Closing the Gap: A Comprehensive Guide to Understanding & Advancing Equity in Healthcare
If you’re like lots of people, you might assume staying healthy is as straightforward as making good lifestyle choices and seeking medical care whenever you don’t feel well. But for many millions of people in the U.S. alone, things, unfortunately, aren’t quite that simple.
Social, economic, and environmental factors can all have a major impact on health and overall well-being. And throughout the course of history and into the present day, certain groups of people have been at a significant disadvantage in all these areas, leading to health disparities throughout the population.
By understanding the root causes of health inequities and some of the steps that can be taken to address them, health providers and healthcare organizations can deliver higher-quality patient care. Just as importantly, they can advocate for policies that advance equity in healthcare, with the goal of ensuring everyone has the chance to live healthily.
Understanding Healthcare Disparities
Healthcare disparities are differences in the quality of healthcare and health outcomes among different population groups. People often experience healthcare disparities due to factors like race or ethnicity, gender identity, socioeconomic status, sexual orientation, or even their geographic location.
Healthcare disparities can come in many forms—including lack of access to care, lack of education about healthy life choices, or even implicit biases from healthcare providers when people are able to access care.
What Causes Healthcare Disparities?
To achieve equity in healthcare, it’s essential to understand and address the underlying causes of healthcare disparities. Let’s take a closer look at some of the main contributing factors and how they can affect health outcomes.
Many studies have shown socioeconomic status to be a significant factor in people’s physical well-being. People with lower incomes tend to eat less healthy food, often due to lack of healthy options nearby—a phenomenon known as food deserts that primarily affect poor areas. Lower-income groups also tend to have fewer educational opportunities, work more dangerous jobs, and are less likely to have insurance coverage.
Race and Ethnicity
People belonging to minority racial and ethnic groups frequently experience worse health outcomes. Even when other factors like income, age, insurance status, and the severity of their condition are similar, nonwhite people routinely receive lower-quality healthcare and are less satisfied with their interactions with healthcare providers.
Gender or Sexual Orientation
People of color aren’t the only ones who experience discrimination in healthcare. Gender bias is also a major source of healthcare disparities. It’s been well-documented that women struggle to have their reported pain levels taken seriously by providers.
In many cases, this has led to potentially serious symptoms being dismissed without adequate investigation, sometimes with serious consequences. Similarly, studies have shown that heterosexual healthcare providers regularly show biases that affect their clinical decision-making when treating LGBTQ+ people.
Geography and Environment
Closely related to socioeconomic status, the places people live also contribute to healthcare disparities. Lower-income communities are frequently located near industrial areas, which can cause exposure to toxins and pollutants that cause long-term health issues. Low-income communities also experience more violence, crime, and stigma, leading to higher stress levels that increase the risk of all types of health issues.
People who work manual labor jobs also have a higher risk of disability and long-term health effects compared to those in other occupations. Rural communities also have significantly fewer healthcare providers per capita, which can cause people who need medical attention to go without.
Access to Care
According to the CDC, over 30 million people in the United States don’t have health insurance—that’s nearly 10% of the population. When people are forced to pay for their own healthcare out of pocket, they often avoid seeking treatment due to the massive medical debt they’re likely to incur as a result. And when people avoid seeking medical care for minor problems, those problems can progress into more serious issues that affect quality of life and even life expectancy.
Implicit Bias in Healthcare
Multiple studies have shown implicit bias can affect even the most well-intentioned healthcare providers. Implicit bias refers to feelings and thoughts about certain groups that exist without conscious awareness. These biases have been statistically shown to lead to lower-quality health care and worse health outcomes for marginalized groups, particularly people of color.
Implicit bias isn’t necessarily anyone’s fault, or a sign that someone is a bad person. It’s programmed into people by interactions and experiences throughout the course of their lives. While implicit bias can be uncomfortable to think about for people who have chosen a career dedicated to helping others, it’s a real phenomenon that must be dealt with before health equity can truly be achieved.
Advancing Equity in Healthcare
Healthy societies consist of healthy communities and individuals. By removing obstacles to health for disadvantaged groups, we can give everyone an equal chance to become the healthiest version of themselves. And when people are healthy, they’re also happier, more productive, and more creative—all things that benefit both local and global communities.
