2.3 Social and economic factors contributing to health disparities
9 min read•august 20, 2024
Social and economic factors significantly impact health outcomes, driving disparities between population groups. These non-medical determinants, including income, education, and social context, shape access to resources and opportunities that promote well-being.
Understanding these factors is crucial for nurses to provide equitable care. By recognizing how social and economic conditions influence health, nurses can better address patients' needs, advocate for vulnerable populations, and work towards reducing health disparities in their communities.
Social determinants of health
- Social determinants of health are the conditions in which people are born, grow, live, work and age that shape health
- These non-medical factors influence health outcomes and are major drivers of health inequities
- Understanding social determinants is crucial for nurses to provide equitable care and advocate for vulnerable populations
Economic stability factors
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- Income and wealth distribution impact access to resources that promote health (nutritious food, safe housing, healthcare)
- Poverty and financial instability contribute to chronic stress and poorer health outcomes
- Employment provides income, benefits, and a sense of purpose, while unemployment is linked to adverse health effects
- Lack of affordable housing and homelessness exacerbate health problems and limit access to care
Education access and quality
- Higher levels of education are associated with better health outcomes and health literacy
- Early childhood education and development lay the foundation for future academic success and health
- Disparities in school funding, resources, and quality perpetuate health inequities
- Nurses can promote health education and partner with schools to support student well-being
Health care access and quality
- Availability, affordability, and accessibility of health services impact health outcomes
- Lack of insurance coverage, high out-of-pocket costs, and limited provider networks create barriers to care
- Cultural and linguistic barriers, discrimination, and mistrust of the healthcare system deter some populations from seeking care
- Nurses play a crucial role in advocating for equitable access and providing culturally competent care
Neighborhood and built environment
- Physical environment, including air and water quality, green spaces, and walkability, influences health
- Exposure to environmental toxins, pollution, and lead contributes to health problems (asthma, developmental delays)
- Food deserts and lack of access to healthy food options impact nutrition and chronic disease risk
- Neighborhood safety, crime, and violence affect mental health and physical activity levels
Social and community context
- Social networks, support systems, and community engagement impact health behaviors and outcomes
- Discrimination, racism, and social exclusion contribute to chronic stress and health disparities
- Cultural norms, values, and practices influence health beliefs, behaviors, and healthcare utilization
- Nurses can foster trust, build relationships, and engage with communities to promote
Health disparities
- Health disparities are preventable differences in health outcomes and determinants between population groups
- Disparities are rooted in social, economic, and environmental disadvantages and inequities
- Recognizing and addressing health disparities is essential for nurses to provide equitable care and advocate for
Definition of health disparities
- Health disparities are differences in health status, outcomes, and determinants that are closely linked with social, economic, and/or environmental disadvantage
- Disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on characteristics (race, ethnicity, socioeconomic status, gender, disability, geographic location)
- Health disparities are avoidable, unfair, and unjust differences in health that result from social inequities
Measuring health disparities
- Disparities can be measured by comparing health outcomes (life expectancy, disease prevalence) between population groups
- Examining differences in access to care, quality of care, and social determinants of health helps identify root causes of disparities
- Data collection and analysis by demographic factors (race, ethnicity, income) is essential for tracking and addressing disparities
- Nurses can contribute to data collection, advocate for inclusive data practices, and use data to inform equitable care strategies
Racial and ethnic disparities
- Racial and ethnic minorities experience disproportionately poorer health outcomes compared to non-Hispanic whites
- Disparities persist across various health indicators (infant mortality, chronic diseases, life expectancy)
- Structural racism, discrimination, and cultural barriers contribute to racial and ethnic health disparities
- Nurses must provide culturally competent care, address implicit biases, and advocate for policies that promote racial health equity
Socioeconomic disparities
- Socioeconomic status, including income, education, and occupation, is a strong predictor of health outcomes
- People with lower socioeconomic status experience higher rates of chronic diseases, mental health problems, and premature mortality
- Limited access to resources (healthy food, safe housing, healthcare) and chronic stress contribute to socioeconomic health disparities
- Nurses can connect patients with social services, advocate for policies that address poverty, and promote health literacy
Geographic disparities
- Health outcomes and access to care vary significantly by geographic location (urban vs. rural, zip code)
- Rural populations face unique challenges (provider shortages, long distances to care, limited resources) that impact health
