Health inequalities: what they are and why


Different groups and communities can have significantly different levels of health. Some populations may have a higher incidence of cancer , for example, while others may be more prone to obesity or tobacco use. These differences in health or medical conditions are called health inequalities and can have a profound impact on the public health of a community.

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The United States government defines health inequalities as "a specific type of health disparity that is closely related to disadvantaged social or economic status." These differences negatively affect entire groups of people who already face significantly more barriers to maintaining good health, often due to certain social or economic factors, such as:

  • Socioeconomic status or income
  • Race or ethnicity
  • Age
  • Gender or gender
  • Geography, ex. rural versus urban
  • Disability
  • Sexual orientation
  • Immigrant status
  • Religion
  • Mental health

Historically, these characteristics have been associated with discrimination or exclusion. When a certain group of people do not have the same access to health care, education, or healthy lifestyles, it can lead them to lag behind their peers in all kinds of health interventions. These imbalances can often persist from generation to generation.


The negative effects of health inequalities extend beyond the individual to their children, communities, and society as a whole. Health inequalities often reproduce themselves. For example, parents who are too sick to work can become poor. Low-income unemployed are less likely to access health insurance. If they can't afford medical care, they can get sick, making them even less able to find a new job, and so on. It is becoming increasingly difficult to recover and get out of poverty.

This downward spiral could also affect future generations . One area of health where this is evident is in pregnant women and new mothers. A mother's health before and during pregnancy can greatly affect her babies. For example, a woman who experiences chronic stress during pregnancy, such as financial stress, is more likely to give birth to a premature baby. Babies born too early are at higher risk for serious health problems later in life. Many of these conditions can lead to complications during pregnancy, such as premature delivery.

Yet health inequalities are costing Americans more than their lives and livelihoods. Persistent gaps in health outcomes can also have economic implications. A study in North Carolina found that the state could save $ 225 million a year if the diabetes imbalance were corrected. According to another report, reducing health inequalities across the country could save the United States nearly $ 230 billion between 2003 and 2006.

Examples of

Health inequalities exist throughout the world, including in the United States, and affect all ages, races / ethnicities, and genders. Here are some examples:

  • Infant Mortality: Babies born to black women in the United States die more than twice as often as babies born to white women.
  • Dementia: Blacks also have the highest risk of developing dementia and are twice as likely to develop Alzheimer's than whites in the United States.
  • Cancer: People with lower incomes and lower levels of education are more likely to develop and die from cancer compared to their wealthier peers, and the gap appears to be widening.
  • Obesity: Even after adjusting for household income, obesity rates for black women and men of Mexican descent are significantly higher than for other races or ethnic groups.
  • Smoking: Native American / Alaska Native men and women have disproportionately high rates of smoking , as do people who live below the federal poverty line and are unemployed.
  • Drunkenness: young White men are more likely to drink alcohol than other groups (more than 5 servings in a 2-hour period).


Like many aspects of public health, the root causes of health inequities are complex. There are so many factors that affect health that it can be difficult to pin down exactly why the gap between the two groups is so wide. However, inequalities are often the result of health inequalities , that is, differences in how resources are allocated between different groups. These resources can be tangible, as in the case of physical parks, where children can play sports safely, or intangible opportunities, such as the possibility of going to the doctor in case of illness. Inequalities often have multiple causes, but in the United States, several serious inequalities are known to contribute to health gaps between groups.

Income differentiation

The US health care system is one of the most expensive in the world, and spending on health care is roughly twice that of other high-income countries. On average, the country as a whole spent about $ 10,348 per person in 2016, and health spending accounts for nearly 18% of the U.S. gross domestic product (GDP), and this figure is increasing from year to year. Americans pay more for medical services like clinic visits, hospital stays, and prescription drugs.

With the growing income gap between rich and poor in the United States, it is increasingly difficult for poor Americans to keep up. While maximum incomes rose dramatically between 1980 and 2015, real wages for low-income people declined, making it increasingly difficult for poor people in the United States to pay for basic health care or lead healthy lives. This, in turn, makes it difficult to maintain health or treat and monitor health conditions.

Systemic discrimination or exclusion

Social driving forces, such as racism, sexism, ellism, classism, or homophobia, can perpetuate inequality by favoring one group over another. These forces are so deeply embedded in cultural norms and practices that many people may not even realize they are happening. These forces are often the result of past inequalities that still affect communities today. Take, for example, the discriminatory housing practices of the mid-20th century. This policy has forced many minority families to move to areas without access to public resources such as public transportation, quality education, or job opportunities, all of which affect the family's financial stability and therefore their long-term health .

