IB 110 Chap.7 Social Determinants of Health and Access
Social Determinants of Health and Access
The unit's opening question
The first unit, titled air pollution and health access, sets three learning objectives: to see how a person's identity can shape their health and their access to care, to analyse how identity builds the environments that do this, and to judge whether today's policies and procedures feed social inequity in health.
The third lecture introduces it with US life expectancy by race and ethnicity from 2000 to 2019 and asks why, if race is not genetic, the lines differ.
Defining health and inequity
Health is presented as both an outcome and a resource for living that allows people to take part in society, with mental, physical and social dimensions.
Social determinants of health are the conditions that leave people without the opportunities and resources to stay healthy. When they produce disparities that come from unfair systems, policies and practices, the result is a health inequity.
The lecture follows three kinds: access to healthcare, rates of disease and health outcomes.
Poverty, race and root causes
A lecture question asks why poverty and race are not themselves counted as social determinants.
The fourth lecture clarifies that relative and absolute poverty both contribute to health inequity, and names two clusters of root causes: the personal, interpersonal, institutional and systemic mechanisms that distribute power and resources, and the unequal allocation of power and resources itself.
The lecture also separates race from racism and class from classism, asking whether a difference is caused directly by race or ethnicity or by social factors in between.
The national access data
The main data set is a 2021 JAMA study of 596,355 adults in the National Health Interview Survey from 1999 to 2018. It found marked racial and ethnic differences in health status, access and affordability, with some subgroups improving while the overall gaps persisted.
In 2018, low-income Black adults had the highest estimated share reporting poor or fair health, 24.9%, and middle or high-income White adults the lowest, 6.3%.
Lack of insurance fell for every low-income group over the period, including a fall of about 13 percentage points for low-income Hispanic adults, but gaps compared with White adults remained.
Why two tables
The lecture shows one table of change within each group over time and another of differences from White adults in 1999 and 2018. The first shows whether a group is better off; the second shows whether inequity is closing.
A lecture question asks why both are needed, and the answer is that either one alone can make persisting inequity look solved.
What this chapter covers
- 01
Unit 1 learning objectives
- 02
Health as a resource for living
- 03
Social determinants and health inequity
- 04
Relative and absolute poverty
- 05
Race versus racism
- 06
The 2021 national access study
- 07
Reading changes in percentage points
- 08
Within-group and between-group tables
Worked example · free
Judge whether an inequity is closing
- 2Compute each group's change.
- 2Compute the gap in each year.
- 2Interpret both together.
Key terms
- Health Disparity
- A difference in health between groups; it becomes an inequity when it stems from unfair systems.
- Relative Poverty
- Having much less than others in the same society, as opposed to lacking basic needs outright.
- Percentage Point
- The unit for the arithmetic difference between two percentages, such as 30% to 17% being 13 points.
- Structural Racism
- Racism built into economic, legal and social structures, shown in the lecture as a root of poor health.
Social Determinants of Health and Access FAQ
What is the difference between a health disparity and a health inequity?
A disparity is any difference in health between groups. The course, following the CDC, calls it an inequity when it stems from systems, policies and practices that are unjust and that limit access to what people need to be healthy.
Why are poverty and race not listed as social determinants of health?
The lecture treats them as markers of who is exposed. The determinants are the conditions and systems behind them, and the root causes are how power and resources are distributed and the unequal allocation itself.
What did the national access study find?
Across 596,355 adults from 1999 to 2018, racial and ethnic differences in health status, access and affordability persisted overall. Some groups improved, such as low-income Hispanic adults on insurance, but gaps with White adults remained.
Exam move
For each statistic you quote from this unit, write its unit, its direction and its comparison group. Then ask the lecture's question: is this a direct effect of race or are social factors in between?
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