Community Health Across Populations: Public Health Issues II
UN I T
Chapter 7 Health Disparities and the Social Determinants of Health Karen Bankston, Christine Savage, and Gordon Lee Gillespie
LEARNING OUTCOMES After reading the chapter, the student will be able to: 1. Differentiate the constructs of health disparity, equity, and inequality from a local to global perspective. 2. Discuss the magnitude of health disparities, both in the United States and internationally.
3. Define and explain the role of the social determinants of health (SDOH), social capital, and social justice in the health of populations. 4. Discuss the construct of racism as an institutional or structural issue and its impact on health equity.
KEY TERMS Advocacy Discrimination Disparity Equity Food insecurity Health disparity Health gradient
Health inequity Infant mortality rate (IMR) Marginalization
Social determinants of health (SDOH) Social gradient Social justice Socioeconomic status (SES) Structural racism
Systemic racism Universal Declaration of Human Rights Vulnerability Vulnerable populations
Poverty Racism Social capital
■ Introduction It has been said that one can tell the health of a commu- nity by measuring the health of its children. According to the World Health Organization (WHO), 5.0 million children died before age 5 years in 2020. 1 In addition, the infant mortality rate (IMR) globally reflects approxi- mately 27.4 deaths per 1,000 live births. The IMR was the highest in the WHO African Region (49.5 per 1,000 live births compared with 6.5 per 1,000 live births in the WHO European Region). 2 Why is there such a disparity , or great difference, between these regions? Is there any- thing that can be done to reduce this and other gaps in health outcomes between populations? Why are some
populations at greater risk for adverse health outcomes compared with other populations? Answering these questions involves understanding the underlying social determinants of health (SDOH) -related gaps in health outcomes between populations. For example, whereas the IMR in the United States was 5.6 per 1,000 live births, the difference between white infants and black infants was 4.5 and 10.5 per 1,000 live births, respectively, in 2019. 3 Equity is the underlying construct behind optimum health as a basic human right. To explore this in more detail, consider three people—one tall, one medium height, and one short—wanting to watch a ball game over a fence (Fig. 7-1). If all three people are provided with a box that is the same height, this represents the
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