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UNIT II ■ Community Health Across Populations: Public Health Issues
interventions to reduce or eliminate the disparity. Health inequity describes avoidable gaps in health outcomes. 4 For example, persons with type 2 diabetes who cannot afford the cost of medication and therefore are unable to take it as prescribed will experience higher hemoglobin A1C levels and experience more adverse outcomes. The inequity in access to diabetic medications may be a major driver in the disparity in outcomes between lower- and middle-income persons. Drivers of health inequities are linked to the vulnerability experienced by some popula- tions based on the SDOH, including where they stand in the social hierarchy related to income, education, occu- pation, gender, race or ethnicity, and other factors. 5 ■ WHY IT MATTERS: Social Determinants of Health Nursing Practice Focus: SDOH contribute to health outcomes. Things to Consider: Systemic inequities have been shown to contribute to health inequities. The National Academies of Sciences, Engineering, and Medicine re- port that whereas individual-level behavioral factors are associated with health outcomes, upstream influences that impact where individuals live, learn, work, play, worship, and age also affect a wide range of health and quality of life outcomes and risks. 6 These characteris- tics, the SDOH, must be considered when assessing, planning, and implementing health-care interventions. What Does It Mean for the Nurse? Nurses can consider the following questions: • How will the nurse assess for a patient’s availability of safe housing and transportation? • How will the nurse consider the impact of racism, discrimination, and violence in the patient’s ability to be healthy? • How will the nurse determine the role of education, job opportunities, and income in relation to health outcomes? • How will the nurse evaluate how a patient’s language and literacy skills impact their ability to adhere to a treatment plan? • How will the nurse use available data to develop a plan of care for patients?
concept of “equality.” Although they were all given the same resource to view the game, the shortest person is still not able to see the game. If, instead, they are pro- vided with boxes at varying heights based on their stature, all of them get to see the game. Then there is “eq- uity” among the three persons. Furthermore, if the fence is removed, as depicted in the third picture, all structures have been dismantled and allow for all to be empowered. Health Disparity and Inequity When health equity does not exist, there are often dif- ferences in health outcomes. The terms used to describe gaps in health outcomes include health disparity and health inequity . Health disparity exists when “a health outcome is seen to a greater or lesser extent between pop- ulations.” 4 The IMR (see Chapter 18) provides a prime example of disparity, with higher rates between countries or between racial or ethnic groups within a country. Iden- tifying a disparity is the first step in understanding the underlying risk factors and the development of possible Figure 7-1 Equality, equity, and liberation. (Source: Equality/Equity/Liberation image is a collaboration between Center for Story-Based Strategy & Interaction Institute for Social Change)
Addressing health inequity requires providing peo- ple the opportunity for optimal health. This may require more services for those who have noncommunicable
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