- Neighborhood characteristics (walkability, safety, green spaces) influence health behaviors and outcomes
- Nurses can partner with communities to address local health needs, promote telemedicine, and advocate for equitable resource allocation
Economic factors
- Economic factors, such as income, wealth, poverty, employment, and housing, are key determinants of health
- Understanding the impact of economic factors on health is crucial for nurses to provide holistic care and advocate for policies that promote economic stability and health equity
Income and wealth inequality
- Income and wealth inequality have widened in recent decades, with significant health implications
- Higher income and wealth are associated with better health outcomes, while poverty is linked to poorer health
- Unequal distribution of resources contributes to health disparities and limits access to health-promoting goods and services
- Nurses can advocate for policies that reduce inequality (progressive taxation, living wage) and connect patients with financial resources
Poverty and low-income status
- Poverty is a major risk factor for poor health outcomes and health disparities
- People living in poverty face multiple barriers to health (lack of insurance, limited access to care, food insecurity, unsafe housing)
- Chronic stress associated with poverty contributes to mental health problems and chronic diseases
- Nurses can screen for social needs, connect patients with resources (food banks, housing assistance), and advocate for anti-poverty policies
Employment and job security
- Employment provides income, benefits, and a sense of purpose, all of which are important for health
- Job insecurity and unemployment are associated with poorer physical and mental health outcomes
- Lack of paid sick leave and other benefits can deter workers from seeking preventive care and managing chronic conditions
- Nurses can support patients in navigating job-related health challenges and advocate for policies that promote fair labor practices and worker protections
Housing instability and homelessness
- Housing instability and homelessness are significant barriers to health and healthcare access
- People experiencing homelessness have higher rates of chronic diseases, mental health problems, and substance use disorders
- Lack of stable housing makes it difficult to manage medications, maintain hygiene, and follow treatment plans
- Nurses can connect patients with housing resources, provide trauma-informed care, and advocate for affordable housing policies
Social factors
- Social factors, such as discrimination, social isolation, adverse childhood experiences, and stress, have a profound impact on health
- Understanding the role of social factors in shaping health outcomes is essential for nurses to provide patient-centered care and promote health equity
Discrimination and racism
- Discrimination and racism, at both individual and structural levels, contribute to health disparities
- Experiences of discrimination and racism are associated with chronic stress, mental health problems, and poorer physical health outcomes
- Racial and ethnic minorities face barriers to accessing quality healthcare due to discrimination, bias, and cultural insensitivity
- Nurses must recognize and address their own biases, provide culturally competent care, and advocate for policies that promote racial equity
Social isolation and loneliness
- Social isolation and loneliness are risk factors for poor mental and physical health outcomes
- Lack of social support and connectedness is associated with higher rates of depression, anxiety, and cognitive decline
- Social isolation can impact health behaviors (decreased physical activity, poor nutrition) and limit access to resources
- Nurses can assess for social isolation, promote social engagement, and connect patients with community resources (senior centers, support groups)
Adverse childhood experiences
- Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, have lifelong impacts on health
- ACEs are associated with increased risk of chronic diseases, mental health problems, and substance use disorders in adulthood
- Toxic stress from ACEs can alter brain development and immune function, leading to long-term health consequences
- Nurses can provide trauma-informed care, screen for ACEs, and connect patients with mental health resources and support services
Stress and allostatic load
- Chronic stress, particularly from social and economic disadvantage, contributes to health disparities
- Allostatic load, the cumulative burden of chronic stress on the body, leads to physiological dysregulation and increased disease risk
- Stress and allostatic load are linked to cardiovascular disease, diabetes, mental health problems, and premature aging
- Nurses can teach stress management techniques, promote resilience, and advocate for policies that address social and economic stressors
Intersection of social and economic factors
- Social and economic factors do not operate in isolation but intersect and interact to shape health outcomes
- Understanding the cumulative impact and cyclical nature of social and economic disadvantage is crucial for nurses to provide holistic care and advocate for systemic change
Cumulative impact on health
- The combination of multiple social and economic disadvantages has a cumulative impact on health
- Individuals experiencing multiple forms of marginalization (low-income, racial/ethnic minority, limited education) face compounded health risks
- Cumulative disadvantage across the life course contributes to widening health disparities over time
- Nurses must consider the intersectionality of patients' identities and experiences when assessing health needs and developing care plans
Cycle of poverty and poor health
- Poverty and poor health are interconnected and can create a self-perpetuating cycle
