Health disparities affect racial/ethnic groups, particularly African Americans, who experience worse health outcomes and shorter life expectancies than their White counterparts. The concept of health disparities is not just theoretical and abstract. They are life-and-death realities that affect people's lives and originate from deep-rooted systemic inequities. A well-known health disparity is that Black women in the United States are 3 to 4 times more likely to die from pregnancy-related complications than White women. I inform readers about these critical issues, propose actionable solutions, and provide insights from my day-to-day work. From understanding systemic racism to delivering culturally competent care, we all, including you, have a collective role in eliminating health disparities. Your understanding and actions are essential in this fight.
I. Laying the foundational ground: What are health disparities?
Health disparities are significant differences in the quality of health and overall well-being among disadvantaged groups that originate from systemic social and economic inequities. Furthermore, health disparities are observable differences in health outcomes in terms of burden, injury, violence, and disease experienced by historically marginalized groups. Healthcare disparities, on the other hand, refer to differences in health insurance coverage, affordability, accessibility, and quality of care. The crucial distinction is that healthcare disparities pertain to the structure and accessibility of healthcare services, such as hospitals and primary care providers. Health disparities focus on the prevalence of chronic diseases and high mortality rates within socially disadvantaged groups. Chronic diseases are a class of medical disorders that are long-term and often result in severe injury and death over time. Examples of chronic diseases are hypertension, diabetes, and cancer.
Black women in the United States have a greater chance of dying from childbirth than White women. This stark disparity exemplifies a dire public health crisis that disproportionately affects Black women. Historically, Black women have been devalued and dehumanized from the early era of slavery to the present. Dehumanization of them is deeply rooted in America's history and continues to manifest in the way in which they are treated and regarded in healthcare systems today. The noxious stereotype that they are less sensitive to pain or emotion has led to their negligence and dismissal of legitimate health concerns and denial of timely medical treatment. It is not only a public health crisis but a moral failure as well that pushes the harmful narrative that Black lives; namely those of Black women, are less worthy of care and respect. In New York State, for example, the maternal mortality rate for Black women is disturbing. Between 2018 and 2021, 65.2 Black women per 100,000 live births died from pregnancy-related complications, which is tragic and morally unjustifiable. How can our country that prides itself on equality and liberty for all live with this unconscionable phenomenon that utterly fails to protect its Black citizens, namely our black mothers, aunts, sisters, cousins, or friends? The dissonance is both concerning and jarring to me.
Another hot topic in the public health field is social determinants of health. They are social and environmental factors shaping individuals' health outcomes, quality of life, and well-being. They include access to reliable transportation, neighborhoods with safe parks, and access to grocery stores and restaurants. The relationship between health and social determinants is akin to oxygen and water, the two most vital elements humans need to survive. Without those things, we would be lifeless. You can understand the relationship between health and social determinants from a cause-and-effect standpoint. If people live in unsafe environments with very few social supports and material resources, then the effect is their health will deteriorate over time.
For example, a lack of access or limited access to grocery stores produces a cascading effect in that people will not get the proper nutrients from a balanced diet and resort to eating processed and junk food, which can make them sick and cause the onset of chronic diseases. The City of Wilmington contains many inner-city neighborhoods that are considered food deserts because there are few to no grocery stores nearby. Convenience stores are more prevalent in inner-city neighborhoods where store owners sell processed and junk food to consumers.
According to the CDC, about 40% of adults consumed fruit less than once a day in 2021 alone, which mirrors the state-wide figure of adults in Delaware who consumed fruit less than once a day in the same time frame. These statistics highlight poor nutritional choices, not because of any personal failure but because of the scarcity in grocery stores, especially in Black communities, and inflation. The price of goods in our economy has been astronomically high in the past year, making it challenging for people to afford groceries and other expenses.
The relationship between health and transportation go hand in hand with one another. Completing daily responsibilities and attending appointments can be challenging and inconvenient. The lack of transportation can produce a domino effect in that this barrier can make people put off their health needs and delay care for an indefinite time, which can unequivocally be detrimental to one's health, especially if one has a chronic disease, such as an aggressive form of cancer. If one does not have reliable transportation to attend appointments regularly, then the spread of the cancer can metastasize quickly and increase one's likelihood of dying. According to a 2023 survey by KFF, about 45% of black adults self-reported that they or a family member experienced difficulty in paying for living expenses, namely food, transportation, or rent/mortgage, within the last year. Furthermore, about a quarter (1/4)of black adults self-reported that either themselves or a close family member experienced financial hardship to pay for healthcare expenses within a 12-month period, which is pretty high.