Researcher Camara Phyllis Jones used the gardening analogy in the American Journal of Public Health to illustrate how this happens. Imagine, for example, two planters, one with new nutrient-rich soil and the other with poor, stony soil. Seeds planted in nutrient-rich soils will thrive, while seeds planted in poorer soils will not. When the flowers sprout, the next generation will fall to the same ground, experiencing similar difficulties or successes. Since this happens year after year, one flower box will always be brighter than the other due to the original condition of the soil. When people are divided and given different resources to start with, it will have an impact on future generations.

Environmental factors

Many health consequences are the result of personal decisions, such as eating healthy foods or exercising. But many of these decisions are shaped, influenced or made by us by the environment in which we find ourselves. Environmental hygiene are the physical, chemical, and biological forces that can affect our health and can be the driving force behind health inequalities. It is difficult for people, for example, to eat healthy food when they do not have access to it in their area (areas known as food deserts ).

Neglected tropical diseases (NTDs) are an example of environmental health inequities. This collection of more than 20 conditions primarily affects the poorest of the poor both in the United States and around the world, often due to a lack of clean water or toilets. These conditions impede the education of children and the work of adults, exacerbating the impact of poverty on human health and well-being.

Address health inequalities

Closing the health outcomes gap is not an easy task. The reasons are usually multi-layered. Decisions will need to take into account not only the root cause of this inconsistency, but also the context that made it possible in the first place.

The Healthy People 2020 goals, a set of goals set by the U.S. government to improve the health of Americans by 2020, aim to reduce health disparities by addressing key factors known as social determinants. health .

The social determinants of health are the environmental conditions and circumstances that affect our health. Many things in our social circles and our environment can affect our behavior and limit our ability to make healthy decisions. These include things like cultural norms (like distrust of authority figures) or social design (like bike lanes). There are dozens of social factors that exacerbate health inequalities, but the Healthy People 2020 goals focus on just five: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.

Increased economic stability

Economic stability refers to things like food security, income or well-being, housing stability, and employment opportunities, and research shows that addressing some of these challenges can help reduce the inequalities associated with a variety of health problems. For example, housing assistance has been shown to improve physical and psychological health. Also, flu vaccination in poorer areas can help reduce the hospitalization gap due to flu. And increasing economic opportunities for financially vulnerable women can help prevent a disproportionate number of HIV infections among this population.

Make sure everyone receives a quality education

Investing in things like language and literacy, early childhood education, high school graduation, and higher education can help close health gaps in a number of ways. For example, expanding access to early childhood education centers has been shown to reduce delinquency and adolescent fertility . High school completion programs also have a high return on investment, often resulting in greater financial benefits that outweigh the costs associated with the program, due in part to the health care costs that are avoided.

Problem solving in a social and community context.

While not always obvious, social influences and dynamics can significantly affect the health of individuals and the entire community. These include things like incarceration, discrimination, civic participation, and social cohesion. Because incarceration can destroy families and affect access to things like education, work, and housing, some researchers have called for policy changes around sentencing laws that disproportionately affect certain black communities as a means to reduce some inequalities, including HIV.

Expand access to health care and improve health literacy

Ensuring that people can see a doctor when they are sick is important to reducing health inequalities. But perhaps just as important is their ability to see a doctor when they are healthy. Many medical problems in the United States can be prevented with routine preventive care, such as checkups, vaccinations, and lifestyle changes.

The Affordable Care Act sought to expand access to primary health care by making it easier to obtain health insurance and requiring insurance companies to cover the full cost of preventive services , such as blood pressure screenings and counseling. about obesity. The law also called on healthcare workers and public health professionals to improve health literacy by ensuring that everyone can receive, understand, and communicate the information they need to make healthcare decisions. However, more than 28 million people still lack health insurance, and more can be done to provide broader access to health care in the United States.

Neighborhood and built environment

Just as a person's social environment can affect their health and well-being, it can also affect their physical environment. Access to healthy food, promote healthy eating behaviors, improve housing quality, reduce crime and violence, and protect the environment can be improved to improve the environmental health of society and, as a result, reduce health inequalities. .

Addressing food deserts and food marshes is an important example of how the United States can reduce health inequalities in obesity. Building partnerships between local governments, food retailers (eg grocery stores), and communities could help provide healthier and more affordable food options in areas where food is scarce. This, along with more targeted education on why and how to include healthy foods in family favorites, can go a long way toward reducing disparities in obesity rates.

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