, healthy equity is “the absence of unfair and avoidable or remediable differences in health among social groups”. Health equity can be achieved by valuing all individuals and populations equally, recognizing and rectifying historical injustices, and addressing contemporary injustices by providing resources according to need. However, it is important to iterate that health equity is a process and not an outcome. Health inequality, on the other hand, consists of “differences in health between different individuals- seen primarily as a consequence of individual biological difference”. Health disparity and health inequality will be used interchangeably in this paper. The social determinants of health mainly consists of general socio-economic, cultural, and environmental conditions. Within these conditions, social/community networks and individual lifestyle factors are also studied.

On a global scale the determinants that are typically focused are economic factors, political/legal influences, material/physical causes, and social aspects. Some of the economic factors that are studied measure poverty in a country based on GDP. Politically, health disparities can be identified through legislations. Physical or materialistic components, such as air pollution or biohazards, are mediated by the government. In this paper three social determinants- political, socio-economic, and environmental- will be discussed on a global scale.

Politics

An executive summary determined five flaws within and between global governments that support the continuation of unequal international health affairs. The first one, democratic deficit, is defined as “participation and representation of some actors… that are insufficient in decision-making processes”. Secondly, “inadequate means to constrain power and poor transparency make it difficult to hold actors to account for their actions (weak accountability mechanisms)”. Institutionally stickiness are the “norms, rules, and decision-making procedures [that] are often impervious to changing needs and can sustain entrenched power disparities, with adverse effects on the distribution of health”. The “inadequate means [which] exist at both national and global levels to protect health in global policy-making arenas outside of the health sector” is known as an inadequate policy space for health. “Lastly, in a range of policy-making areas, there is a total or near absence of international institutions to protect and promote health (missing or nascent institutions)”. Based on the five dysfunctions it can be concluded that “the basic, root causes of health inequity lie in the unequal distribution of power, money, and resources”. Some countries have found some strategies to reduce the causes of political health disparities. For example, “mass demonstrations across Arab countries removed rulers in Tunisia, Egypt, Libya, and Yemen”.

In addition, “civil society groups have also mobilised transnationally and successfully deployed normative power to effect concrete policy changes”. Health equity was successful in low income countries like Costa Rica and Cuba “by popular mobilisation in social and political movements” because of the citizens’ “normative power on a national level and globally which caused new social movements to continually spring up to call for action, challenging undemocratic processes, or protesting against unfair policies”. The researchers suggested that “health equity should be a cross-sectoral political concern, since the health sector cannot address these challenges alone. A particular responsibility rests with national governments”. They encouraged policy makers in each level of society to understand how global political determinants can lead to health inequities, and begin an international public discussion to disclose those causes. Based on their observations, the study proposed “a Multistakeholder Platform on Governance for Health which would serve as a policy forum to provide space for diverse stakeholders to frame issues, set agendas, examine and debate policies in the making that would have an effect on health and health equity, and identify barriers and propose solutions for concrete policy processes”.

Another strategy the researchers advised was to institutionalize “the independent monitoring of how global governance processes affect health equity …through an Independent Scientific Monitoring Panel” and to authorize “health equity impact assessments within international organisations”. Socio-economic A 2010 article studied the socio-economic health disparities in the United States to identify multiple health indicators and the social groups effected by them. Both child and adult parameters were used to measure health. These indicators included infant mortality, life expectancy, health status, and activity limitations. Results showed that social groups with lower income and less education were more prone to experiencing or expressing unhealthy characteristics. By examining the differences in indicator levels within the population, researchers found “with the exception of activity limitation, for which no education gradient was apparent — the patterns were consistent with a socioeconomic gradient: whereas the most adverse levels of health were observed for the least-educated or lowest-income groups, improvements in health generally were seen at each higher level of socioeconomic advantage”. However, when observed between different racial/ethnic groups, they “found similar stepwise patterns among both White and Black children in every indicator except sedentary behavior, for which the education gradient among Whites and income gradient among Blacks were less apparent”. For example, “infant mortality and adult life expectancy… revealed that Blacks have worse outcomes than do Whites at each level of income or education. Blacks may not experience the same health benefits from a given level of income or education as Whites; which could potentially be explained by adverse health effects of more concentrated disadvantage (e. g. , far lower levels of wealth and greater likelihood of living in more disadvantaged neighborhoods at a given level of income) or a range of experiences related to racial bias that are not captured by routinely collected socioeconomic measures”.

A second study compared the racial disparities within childhood obesities in the US and the UK. They concluded that “disparities for Bangladeshi children in the UK and Mexican, other Hispanic and American Indian children in the US can be explained by socioeconomic disadvantage, whereas a range of cultural and family characteristics partially explain disparities for other groups in the UK”. The reason why the UK does not experience as much socioeconomic-related disparities as the US is because it has more income equality. The “differences according to income and education …should be modifiable with social policies, including but not limited to policies affecting medical care”. Therefore, studies should form “a broader spectrum to measure the patterns used” and “consider the different socioeconomic and cultural profiles of race/ethnic groups” as well as maintain “regular reporting of these observations”.

Environment

A study done in 2014 highlighted the use of urban green space, the public health influences, and potential environmental injustice experienced within certain minority communities. Demographically, minorities and low-income residents live in the center of cities where there is not much green space. On the other hand, suburbs where green space is more prominent and maintained, are occupied by higher-income people. “This environmental injustice has become a planning priority, leading to parkland acquisition programs and diverse strategies to deploy underutilized urban land for additional green space”. In China, there are income and racial disparities that negatively affect health due to disproportionate living conditions, especially under “China's hukou registration system and thus not entitled to health, education, and other benefits in the city”. Compared to the United States which has an average green space area of 50. 18 m2 per capita, China only has 6. 52 m2 per capita.

Although intervention has begun in the United States, it has become contradictory to its concept. “As more green space comes on line, it can improve attractiveness and public health, making neighborhoods more desirable. In turn, housing costs can rise”. Due to increases in housing costs, gentrification “a displacement and/or exclusion of the very residents the green space was meant to benefit”, can occur. “In turn, residents may face higher rents and thus become precariously housed, while those who are actually displaced may be forced to leave their communities, ending up in less desirable neighborhoods with similar park-poverty problems”.

The study advocated to use the ‘just green enough’ strategy, which “depends on the willingness of planners and local stakeholders to design green space projects that are explicitly shaped by community concerns, needs, and desires rather than either conventional urban design formulae or ecological restoration approaches”. By using ‘just green enough’ strategies, community involvement will be needed to develop ideas for green space projects and will aid in decreasing housing cost for lower income residents. Nevertheless, “active involvement of urban planners, designers, and ecologists should still be essential, to articulate strategies for urban green space that explicitly advance public health, environmental equity, and social justice in urban communities”. Health disparities are an avoidable, unjust challenge that public health official face at all levels- politically, communicably, and individually. Social determinants have influenced these differences between groups of people.

To solve this issue globally, many of the strategies available cannot be used alone. Each factor- social, political, or environmental- must be addressed and handled through interventions at each level of society. As previously stated, policies must be taken into place and practiced through institutions and individuals in order to limit health disparity. Global health equity can be achieved by the cooperation of these comprehensive approaches.