- Poverty limits access to health-promoting resources and increases exposure to health risks, leading to poorer health outcomes
- Poor health, in turn, can limit educational and employment opportunities, further entrenching poverty
- Nurses can work to break this cycle by connecting patients with resources, advocating for policies that address poverty, and promoting health education
Intergenerational transmission of disparities
- Health disparities can be transmitted across generations through social, economic, and biological pathways
- Children born into disadvantaged families are more likely to experience poverty, limited educational opportunities, and adverse health outcomes
- Maternal health and prenatal exposures can have long-term impacts on child health and development
- Nurses can provide prenatal and early childhood interventions, support parenting skills, and advocate for policies that promote equal opportunities for all children
Addressing health disparities
- Addressing health disparities requires a multi-faceted approach that includes improving access to care, enhancing social and economic policies, and promoting health equity
- Nurses play a crucial role in reducing disparities through patient care, advocacy, and community engagement
Improving access to healthcare
- Expanding insurance coverage and reducing financial barriers to care can help improve access and reduce disparities
- Increasing the diversity and cultural competence of the healthcare workforce can enhance trust and engagement with underserved populations
- Implementing community health worker programs and mobile health services can bring care to hard-to-reach populations
- Nurses can advocate for policies that expand access, provide culturally competent care, and partner with community organizations to reach underserved groups
Enhancing social and economic policies
- Addressing social and economic determinants of health through policy change is essential for reducing disparities
- Policies that promote income stability (minimum wage, earned income tax credit), affordable housing, and access to education can improve health outcomes
- Investing in early childhood programs and parental support can help break the cycle of poverty and promote health equity
- Nurses can advocate for policies that address social and economic inequities, educate policymakers on the health impacts of these issues, and mobilize communities for change
Promoting health equity
- Health equity means that everyone has a fair and just opportunity to be as healthy as possible
- Promoting health equity requires removing obstacles to health, such as poverty, discrimination, and lack of access to good jobs, education, and housing
- Addressing implicit bias, cultural insensitivity, and structural racism within the healthcare system is crucial for promoting equity
- Nurses can champion health equity by providing equitable care, advocating for inclusive policies, and partnering with diverse communities
Role of nurses in reducing disparities
- Nurses are well-positioned to address health disparities through their roles as caregivers, educators, advocates, and leaders
- Providing patient-centered, culturally competent care that addresses social and economic barriers to health is essential
- Educating patients, families, and communities about health promotion, disease prevention, and navigating the healthcare system can empower them to take control of their health
- Advocating for policies that address social determinants of health and partnering with community organizations can help drive systemic change
- Nurses must continue to develop their cultural competence, engage in lifelong learning about health equity, and use their voices to champion social justice in healthcare
Key Terms to Review (18)
Centers for Disease Control and Prevention: The Centers for Disease Control and Prevention (CDC) is a national public health institute in the United States, focused on protecting public health and safety through the control and prevention of disease, injury, and disability. The CDC plays a crucial role in addressing health disparities, promoting health equity, ensuring access to care, and assessing community health needs through data collection and analysis.
Community Health Initiatives: Community health initiatives are organized efforts designed to improve the health and well-being of a specific community or population. These initiatives often focus on addressing various social and economic factors that contribute to health disparities, aiming to promote health equity and provide resources to underserved populations. By engaging community members and stakeholders, these initiatives seek to create sustainable changes that enhance overall community health outcomes.
Community-based care: Community-based care refers to a healthcare delivery model that focuses on providing services in the community where individuals live, rather than in traditional hospital settings. This approach aims to improve access to healthcare, enhance patient engagement, and promote better health outcomes by addressing the specific needs of vulnerable populations within their own environments. By prioritizing preventive care and managing chronic conditions locally, community-based care plays a crucial role in reducing health disparities and fostering overall well-being.
Educational Attainment: Educational attainment refers to the highest level of education an individual has completed, which significantly influences their opportunities and quality of life. It encompasses various degrees and certifications, from high school diplomas to advanced degrees like master's or doctoral qualifications. The level of educational attainment is closely linked to socioeconomic status, employment opportunities, and overall health outcomes, making it a critical factor in understanding disparities in health across different populations.
