Closing the Gap on Health Disparities
This post is shared with permission from the Association of State and Territorial Health Officials. It was originally posted on StatePublicHealth.org. Stylistic edits have been made.
What do health disparities, interest on the national debt, and gun violence have in common? Would you believe it’s economic impact, to the tune of $229 billion dollars? That is not small change. This figure demonstrates the magnitude of an issue that continues to burden our society.
The number comes from the Joint Center for Political and Economic Studies, which calculated that during 2003-2006, we would have saved $229 billion in direct healthcare expenditures if we had eliminated health disparities (MMWR). Surprisingly, it also happens to be the total annual cost of gun violence each year, ($8.6 billion in direct costs and $221 billion in indirect costs; Mother Jones). It also happens to be what our country spent as interest on the national debt in 2015 (National Priorities Project).
In its second Health Disparities and Inequities Report of the United States, published in 2013, CDC cited this cost and noted that “During the past decade, documented disparities have persisted for 80 percent of the Healthy People 2010 objectives and have increased for an additional 13 percent of the objectives” (MMWR).
The World Health Organization (WHO) defines social determinants of health as the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” WHO also states “social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.”
How can we reduce disparities? A recent study related to the progression of atherosclerosis has important implications. While there is some evidence that suggests that that neighborhood deprivation affects health outcomes related to atherosclerosis, earlier studies have not been able to pinpoint what specific characteristics of neighborhoods were driving the association.
A number of neighborhood factors could play a role in the hardening of arteries and the likelihood of a heart attack. A recent prospective study in six large US cities examined six neighborhood characteristics including neighborhood walkability and access to healthy food stores within a one-mile radius of the study participants. The researchers examined the presence of calcium in the arteries of study participants through a heart scan, calculating a coronary artery calcium (CAC) score. A score of zero means there is no level of calcium detected in the arteries and that a person is unlikely to develop a heart attack. The higher the score, the higher the likelihood of suffering heart attacks. Research participants were tested again for the presence of arthrosclerosis 12 years later were tested again for their (CAC) score.
The lead author Jeffrey Wing and his colleagues published “Change in neighborhood characteristics and change in coronary artery calcium: a longitudinal investigation in the MESA (Multi-Ethnic Study of Arteriosclerosis) cohort” in Circulation. They found that increases in the density of healthy food stores were associated with decreases in CAC scores, after adjusting for time-varying demographic and other confounders and scanner types. Moreover, the magnitude of the association was as strong after taking into consideration other confounders such as behavior risk factors and depression. The investigators concluded that in middle-aged and older adults, greater density of healthy food resources could slow development of coronary atherosclerosis.
Another study in the Journal of Urban Health was one of the first to focus on health disparities over time in a community affected by an environmental shock. Researchers from Tulane University examined citywide supermarket access in New Orleans prior to and after Hurricane Katrina. They found that racial-ethnic disparities existed before the storm and worsened after the storm. Moreover, it took four years to return to the pre-Katrina disparity levels. On a happier note, New Orleans’ “Fresh Food Retailer Initiative consciously sought to foster neighborhood development through investments that would make food access more equitable, and two supermarkets funded through this program opened in 2014.”
The slow recovery of the city’s retail food infrastructure after Hurricane Katrina illustrates the need for an increased focus on long-term planning to address disparities and to be ready for the environmental impacts of climate change.
While the term “health disparities” was not around decades ago, the vision was. First Lady, diplomat, and visionary Eleanor Roosevelt led the drafting of the Universal Declaration of Human Rights. The 30 articles were unanimously adopted by 48 nations on December 10, 1948. Article 25 declared “that everyone has the right to health and well-being including food, clothing, shelter, medical care and social services and the right to security in the event of unemployment, sickness, disability, widowhood or old age…”
While there are a number of “rights” that get a lot of attention today, sadly it is not the right to health and well-being. Eliminating health disparities and ensuring that everyone has a right to health and well-being would not only translate into enormous economic savings for the nation, it is also the moral right thing to do. Let us work together to close the gap on health disparities once and for all.