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Fundamental causes of health disparities

  • Health Equity

The Robert Wood Johnson Foundation has a lot of content and resources dedicated to social determinants of health. It includes briefs covering various factors that look like good sources of ideas and human contacts. It also links out to even more data and other information on intersectional aspects of SDOH, including rural health.

Immigration as a Social Determinant of Health: Proceedings of a Workshop
Immigrants are a significant and growing population that makes up about one-quarter of the United States population. On November 28, 2017, in Oakland, Calif., a workshop held by the Roundtable on the Promotion of Health Equity, titled Immigration as a Social Determinant of Health, explored the complex interactions between immigration and health disparities. Topics of the workshop included discussing the history of immigration and the relationship of immigration status to economic and health policies, the ongoing importance of immigrant health outcomes in the United States, and the role of immigration as a social determinant of health.

The Kaiser Family Foundation: Disparities Policy
The Henry J. Kaiser Family Foundation (KFF), a nonpartisan group, offers comprehensive resources on policies related to health disparities. It includes information on utilization by race, health care coverage – including for those who are uninsured or on Medicaid or Medicare, health promotion and other related topics. There are also plenty of visuals, from polls to graphics. For those just starting on the issue, these Five Key Questions and Answers are a good starting point. (KFF is not part of health care provider Kaiser Permanente.)

The Quality of Data on ‘‘Race’’ and ‘‘Ethnicity’’: Implications for Health Researchers, Policy Makers, and Practitioners
Judith B. Kaplan (2014)
Researchers and reporters writing about health disparities may make assumptions about the quality of underlying data on race and ethnicity. It is often taken for granted that these terms are defined universally or consistently, or that the classifications themselves are worthwhile. In this paper, Judith Kaplan, Center for Quality Improvement, Centers for Medicare and Medicaid Services, outlines some challenges to the assumption that “race and ethnicity data” is generalizable and of good quality. “These classifications are inherently too imprecise to allow meaningful statements to be made about underlying biological or genetic differences between groups,” Kaplan cautions. “Findings of racial/ethnic differences should be reported with appropriate caveats and interpreted with caution.”

Social Conditions as Fundamental Causes of Disease
Bruce G. Link, Jo Phelan
Journal of Health and Social Behavior (1995)
In this influential 1995 paper, Link and Phelan were among the first to make the case that inequalities in health are unlikely to change unless we take steps to reduce inequalities in income, education, and social status: “For example, there are powerful social, cultural, and economic factors shaping the diet of poor people in the United States. Consequently, providing information about healthy diet to poor people and exhorting them to follow nutritional guidelines is unlikely to have much impact. Without an understanding of the context that leads to risk, the responsibility for reducing the risk is left with the individual, and nothing is done to alter the more fundamental factors that put people at risk of risks.”

Technological Innovation and Inequality in Health
Sherry Glied & Adriana Lleras-Muney, Demography (2008)
People with more education live longer than those with less education, and this survival advantage of the more-educated increases in the case of diseases with more rapid progress in treatment technology. The findings support the idea that higher levels of education equip people with the knowledge and resources to access new treatments more readily than those with limited education.

Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications
Jo C. Phelan, Bruce G. Link and Parisa Tehranifar, Journal of Health and Social Behavior (2010)
The authors explain the theory of fundamental causes, review the supporting evidence, consider limits to the theory, and discuss its implications for policy efforts to reduce health inequalities.

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