The great Dr. Martin Luther King Jr. in his Letter from Birmingham Jail said “Injustice anywhere is a threat to justice everywhere…whatever affects all directly affects all indirectly.” Though Dr. King was referring to the injustices of the 1960s Civil Rights Era, those same injustices are alive and present today. Police brutality and the unjust treatment of black and brown women and men in our court and prison industrial complex systems still run rampant. Yet we’ve come a long way and have even further (much further) to go in our quest for equality.
Though strides have been made since the Civil Rights Era, injustice, inequity and inequality are still very well embedded in America’s institutional and social fabric. These injustices have directly led to and continue to lead to poor health outcomes of some of our most vulnerable populations. As the current administration seeks to make “America Great Again” (insert side-eye) and prohibit the CDC from using the following words: “vulnerable,” “entitlement”, “diversity”, “transgender,” ”fetus”, “evidenced-based” and “science-based” in the 2018 budget; I cannot help but pause to ask myself, “What’s really good?”
In my moment of pause, I found it important to write about (possibly a series of blog posts) on the topic of health disparities and inequities, specifically focused on the eight principles of health disparities and health inequity as described by Braveman et al. (2011). But before moving into these eight principles lets go into a brief overview of health disparity, health inequities and distributive justice.
Health Disparity, Health Inequality, and Distributive Justice
The definition of health disparity according to Braveman et. al (2011) is as follows:
“…health differences that adversely affect socially disadvantaged groups. [They] are systematic, plausibly avoidable health differences according to race/ethnicity, skin color, religion, or nationality; socioeconomic resources or positions (i.e. income, wealth, education, or occupation); gender, sexual orientation, gender identity; age, geography, disability, illness, political or other affiliation; or other characteristics associated with discrimination or marginalization.”
So, think about how black adults are 80 percent more likely than white adults to be diagnosed with diabetes; how black babies are more than 3 times as likely to die from low-birth weight complications compared to white babies; how Hispanic mothers are 70 percent more likely to receive later or no prenatal care compared to white mothers; or how suicide was the second leading cause of death among American Indian/Alaskan Natives between the ages of 10 and 34 in 2014.
Although health disparities are not only specific to race and ethnicity, because I am a black woman most of my examples do focus on race and ethnicity. However, health disparities are more than just racial and ethnic as the provided definition states.
So then, what exactly are health inequities in relation to health disparities?
The short definition is that health inequities are differences in health that are unnecessary, avoidable, unfair and unjust, according to Whitehead’s (1992) The Concepts of and Principles of Equity in Health. Somewhat synonymous to social injustices; health inequities are due to systematic differences in health influenced by distributive injustice (Braveman & Gruskin, 2003).
The concept of distributive justice concerns the equal distribution of resources in society to ensure the well-being of all people, regardless of race, ethnicity, educational status, income, and/or other factors (Braveman, 2006). Consider institutional racism; distributive justice is absent from institutional racism if we consider Jones’ definition of institutional racism. According to Jones (2000) institutional racism is defined as
“differential access to goods, services and opportunities of society by race…[it] manifests itself both in material conditions and in access to power…examples include differential access to quality education, sound housing, gainful employment, appropriate medical facilities, and a clean environment.”
Taking these previously mentioned factors into consideration, addressing health disparities and health equity is clearly a social justice issue within public health. In fact, it is a human rights issue as stated in Article 25 of the United Nations Declaration of Human Rights.
Eight Principles of Health Disparities and Health Equity
Acknowledging the Declaration of Human Rights, Braveman et al. (2011) provides us with their proposed underlying values and principles of health disparities and health equity:
- All people should be valued;
- Health has a particular value for individuals because it is essential to an individual’s well-being and ability to fully participate in the workforce and democratic society;
- Nondiscrimination and equality; every person should be able to achieve his/her optimal health status, without distinction…;
- Health is also of importance for society because a nation’s prosperity depends on the entire population’s health;
- Rights to health and to a standard of living adequate for health;
- Health differences adversely affecting socially disadvantaged groups are particularly unacceptable because ill health can become an obstacle to overcoming social disadvantage;
- Resources needed to be healthy should be distributed fairly; and
- Health equity is the value underlying a commitment to reduce and ultimately eliminate health disparities.
Given the number of published papers addressing health disparities and health inequity since the 1985 Secretary’s Task Force Report on Black and Minority Health, health disparities and health equity is a big deal within public health, that extends beyond just race and ethnicity. Health disparities and health equity is such as focal point of public health efforts that reducing and eliminating health disparities toward achieving health equity has been an overarching goal of Healthy People since 2000, yet we’re still crawling toward achieving these goals 2 decades later. Health inequality essentially infringes on the rights of communities of color.
So, what exactly is taking so long to correct current societal ills that prohibit all people from complete and total well-being?
What are your thoughts?
Braveman, P. A., Kumanyika, S., Fielding, J., LaVeist, T., Borrell, L. N., Manderscheid, R., & Troutman, A. (2011). Health Disparities and Health Equity: The Issue Is Justice. American Journal of Public Health, 101(Suppl 1), S149–S155. http://doi.org/10.2105/AJPH.2010.300062
Braveman, P. (2006). Health disparities and health equity: concepts and measurement. Annual Review of Public Health. 2006; 27:167-94. http://doi.org/10.1146/annurev.publhealth.27.021405.102103