Health inequities are systematic variations in health between groups in society. They’re driven by differences in the social determinants of health, which are non-medical factors like income, education, healthcare access and economic stability. Understanding these determinants is essential to improving the health of individuals and population groups. What causes health inequity? Here are 15 root causes:
| # | Issue |
|---|---|
| 1 | Socioeconomic status |
| 2 | Employment status |
| 3 | Racial discrimination |
| 4 | Sex and gender discrimination |
| 5 | Exposure to violence |
| 6 | Food insecurity |
| 7 | Housing insecurity |
| 8 | Access to education |
| 9 | Exposure to pollution |
| 10 | Climate change |
| 11 | Transportation |
| 12 | Poor cultural communication |
| 13 | Costs of healthcare |
| 14 | Treatment by the healthcare system |
| 15 | Behavioral differences |
#1. Socioeconomic status
A person’s wealth and access to resources can significantly impact their health. Most obviously, a person needs enough money to afford basics such as food, safe housing and healthcare. The more money a person has, the more access they have. If a person has a lower socioeconomic status, they’re more likely to suffer from malnutrition, live in unhealthy environments and delay important medical care. According to one survey by the Health Foundation, 10% of surveyed adults with the lowest incomes reported having “bad” or “very bad health,” while just 1.5% of those on the highest incomes reported bad health. A high income doesn’t guarantee good health, but research supports wealth as a buffer against factors that negatively affect health.
#2. Employment status
Does having a job protect your health? It depends on the job. Most jobs provide some degree of protection because they’re usually a person’s main source of income. However, jobs can also create health problems if they expose a person to environmental risks, physical danger and high stress. Unemployment can also negatively impact health, especially if a person’s healthcare access is affected. According to a 2021 study from the National Institute for Occupational Safety and Health, people who were unemployed for a short time faced the most challenges getting healthcare. Around 1 in 3 survey respondents said they had needed to see a doctor in the past year, but couldn’t because of the high cost.
#3. Racial discrimination
Racial discrimination is a complex system of institutions, practices, policies and social norms. Research shows its negative impact on health. In places where racism has pervaded society for centuries, health inequities have been brewing just as long. According to the CDC, American racial and ethnic minority groups experience higher rates of death and illnesses like heart disease, diabetes, asthma and more. The reasons why are complex, but racial discrimination affects a person’s ability to get an education, healthcare, a good job, safe housing and other basics that support good health.
#4. Sex and gender discrimination
Sex and gender affect health outcomes to a certain degree, but discrimination complicates the connections. According to the World Health Organization, gender has “implications for health” regarding access to healthcare, clean water, hygiene and so on. Gender also influences how a person experiences emergencies and disease exposure. Because of gender inequality, women and girls are more likely to face barriers to healthcare, as well as exposure to violence, harmful health practices, malnutrition and more. Gender-diverse people are also at a higher risk for violence and discrimination, which affects health.
#5. Exposure to violence
Violence, public safety, and health are closely connected. Violence and physical health are most obviously linked as a variety of injuries can cause short and long-term problems. According to the study “The Effects of Violence on Health,” exposure to violence also increases the risk of heart disease, premature mortality, depression, anxiety and suicide. Those who are exposed as children face an increased risk of mental illness, substance use, risky sexual behavior, and certain chronic diseases like migraines and ulcers. Certain factors such as poverty also increase a person’s risk for exposure to violence, which creates health inequities.
#6. Food insecurity
Healthy food is essential to a healthy life. If people can’t access enough food (or food with enough nutrients), they’re at risk for a host of health issues such as heart disease, diabetes, mental illness, cancer, birth defects and other chronic conditions. According to the National Institute on Minority Health and Health Disparities, almost 15% of US households in 2020 were food insecure at some point. Children were especially affected, as were people from racial and ethnic minority groups. Globally, undernutrition is linked to around 45% of the deaths among kids under 5 years.
#7. Housing insecurity
According to a literature review on health and housing, research shows that being without stable housing can cause health issues. When people experience homelessness, they’re more likely to struggle with poor physical and mental health, as well as increased mortality. Some housing is better than none, but unhealthy home conditions, like crowding, water leaks, poor ventilation, and high and low temperatures can also lead to issues such as asthma, cardiovascular events, infectious disease and more. The cost of housing has serious consequences, as well, as those who struggle to afford rent or mortgages have to make hard decisions about food, healthcare, and other essentials.
