Understanding where health disparities begin

The paper appeared in the October issue of the journal Health Affairs, authored by Steven Woolf, M.D., M.P.H., professor in the Virginia Commonwealth University Department of Family Medicine, and director of the VCU Center on Human Needs, and Paula Braveman, M.D., M.P.H., professor in the Department of Family and Community Medicine at the University of California, San Francisco, and the Center on Social Disparities in Health. The article reviewed the challenges of overcoming health disparities in this country and the need to connect with policy makers and turn their attention to the “non-health” issues outside the clinic that contribute to the problem.

In the article, Woolf and Braveman suggest that ensuring that all Americans get a solid education, a good job and healthy living conditions are important not only for quality of life and economic growth, but also because they save lives, improve health and thereby curb the costs of medical care.

Woolf, Braveman and colleagues from the VCU Center on Human Needs reviewed an extensive literature on the social determinants of health, including data analyzed by the Project on Societal Distress at VCU and the Robert Wood Johnson Commission to Build a Healthier America.

According to Woolf, health care exerts a gravitational pull on health policy: people instinctively assume that health problems have their answer in the actions of doctors, hospitals, and health insurance companies. 

“Health is about more than health care, and the same is true for health disparities,” Woolf said. “The poorer health that exists on average for minorities and disadvantaged groups has less to do with the health care they receive than with the unhealthy conditions in which they live.

“The solution to health disparities, and frankly to getting a handle on health and medical costs in this country, is to get outside the walls of the clinic and help Americans secure a solid education, a good job, stable income and a decent place to live. It’s a mistake to think these conditions are unrelated to health care. States that cut spending on education to pay for Medicaid are missing the point.”

Further, Woolf said that health is affected by our surroundings, as when our neighborhoods offer limited access to healthy foods, few opportunities for exercise or intense exposure to tobacco and alcohol advertising, unhealthy housing, pollution and violent crime. Major factors that determine whether families find themselves in these circumstances are income, education and other social determinants of health — which disproportionately affect minorities and disadvantaged groups.

“The change agents who are best positioned to resolve health disparities are not doctors or hospitals but the policymakers who are responsible for addressing unemployment, educational achievement and economic growth,” said Woolf.

“Improving education, income and living conditions can improve health and prevent the development of diseases — thus keeping people from becoming ‘patients’— and also enable patients with chronic conditions to achieve better health outcomes and avert complications,” he said.

The VCU Center on Human Needs has an active research portfolio for the study of social determinants of health, in which researchers track the prevalence of food insecurity, poor housing, disease, inadequate education and low income /poverty in the United States and in specific states. Researchers at the VCU Center on Human Needs study the relationship of education and income on avertable deaths, diabetes and health care costs. Further, they study how health disparities by census tract or neighborhood relate to local behavioral, socioeconomic or environmental conditions in cities and rural areas across the country.

Woolf will speak at a forum hosted by the Health Affairs entitled “Disparities in Health and Health Care,” on Oct. 6 in Washington, D.C., where he will be among a panel of experts whose findings appear in the October theme issue.

Provided by Virginia Commonwealth University