“There is no such thing as race. There's just the human race, scientifically. Racism is a construct, a social construct,” stated Toni Morrison (Appelo, 2019). The plague of racism remains one of our nation's most traumatic topics. The American Society of Human Genetics expresses that the very idea of race is a lie, and has no biological basis. “The science of genetics demonstrates that humans cannot be divided into biologically distinct subcategories therefore, race itself is a social construct” (Prontzos, 2019). The human genome project confirms that the genomes found around the globe are 99.9 percent identical in every person. Hence, the very idea of different “races” is nonsense.
Health disparities in the United States are the differences that exist among specific population groups in the attainment of full health potential that can be measured by differences in incidence, prevalence, mortality, the burden of disease, and other adverse health conditions (NCBI, 2017). The Centers for Disease Control and Prevention (CDC) identifies health disparities as, “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.” (Nabi Ndugga, 2021). Disparities cut across dimensions such as race and ethnicity, gender, sexual orientation and gender identity, disability status, socioeconomic status, age, and geographic location.
Racial and ethnic disparities
Health disparities - that stem from unequal access to safety, to healthy and affordable food, housing, medical care, and transportation - in the racial and ethnic demographics are arguably the most obstinate iniquities in health throughout the history of our country. Health disparities among black and brown populations of America take many forms such as increased rates of chronic disease and premature death compared to the rates among whites. Conditions in the places where people live, learn, work, play, and worship affect a wide range of health risks and outcomes. The National Center for Health Statistics (NCHS) reports that among the five racial and ethnic groups measured in the National Vital Statistics Survey (NVSS) in 2014, African American women had the highest percentage of preterm singleton births at 11.1 percent, while Asian or Pacific Islander women had the lowest at 6.8 percent (NCHS, 2016). For indigenous populations, infant mortality rates are staggering. Native Americans and Alaska Natives have an infant mortality rate that is 60 percent higher than the rate for their white counterparts (HHS, 2014).
Obesity also affects racial and ethnic populations disproportionately; From 2011 to 2014, Latinx children and adolescents ages 2 to 19 had the highest prevalence of obesity in the United States (21.9%), and Asians had the lowest (8.6%) (NCHS, 2016). The U.S. Centers for Disease Control and Prevention (CDC) reports that nearly 44 percent of African American men and 48 percent of African American women have some form of cardiovascular disease and African American and American Indian/Alaska Native females have higher rates of stroke-related death than Latinx and white women (Blackwell DL, 2014).
Mortality rates for Native Americans are almost 50% higher than that of their white counterparts with an infant mortality rate that is 1.5 times higher than for whites (Mathews TJ, 2015). The rate of diabetes as an underlying cause of death and a multiple cause of death has remained 2.5 to 3.5 times higher for Native Americans than for whites of all ages 20 and older.
Gender disparities in health are not based on biological mechanisms, rather on socioeconomic conditions that can shape gender differences in health outcomes such as mortality rates, alcohol, and substance abuse, mental health disorders, and violence victimization (NCBI, 2017). Within health care systems, unconscious gender biases –based on gender stereotypes and sexism affect patient care.
In 2014 life expectancy at birth was 81.2 years for women and 76.4 years for men, and from 2004 to 2014, the gap in life expectancy between men and women decreased from 5.1 years to 4.8 years (NCHS, 2015). The narrowing of the age gap between men and women might be mistaken for a positive event; while in fact, it is troubling because it stems from a rise in mortality rates among women.
The gender pay gap, men earning more than women, has serious implications on health iniquities because income is closely tied to health. The number of men not insured in the country is higher than that of women because historically, men have not qualified for Medicaid.
Living in low-income neighborhoods is linked to an increased risk of gender-based violence for African American and white women. Women are at a higher risk of sustaining injuries compared to men, and the effects of the violence continue having lasting effects on the health of women. The women who experience violence are at a higher risk of arthritis, asthma, heart disease, gynecological problems, and risk factors for HIV or sexually transmitted diseases (STDs) than those who do not experience violence (Campbell JC, 2000). For men, community violence is likely to affect their health, and this is particularly true for men of color, who experience disproportionate amounts of violence. Men also have higher suicide rates than women regardless of age, race, or ethnicity, with overall rates at almost four times those of women.
Sexual orientation(Lesbian, Gay, Bisexual, and Transgender, Intersex, Asexual) health disparities
The acronym LGBTIA is an umbrella term for Lesbian, Gay, Bisexual, and Transgender, Intersex, Asexual even though there exist within this population more forms of sexual and gender expression. The LGBTQIA population has been the subject of hate crimes and were excluded from many of the rights and social advantages of our society. Despite there being laws that protect the rights of the LGBTQIA community, they still face disturbing rates of healthcare discrimination from humiliation, harassment, and outright being turned away by medical practitioners and hospitals.