#8. Access to education
A good education is linked to positive life impacts, such as the increased potential for higher income. When people don’t receive a good education, it affects their health as well as their wealth. According to a study on education’s influence on health, poor education is linked to poor health due to resources, behaviors, neighborhoods, and other socioeconomic factors. People not only expand their job opportunities with a good education, but they also develop skills and behaviors that provide buffers against bad health outcomes.
#9. Exposure to pollution and other hazards
Physical environments contribute to health inequities. People who live in safe environments with clean air and water aren’t guaranteed good health, but it’s an important health determinant. According to the World Health Organization, contaminated water and poor sanitation can cause diseases like cholera, dysentery, typhoid and polio. Around 1 million people die every year as a result of unclean drinking water, poor sanitation, or poor hygiene. Air pollution, which includes smog and smoke, drives an increased risk for strokes, lung cancer, respiratory diseases and heart disease. Around 2.4 billion people are exposed to dangerous levels of air pollution in their homes.
#10. Climate change
According to the Intergovernmental Panel on Climate Change, climate change is accelerating. Around 3.6 billion people live in areas already highly vulnerable to climate change, and between 2030 and 2050, there will be an increase in deaths related to undernutrition, malaria, heat stress, and other climate risks. Already marginalized groups like lower-income communities, ethnic minorities, migrants, the elderly, women, children and those with underlying health conditions will face the worst health outcomes.
#11. Transportation
Certain health inequities are fueled by peoples’ ability (or inability) to freely travel. According to a 2022 study, a lack of transportation affected 5.8 million Americans during the COVID-19 pandemic; they delayed medical care because of it. A lack of transportation also impacts groups already dealing with access barriers and health inequities, such as people with lower incomes, chronic health conditions, and no insurance. People also need reliable transportation to get to jobs, grocery stores, and other essential social services, which makes transportation a multifaceted health determinant.
#12. Poor cultural communication
Every group has different cultural health beliefs. According to the Culture and Society chapter of the book Health Literacy: A Prescription to End Confusion, cultural beliefs affect things such as how people think about their health issues, when and where they seek treatment, who they respond to, and what treatments they may accept. Culture also affects how people communicate and what communication they respond to, which makes health literacy and communication so important. If healthcare professionals fail to understand cultural beliefs, it creates health inequities based on ethnicity, culture, gender and so on.
#13. Costs of healthcare
Healthcare is expensive, and even in places where there’s universal healthcare, funding distributions can create health inequities. The biggest issues involve countries without universal healthcare. In the United States, a 2020 survey found that 22% of Americans did not seek healthcare because of the cost. Those without insurance face serious medical bills, while those with insurance still have to consider costs such as co-payments, coinsurance costs, and how much they have to pay out-of-pocket because insurance kicks in. On average, an individual pays about $111 a month for employee-sponsored coverage while those with plans from the insurance market pay $456 a month. When access to healthcare is determined by wealth, health inequities are inevitable.
#14. Treatment by the healthcare system
The healthcare system itself is a root cause of health inequity. According to research, healthcare professionals are not immune from implicit bias, which has led to discriminatory treatment against racial and ethnic minorities. In a 2016 study, white medical students would offer Black patients less pain medication, believing the myth that Black people feel less pain. Other studies show this bias is common. Health inequities are also driven by how the American healthcare system works. Workers from low-income racial and ethnic minorities are more likely to be covered by employee-sponsored plans with poor coverage, and while they often end up with higher out-of-pocket costs than those on the insurance marketplace, they’re not eligible for Medicaid or federal subsidies. This creates an unequal, unjust system.
#15. Behavioral differences
While the most serious health inequities are structural, individual behavioral differences do make some impact. Whether a person eats well, exercises, avoids risky behavior, goes to the doctor and so on will affect their risk for serious diseases and health conditions. However, what influences a person’s behavior is complex and connected to things like their level of education, the availability of healthy food, their access to healthcare, whether or not they have stable housing and more.