Employment status: Employment status refers to an individual's current work situation, which can include being employed full-time, part-time, unemployed, or engaged in self-employment. Understanding employment status is essential as it directly affects economic stability, access to healthcare, and overall well-being, influencing health outcomes across various populations.
Epidemiological Studies: Epidemiological studies are research investigations that seek to understand the distribution and determinants of health-related states or events in specified populations. These studies help identify how social and economic factors contribute to health disparities by examining the relationships between various risk factors, health outcomes, and demographic characteristics within different groups.
Health Equity: Health equity refers to the principle of fairness in health care and the idea that everyone should have the opportunity to attain their highest level of health. It emphasizes reducing and eliminating disparities in health and its determinants, such as social and economic factors, and aims to ensure that vulnerable populations receive appropriate resources and care.
Healthcare affordability: Healthcare affordability refers to the capacity of individuals and families to access necessary medical services without experiencing financial hardship. This concept is closely linked to various social and economic factors, including income levels, insurance coverage, and overall economic stability, all of which contribute to health disparities among different populations.
Homelessness-related health challenges: Homelessness-related health challenges refer to the various physical and mental health issues that individuals experiencing homelessness face due to their living conditions and lack of access to resources. These challenges are often exacerbated by social and economic factors, such as poverty, unemployment, and lack of healthcare, which contribute to health disparities among homeless populations. Addressing these challenges requires understanding the complex interplay between social determinants of health and the unique vulnerabilities that homeless individuals encounter.
Income inequality: Income inequality refers to the unequal distribution of income within a population, where a small percentage of individuals or households earn significantly more than the majority. This disparity in income can lead to various social and economic issues, including limited access to healthcare, education, and opportunities, ultimately contributing to health disparities among different groups within society.
Integrated Care Models: Integrated care models refer to a coordinated approach to health services that aims to enhance patient outcomes by unifying various aspects of healthcare delivery, including prevention, treatment, and rehabilitation. These models address the complex needs of patients, particularly those from vulnerable populations, by promoting collaboration among healthcare providers and social services, ensuring that patients receive comprehensive and holistic care that considers their social, economic, and cultural contexts.
Language barriers: Language barriers refer to the difficulties individuals face in communicating due to differences in language, which can lead to misunderstandings and hinder effective interaction. These barriers are especially significant in healthcare settings, where clear communication is crucial for providing quality care, understanding health information, and ensuring patient safety.
Medicaid Expansion: Medicaid expansion refers to the provision of the Affordable Care Act that allows states to extend Medicaid eligibility to more low-income individuals and families. This expansion aims to improve access to healthcare for vulnerable populations, reduce the number of uninsured, and promote overall health equity across diverse communities.
Migrant health issues: Migrant health issues refer to the unique health challenges faced by individuals and families who move from one location to another, often across borders, in search of better living conditions, employment, or safety. These issues are deeply intertwined with social and economic factors that contribute to health disparities, impacting access to healthcare, quality of services, and overall well-being.
Qualitative Research: Qualitative research is a method of inquiry that focuses on understanding human experiences, behaviors, and social phenomena through the collection and analysis of non-numerical data. This approach emphasizes exploring the meanings and interpretations that individuals or groups attach to their experiences, often through methods like interviews, focus groups, and observations. It plays a crucial role in uncovering the complexities behind social issues such as health disparities and access to mental health services.
Social Justice: Social justice refers to the fair distribution of resources, opportunities, and privileges within a society, emphasizing equality and addressing systemic inequalities. It connects to issues like health disparities, poverty, and access to care, highlighting the need for policies and actions that promote equity for all individuals, particularly those from marginalized communities.
Transportation Barriers: Transportation barriers refer to the obstacles that individuals face in accessing transportation options, which can limit their ability to reach essential services, including healthcare, employment, and education. These barriers can be influenced by economic conditions, social factors, cultural beliefs, and systemic inequities, impacting vulnerable populations disproportionately.
World Health Organization: The World Health Organization (WHO) is a specialized agency of the United Nations focused on international public health. Established in 1948, its primary goal is to promote health, keep the world safe, and serve vulnerable populations by addressing health disparities, ensuring access to healthcare, and assessing community health needs globally.