Center of American Progress, CAP, survey data shows that 8% of LGBTQIA were denied access to a health practitioner because of their actual or perceived sexual orientation, 6% said that the doctor refused to give them healthcare related to their actual or perceived sexual orientation, 9% said that a doctor used harsh or harmful language and 7% said that they experienced unwanted physical touch such as fondling and even rape from the care providers (CAP, 2018).
In a case, a transgender teenager who was admitted to a hospital for suicidal ideation and self-inflicted injuries was repeatedly misgendered and then discharged early by hospital staff. Unfortunately, he ended up committing suicide. Infants have been turned away from pediatricians for having same-sex parents.
Discrimination, or even the potential of discrimination, has the potential of keeping the LGBTQIA community away from hospitals.
Geographical location disparities
Rural counties have always had the highest premature death rates in the country. In comparison to urban areas, they have increased rates of preventable conditions such as obesity, diabetes, cancer, and injury. Rural areas have historically been affected by poverty and lack of opportunities for achieving optimal health, including factors such as employment, education, housing, and access to transportation. Limited or no access to a health care provider, poor management of chronic disease, and limited subspecialty availability are very real concerns for rural communities (Wong ST, 2009).
In urban areas, violence, and the resulting injuries and trauma, put them at higher risks of health complications than any other area. Approximately two-thirds of all U.S. firearm homicides occur in large urban areas, with inner cities as the most affected by firearm homicide (Prevention Institute, 2011). Youth violence is also higher in cities than in rural areas.
Urban communities have been characterized by a high burden of asthma, especially for children living in crowded and polluted areas.
United States citizens within lower-income or otherwise socially disadvantaged groups are confronted with a multilevel web of challenges that negatively impact their health and wellbeing. Discrimination exists in systems meant to protect the well-being or health of its people. Individuals who have experienced discrimination in the past may be more reluctant to seek health care, as they may perceive it as a setting of increased risk for discrimination. These disparities need to be addressed and a long-term solution reached to ensure equity in the healthcare system.
Appelo, T. (2019, August 6). Impact of celebrated author's work reverberates in nation's conscience. From AARP: https://www.aarp.org/entertainment/books/info-2019/toni-morrison-national-treasure.html
Blackwell DL, L. J. (2014). Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics; Vital and Health Statistics. PubMed. Retrieved February 10, 2014
Campbell JC, B. D. (2000). Violence against women: Synthesis of research for health care professionals. Washington, DC: National Institute of Justice.
CAP. (2018, January 18). Discrimination Prevents LGBTQ People From Accessing Health Care. From CAP: https://www.americanprogress.org/article/discrimination-prevents-lgbtq-people-accessing-health-care/
HHS. (2014). Infant mortality disparities fact sheets. Retrieved October 21, 2016 from http://minorityhealth.hhs.gov/omh/content.aspx?ID=6907&lvl=3&lvlID=8
Mathews TJ, M. M. (2015). Infant mortality statistics from the 2013 period linked birth/infant death data set. Hyattsville, MD: National Center for Health Statistics; National Vital Statistics Reports.
Nabi Ndugga, S. A. (2021, May 11). Disparities in Health and Health Care: 5 Key Questions and Answers. From KFF: https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
NCBI. (2017). The state of health disparities in the United States. Bethesda MD: National Academy of Sciences.
NCHS. (2015). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics. Retrieved 2016 from https://www.ncbi.nlm.nih.gov/books/NBK425844/#
NCHS. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics. Hyattsville, MD:: PubMed.
NCHS. (2016). Health, United States, 2015: With special feature on racial and ethnic health disparities. Hyattsville, MD: National Center for Health Statistics.
Prevention Institute. (2011). Fact sheet: Links between violence and health equity. Oakland, CA: Prevention Institute. Retrieved October 12, 2016 from https://www.preventioninstitute.org/sites/default/files/publications/Fact%20Sheet--Links%20Between%20Violence%20and%20Health%20Equity.pdf.
Prontzos, P. G. (2019, May 14). The Concept of “Race” Is a Lie. From SCIENTIFIC AMERICAN: https://blogs.scientificamerican.com/observations/the-concept-of-race-is-a-lie/
Wong ST, R. S. (2009). Patient perspectives on primary health care in rural communities: Effects of geography on access, continuity and efficiency. Rural and Remote Health.
Sarah Hobson, Ph.D. specializes in supporting teams, departments and schools, businesses, and government agencies in building inclusive innovative change-making communities who understand how to connect well with and join diverse populations in providing needed sustainable resources for all youth and families.