Because the causes of health inequity are complex and interconnected, it will take a collective effort from policymakers, healthcare organizations, and individual providers to create a more equitable healthcare system. (For now, we’ll cover steps that can be taken within the healthcare landscape—we’ll go into the related social factors later.)
Increasing access to affordable healthcare coverage is arguably the single most important step in advancing health equity. Millions of people don’t receive insurance coverage through an employer, so expanding on policies like the Affordable Care Act will be a critical step in eliminating healthcare disparities. One of the best ways to tackle health inequity is by supporting organizations and government representatives who want to make healthcare affordable for everyone.
To address healthcare access gaps, community health centers that serve disadvantaged populations have also proven effective in many areas. When people can easily receive low- or no-cost care close to home, they’re more likely to seek the preventative and primary care that’s a major factor in health disparities between demographic groups.
Besides making healthcare more affordable and accessible, it’s also critical to ensure everyone receives the same high-quality care. A number of healthcare researchers believe education and training that focuses on cultural competence can improve patient outcomes and increase patient satisfaction. Anti-bias and anti-discrimination initiatives are important for continuing progress in this area. So are hiring policies that encourage a diverse mix of providers that reflects the populations they serve.
Addressing Intersectionality in Healthcare
Intersectionality describes the idea that people have multi-layered social identities. Different pieces of each person’s individuality—like race, gender, sexual orientation, and socioeconomic status—all combine to influence the way they experience the healthcare system and life in general.
For example, while women of color already experience certain healthcare disparities, a queer woman of color who lives in poverty will naturally face even more obstacles because she belongs to multiple marginalized groups.
Talking about intersectionality in healthcare isn’t meant to invalidate anyone’s struggles or to make a competition out of who faces the most problems. It’s just part of acknowledging that social issues are as multi-layered as the individuals who make up a society.
Understanding how intersecting identities affect health outcomes is an essential part of achieving health equity. Educational institutions and employers who prioritize cultural competence training can prepare healthcare providers to more effectively treat people with compounding life circumstances.
Because people with multiple marginalized identities experience life very differently from people who haven’t had to deal with the same challenges, it’s critical to include diverse perspectives when creating healthcare policy and developing community health initiatives.
Finally, while it may not be the most exciting topic, collecting accurate demographic data is also a surprisingly important part of addressing intersectionality in healthcare. Policymakers and health organizations need tangible numbers to use when researching health disparities, creating programs to address them, and measuring how well those initiatives are working.
Improving Health Literacy
Health literacy refers to a person’s ability to understand important information about their own health and to make informed decisions about their healthcare and lifestyle habits. Knowing how to access healthcare services, how to follow a provider’s home-care instructions, or how lifestyle decisions impact certain health risks are all examples of healthcare literacy.
Not everybody is fortunate enough to be taught about common health risks or the basics of nutrition and anatomy. And when people struggle to understand instructions from their provider—or even to see one in the first place—it can cause poor continuity of care, or delays in care that allow health problems to worsen.
According to the National Library of Medicine, nearly 9 out of 10 adults in the United States struggle with some aspect of health literacy, especially people with less education and/or lower incomes. Fortunately, studies have shown that efforts to improve health literacy can mediate some of the health disparities caused by differences in socioeconomic status.
Education outreach initiatives can promote healthcare equity by increasing health literacy in the communities that need it most. Whether it’s educating people on heart disease, how to eat healthier diets, the dangers of tobacco use, or how to practice safer sex, non-judgmental health education is an essential piece of addressing healthcare disparities.
Many hospitals and health organizations are also becoming wise to the importance of plain-language communication in improving health literacy. Physicians and nurses use lots of technical medical terminology that seems second-nature to them, but can leave the average person’s head spinning. By taking the time to deliver instructions and information in terms their patients can understand, providers can make it easier for patients to follow their treatment plan and achieve better health outcomes.
Addressing Social Determinants of Health
Besides factors within the healthcare system, how and where people live, work, play, and grow old can also have a serious impact on health disparities. These underlying social determinants of health are closely linked to health outcomes for people from a wide range of demographic groups.
What Are Some Social Determinants of Health?