II. Factors that perpetuate racial disparities
Health disparities do not happen inside of a vacuum. They are shaped by historical events, like segregation and redlining, and perpetuated by myriad systems, including the criminal justice, governmental, and healthcare systems. Additionally, individual experiences, beliefs, and attitudes influence how people treat those different from them. However, the most pervasive form of racism is systemic racism. Unlike overt prejudice, systemic racism is present in many laws, policies, and institutions, often unnoticed by White folks. Influential people in these institutions have relegated marginalized people of color, particularly Black individuals, to the bottom of society, stemming from the belief that they are inferior.
Systemic racism can manifest in everyday interactions, such as in the healthcare system. A U.S. survey on racism and discrimination revealed that 25% of black adults reported unfair treatment or blatant disrespect from a healthcare provider within three years. Voter suppression also disproportionately affects Black and Brown communities, which can indirectly influence health by hindering people's right to elect representatives who could advocate for positive, impactful changes in their communities. Climate change significantly influences health. Communities plagued by poor air quality, dangerous toxic waste, and other pollutants face multiple health issues. The Flint water crisis in Michigan is a prime example of an environmental injustice that continues to affect Black communities disproportionately.
III. Solutions/ My Experience
Addressing health disparities requires systemic change and a multisectoral approach because they are ubiquitous in every facet of American society, including the criminal justice and legal systems. One proposed solution is for medical providers to incorporate survey tools that assess environmental conditions grounded in evidence-based practices and rooted in a health equity framework. Additionally, research needs to be more inclusive, representing diverse population groups that it aims to target.
In my role with WIC, I gained valuable experience in managing client data and maintaining comprehensive records. This experience deepened my understanding of the challenges endured by underserved communities. WIC, or Women, Infants, and Children, is a special supplemental nutrition program that assists pregnant, breastfeeding, and non-breastfeeding postpartum mothers, infants, and children up to age five by providing nutritious food, nutrition education, and referrals to essential services.
The Delaware WIC program addresses health disparities through community outreach and partnerships with entities like Christiana Care and insurance companies like Amerihealth. It maintains a robust referral system, connecting participants with WIC-related services. The program serves a diverse population of mothers and children from various racial and ethnic backgrounds, and the U.S. Department of Agriculture funds it. The USDA mandates WIC agencies to provide free linguistic services to non-English speakers, ensuring equal access to nutrition assistance. Additionally, USDA prohibits discrimination against participants based on age, race, sexual orientation, and other protected statuses, promoting equity across all WIC services.
I currently volunteer with the WRK Group, a collective of three organizations called Kingswood Community Center, Teen Warehouse, and REACH Riverside-that work in tandem to combat structural racism and environmental barriers in Wilmington's low-income neighborhoods. The Teen Warehouse offers teens and young adults diverse educational and recreational activities and professional development. The organization also hosts a weekly food pantry and community refrigerator, which provide free nutritious food to those in need. It directly addresses food insecurity at a grassroots level. I find deep, rewarding fulfillment in volunteering because it allows me to give back and serve the community meaningfully.
The importance of dismantling health disparities cannot be understated. Respect and dignity are fundamental human rights tenets. People have the innate right to access quality healthcare and live and thrive in healthy, safe communities. Our world is becoming increasingly diverse. From an economic perspective, early deaths and illness rates among racial/ethnic disparities can significantly weaken our economy's growth and prosperity. If many people are dying from chronic diseases left and right, then our nation will lose our financial standing power.
To tackle health disparities, you have the power to influence powerful change. Here are a few ideas to get the ball rolling:
Volunteer: Get involved with a local organization that services low-income communities. Regular exposure to real-world examples of health disparities will deepen your understanding of the issues and the people affected.
Local organizations include the YMCA, the Boys and Girls Club, the Food Bank, etc.
Advocate: Write a letter to your local representative about a social issue, no matter how small or large. Raising awareness is the first step toward brainstorming solutions and driving monumental policy change.
Stay informed: Subscribe to a podcast or magazine, or follow important influencers on social media who are passionate about health equity, human rights, or social justice. Staying informed keeps the conversation new and fresh and empowers you to take immediate action.
Follow these Influencers for Insight and Inspiration:
@soogia1: Soogia is a Korean-American influencer who addresses racism and injustice towards the Asian community. She provides valuable education on social injustices and cultural practices that shape our society. #koreanamericans #soogia
@drkalimd: Dr. Kali, a double-board licensed psychiatrist, confronts medical bias and stigma in healthcare. She offers insights into mental health stigma, police brutality, and systemic oppressions impacting Black and Brown communities. #drkalimd
@victoria_phd: Victoria Alexander, a PhD candidate in social justice, explores race relations, gender issues, and U.S. systems through an intersectional lens. Her content is educational and fascinating. #socialjustice #intersectionality #victoriaalexander
@empress_onyxx: TikTok influencer Empress Onyxx delves into U.S history from a social justice framework, highlighting anti-Black racism and addressing the sanitized, whitewashed narratives of America's past. #americanhistory #empressonyxx
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