166
UNIT II ■ Community Health Across Populations: Public Health Issues
justice is a matter of life and death.” 44 Although this re- port was completed nearly two decades ago, the gaps in life expectancy among countries remain. In fact, the United Nations, during the February 2022 World Day of Social Justice, described the significance of social justice as an action to improve the status of people globally. The organization pointed out that the advent of COVID-19 showcased the vulnerability of workers in informal economies, thus enhancing poverty and other inequali- ties that negatively impact people. 45 Unfortunately, there continues to be a major issue at the policy level, with the United States continuing to debate whether health is a right or a privilege. At the global level, distribution of needed health services continues to be hampered by poverty, war, and fragile infrastructure in low-income countries. The Intersection of Race, Poverty, and Place Although blacks account for only 13.4% of the U.S. pop- ulation, they account for almost 40% of persons infected with HIV when there is no biological or genetic basis for the difference (Fig. 7-5). 46 The driving factors are a “nexus of race, poverty, and place,” as demonstrated in 2014 by Gaskin and colleagues. 47 Race is a social con- struct with no biological foundation and is not a useful clinical marker for disease. However, there is evidence that demonstrates that racial inequity, developed through structural and systemic racism, facilitates many of the disparities that are experienced. 48 The Aspen Institute defines structural racism as a system in which public policies, institutional practices, cultural representations, and other norms work to reinforce racial group inequity.
Systemic racism , although similar, is said to exist in the historical, cultural, and social psychological aspects of our society. 49 Although most studies on racism are fo- cused on blacks, other populations may be at risk for demonstrations of racism that differ from those expe- rienced by blacks. Most recently, Asians and Hispanics have been subject to social and economic inequities that have led to health disparities. 50 Although not discrimi- nation based on race or ethnicity, religious profiling has risen to a level of concern, both in the United States and globally. Specifically, the Islamophobia experienced by some Muslim communities can lead to increased stress and disruption of interpersonal relationships that create health disparities and poor health outcomes. Understanding the role of poverty and place and their intersection with race should drive the development of policies aimed at addressing health disparity. Roth- stein describes the impact of government-sponsored segregation and how it has had tragic and long-term consequences for black families. 51 This segregation led to the establishment of communities with a higher level of poverty that are less apt to be able to provide community-level resources, such as grocery stores, parks and recreation facilities, quality schools, and pub- lic transportation. There are also fewer employment op- portunities and limited access to health care. 47 Based on the WHO list of 10 facts on health inequities and their causes, 52 addressing health disparity requires more than improving treatments for specific diseases. Specifically, it defines the causes as “an unequal distri- bution of income, power and wealth.” It requires a more comprehensive approach in which health-care services are linked with social services. 53 Furthermore, it is vitally important to include the community in the development of strategies that are aligned with their values and beliefs to effectuate positive changes in health outcomes. ● APPLYING PUBLIC HEALTH SCIENCE The Case of the Physicianless Children Public Health Science Topics Covered • Community assessment • Health planning Emily, a school nurse in a large community-based public elementary school, recognized the increasing di- versity among the students. Many first-generation immi- grants have moved into the lower-income, working-class community served by the school. Emily found that, among the students, 15 different languages were spoken
Figure 7-5 New HIV infections by race, 2019. (Source: Reference [46])
Powered by FlippingBook