Let’s explore a few of the most widely recognized social determinants of health, and how they can affect people’s ability to live healthily.
When people are struggling to make ends meet, they may not have the time or resources to seek the primary and preventative medical care that many people take for granted. They’re also less likely to have health insurance or disability coverage through their employer, which can cause people to avoid seeking care because they can’t afford to take time off of work—let alone pay the medical bills they’ll receive as a result.
Level of Education
Research has shown that people who achieve higher levels of education have longer life expectancy, better self-reported health, and less severe illness when they do get sick. People’s education level is also linked to their health literacy, which we’ve already discussed. From standard pre-K-12 education to health-focused community learning programs, ensuring adequate educational funding and opportunities throughout our society is essential for advancing equity in healthcare.
Imagine getting severely ill without a safe, comfortable place to recover. While it’s unpleasant to think about, it’s a reality for many people. Secure and safe housing is a major social determinant of health—not just for acutely ill or injured people, but also because housing insecurity can lead to chronic stress that exacerbates all types of health problems. Social programs designed to address housing insecurity can improve underprivileged people’s lives in many areas, and health equity is right at the top of the list.
Especially for lower-income families and individuals, eating a well-balanced diet can be a real struggle. Lower-income areas have fewer options for fresh, healthy food, and highly processed, high-calorie foods are often the cheapest and easiest option for feeling full on a limited budget.
Poor nutrition has been linked to higher rates of obesity, heart disease, certain cancers, and chronic conditions like diabetes. In addition to educational programs that teach people about how diet affects their health, social programs like the Supplemental Nutrition Assistance Program (SNAP) are also valuable assets in tackling health disparities.
While easy access to transportation might not be the first thing that springs to mind when you think of factors that influence public health, it’s a big piece of the puzzle. Many lower-income people rely on public transportation to access their jobs, education, recreation, and any healthcare services.
When people don’t have access to timely and reliable forms of transportation, they may miss appointments or avoid seeking care altogether. By lobbying local governments for adequate public transit, or instituting programs like local shuttles or ride-share services, healthcare organizations can remove barriers to access and promote health equity in their communities.
How Can Healthcare Providers Address Social Determinants of Health?
While many healthcare providers specialize in certain areas, they’re still in the business of treating the whole person. Healthcare providers play an important part in addressing social determinants of health by screening for potential issues when meeting with their patients.
For example, a physician or nurse may notice signs of poor nutrition and provide information on supplemental food programs, or help their patient get in touch with a case manager if they determine their patient is dealing with housing insecurity. Besides connecting patients with relevant support resources, providers can also help address social determinants of health by advocating for policy changes, or getting involved with organizations that are taking on these big-picture social issues.
Promoting Diversity and Inclusion in Healthcare
From creating healthcare policy to shaping hiring practices, diversity and inclusion are paramount in reducing disparities and building a healthier, more equitable society. Elevating under-represented perspectives helps ensure our healthcare systems and policies accurately reflect the needs of the diverse patient populations they treat. When patients can relate to their healthcare providers—and vice versa—trust and communication both come more easily, which can have a significant impact on the patient experience, continuity of care, and overall health outcomes.
In addition to recruiting, hiring, and retaining a diverse mix of providers and administrators, healthcare organizations must constantly re-evaluate their policies to determine they’re doing everything they can to promote diversity and inclusion. This may include cultural competency training for employees, as well as public outreach programs designed to build trust, increase awareness, and reduce healthcare stigma among certain populations.
Spend Your Career Advancing Equity in Healthcare
Civil rights icon Martin Luther King, Jr. summed it up best when he said, “Of all the forms of inequality, injustice in health is the most shocking and inhuman.” Until we can fully address healthcare disparities in all their forms, we still have lots of work to do to become a stronger, healthier, and more ethical society.
If you want to become part of the solution, a career in healthcare can provide opportunities to earn a great living while also making a positive difference—both for the individual patients you treat and the communities to which they belong.
At Provo College, you’ll receive up-to-date healthcare education from experienced instructors, including cultural competency training that prepares you to promote health equity throughout your career. Learn more about our healthcare and nursing programs, and start working toward a career spent eliminating injustices by promoting public health.