Public health expert discusses the drivers of health inequality

June 7, 2017 by Peter Dizikes, Massachusetts Institute of Technology
“Investing in clean energy, for instance, can create jobs, help the environment, and reduce health costs for a broader range of the population,” says MIT professor Mariana Arcaya. Credit: Mariana Arcaya

As economic inequality has risen in the U.S. over the last few decades, so has health inequality. What's driving the growth of these disparities in public health, now documented in numerous studies? In a new article, published this week in the journal Health Affairs, MIT Assistant Professor Mariana Arcaya, along with her co-author, Jose F. Figueroa of Harvard Medical School and Brigham and Women's Hospital, takes a big-picture look at the global trends exacerbating uneven health outcomes—and urges public-health advocates to do the same. MIT News talked to Arcaya, the Charles H. and Ann E. Spaulding Career Development Assistant Professor in MIT's Department of Urban Studies and Planning, about the need to think on large scales in public health.

Q: Your new article advocates viewing health-inequality problems through virtually the broadest lens possible. Why is that?

A: One of the main points of the article is that in the community we often track specific health disparities. If we see a disparity in breast cancer screening among ethnic groups, for instance, we try to target a group and increase screening rates. When we notice disparities in smoking rates according to income or education, we try to come up with an intervention to address that problem.

Targeted approaches are effective in many cases. You can create interventions that reduce specific inequalities in specific health outcomes between specific groups. That's great, and we should keep making progress that way, but we also need to be aware of what is happening more broadly, because we also face hazards that are disproportionately harming vulnerable groups or unevenly benefitting privileged groups. And those secular trends may be so powerful that the ability of targeted interventions to eliminate health inequities could be overwhelmed.

Q: In that case, what are these big trends driving health inequality?

A: The first involves in health care—anything from advances in diagnostic technologies, to new drugs, precision medicine, or wearable technologies—all of which represent positive trends but have problematic distributional effects. If clinical advances disproportionately benefit well-off groups more than the socially vulnerable, even advances in care can exacerbate health inequalities.

The second is about , such as the consequences of removing provisions from national that protect people with pre-existing conditions. About 27 percent of nonelderly adults have pre-existing conditions, and racial and ethnic minorities are disproportionately represented in that group. Weakening protections for patients with pre-existing conditions will therefore have uneven impacts by race and ethnicity.

A third is about how wealth is generated in the country … from the financialization of the economy to technological progress that puts many low-skill jobs at risk. The same trends that put people of low socioeconomic status in precarious financial positions appear to benefit those who are already well-off.

The fourth is focused on environmental hazards. We're seeing an exponential increase in the number of chemicals that industries synthesize, and for a lot of them, we really don't understand their health impacts, for example in our endocrine systems. Our public dialogue is often about what we can do as consumers to avoid chemical risks rather than regulation as a mechanism to keep us safe, but counting on consumers to know about, and to be able to afford, safer products will only increase disparities in chemical exposures. Additionally, climate change brings drought, flooding, heat waves, food insecurity, and new infectious disease risks, among other issues. The poorest and most vulnerable in society contribute least to the problem but are bearing the brunt of the impacts.

Q: Okay, there's a lot to worry about, and these are massive trends. But what can people do on a practical level to create solutions, especially as some of these trends go well beyond the traditional boundaries of public health advocacy?

A: We recommend solutions where you can imagine a fix that works across multiple trends. We can ask: To whom do the benefits of technological progress accrue? Can health care information technology allow us to identify vulnerable patients during a heat wave? Can technology help us understand the health effects of new chemicals being synthesized? Investing in clean energy, for instance, can create jobs, help the environment, and reduce health costs for a broader range of the population.

The and medical communities need to join with other sectors and form policy advocacy coalitions around factors that promote social mobility: basic environmental protections, transit, , and education, to lower overall levels of socioeconomic inequality. What's really driving population-level differences in health are these broad social factors. So let's keep our eyes on that. Nobody's solely responsible for them, and the solutions are hard, but we have to face them and think about them as health problems.

Explore further: Amenable death in Europe: Health care expenditure decreases mortality rates

More information: Mariana C. Arcaya et al. Emerging Trends Could Exacerbate Health Inequities In The United States, Health Affairs (2017). DOI: 10.1377/hlthaff.2017.0011

Related Stories

Amenable death in Europe: Health care expenditure decreases mortality rates

June 5, 2017
The June issue of Health Affairs includes an analysis of amenable mortality rates—rates of deaths that are potentially preventable with available health care treatment options—in seventeen European countries, which found ...

Socioeconomic differences in adolescent health getting wider

February 3, 2015
Health inequalities in young people have grown alongside socioeconomic disparities between the rich and poor.

Study clusters health behavior groups to broaden public health interventions

March 15, 2017
For the most part, public health initiatives focus on stemming one type of unhealthy behavior: Anti-smoking campaigns, curbing alcohol abuse, or ramping up exercise, for example.

CDC report says health disparities persist in America

November 22, 2013
(HealthDay)—Despite progress in some areas, health disparities remain for many Americans, health officials reported Thursday. These inequalities are related to income, education, sex, race, ethnicity, employment and sexual ...

Life expectancy not declining as rapidly as believed, but health inequality has worsened

December 8, 2015
While previous findings of dramatic decreases in life expectancy for some socioeconomically disadvantaged groups in the United States have been overstated, health inequalities persist and, in fact, have worsened, according ...

ATS and ERS publish policy statement on disparities in respiratory health

October 1, 2013
To address the global phenomenon of disparities in respiratory health, the American Thoracic Society and the European Respiratory Society have released an official policy statement in which each pledges its commitment to ...

Recommended for you

First ever meta-analysis on Indian lead exposure reveals link to devastating intellectual disability in children

October 12, 2018
New Macquarie University research has revealed the devastating disease burden associated with elevated blood lead levels in India. The results of the first ever meta-analysis of Indian blood lead levels found the burden of ...

The long-term effects of maternal high-fat diets

October 12, 2018
If a mother eats a high-fat diet, this can have a negative effect on the health of her offspring—right down to her great-grandchildren. This is the conclusion drawn by researchers at ETH Zurich from a study with mice.

Sit-stand office desks cut daily sitting time and appear to boost job performance

October 11, 2018
Sit-stand workstations that allow employees to stand, as well as sit, while working on a computer reduce daily sitting time and appear to have a positive impact on job performance and psychological health, finds a trial published ...

Molecular link between body weight, early puberty identified

October 11, 2018
Becoming overweight at a young age can trigger a molecular chain reaction that leads some girls to experience puberty early, according to new research published in Nature Communications.

Hearing and visual aids linked to slower age-related memory loss

October 11, 2018
Hearing aids and cataract surgery are strongly linked to a slower rate of age-related cognitive decline, according to new research by University of Manchester academics.

Hundreds of patients with undiagnosed diseases find answers, study reports

October 10, 2018
More than 100 patients afflicted by mysterious illnesses have been diagnosed through a network of detective-doctors who investigate unidentified diseases, reports a study conducted by scientists at the Stanford University ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.