Key points
Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.
CDC's CORE Health Equity Strategy
CDC is transforming its research, surveillance, and implementation science efforts to identify and address the drivers of health disparities. CDC's CORE strategy integrates health equity as a foundational element in science and research, programs, partnerships, and workforce.
Preventable Health Disparities
Health disparities are preventable differences that populations experience in the burden of disease, injury, violence, or opportunities. When people have limited access to resources they need to be healthy, they are more likely to struggle with health issues.
Factors Affecting Health Equity
Social Determinants of Health
Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age. Long-standing inequities in the five areas below influence health outcomes and quality of life. Understanding these inequities can help us improve health outcomes and promote health equity.
Social and Community Context
Social context includes the human interactions where one lives, works, learns, plays, and worships.3 Special programs help protect the health and well-being of people who experience disadvantage. Social and community context also includes discrimination (the unfair treatment of people or groups based on their race, gender, age, or sexual orientation). Discrimination—including racism—can be found in many societal systems, including housing, education, criminal justice, and finance.4
Healthcare Access and Use
Some groups that have been marginalized face multiple barriers to accessing health care. Structural barriers include socioeconomic status, lack of insurance,5 transportation, childcare, or ability to take time off work to visit a doctor. Barriers to patient-provider interactions and health care quality also include cultural differences and language barriers.6 Historical events, like the Tuskegee Study of Untreated Syphilis and sterilization of American Indian women without permission, might explain lack of trust in healthcare systems.7,8,9,10
Neighborhood and Physical Environment
Access to public transportation, supermarkets, and health care contribute to segregation of American cities. Discriminatory practices limit housing options to neighborhoods with inadequate funding for school districts, higher crime rates, poorly resourced infrastructure, and limited access to nutritious, affordable foods.11,12 These conditions can make illnesses, diseases, and injuries more common and severe among discriminated groups.13
Workplace Conditions
Occupational health inequities are avoidable differences in work settings. Physical and mental health outcomes are linked to social, economic, and environmental disadvantages. Other workforce factors include temporary work arrangements, socio-demographic characteristics (e.g., age, sex, gender identity, race), and organizational factors (e.g., lack of safety measures, limited or no health insurance).
Education
Inequities in access to high-quality education commonly affect people who have been historically marginalized.13,14 Lower-quality education leads to lower literacy and numeracy levels, lower high school completion rates, and barriers to college entrance. Educational barriers limit future job options and lead to lower paying or less stable jobs.
Income and Wealth Gaps
In addition to lower-quality education,15 other barriers to good jobs include geographic location, language differences, discrimination, and access to transportation. Redlining (denying mortgages to people of color) also limits home ownership opportunity and ability to build wealth. Financial challenges make it difficult to manage expenses and access affordable quality housing, education, nutritious food, and reliable childcare.
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- 2. Braveman P, Arkin E, Orleans T, Proctor D, & Plough A. (2017, May 17). What is health equity? And what difference does a definition make? Robert Wood Johnson Foundation. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html.
- 3. DHHS Office of Disease Prevention and Health Promotion. Healthy People 2030: Social and Community Context. Retrieved April 21, 2022 from https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context.
- 4. American Psychological Association (2019, October 31). Discrimination: What it is, and how to cope. Retrieved March 21, 2022 from https://www.apa.org/topics/racism-bias-discrimination/types-stress.
- 5. Berchick ER, Barnett JC, and Upton RD. Current Population Reports, P60-267(RV), Health Insurance Coverage in the United States: 2018, U.S. Government Printing Office, Washington, DC, 2019.
- 6. Institute of Medicine (US) Committee on the Consequences of Uninsurance. Care Without Coverage: Too Little, Too Late. Washington (DC): National Academies Press (US); 2002. DOI: https://doi.org/10.17226/10367.
- 7. U.S. National Library of Medicine. Native Voices: Timeline: Government admits forced sterilization of Indian Women [online]. 2011 [cited 2020 Jun 24]. Available from: https://www.nlm.nih.gov/nativevoices/timeline/543.html.
- 8. Novak NL, Lira N, O'Connor KE, Harlow SD, Kardia SLR, Stern AM. Disproportionate Sterilization of Latinos Under California's Eugenic Sterilization Program, 1920-1945. Am J Public Health. 2018;108(5):611-613. DOI: https://dx.doi.org/10.2105%2FAJPH.2018.304369.
- 9. Stern AM. Sterilized in the name of public health: race, immigration, and reproductive control in modern California. Am J Public Health. 2005 Jul;95(7):1128-38. DOI: https://dx.doi.org/10.2105%2FAJPH.2004.041608.
- 10. Prather C, Fuller TR, Jeffries WL 4th, et al. Racism, African American Women, and Their Sexual and Reproductive Health: A Review of Historical and Contemporary Evidence and Implications for Health Equity. Health Equity. 2018;2(1):249-259. DOI: https://dx.doi.org/10.1089%2Fheq.2017.0045.
- 11. Krieger, J., & Higgins, D. L. (2002). Housing and health: time again for public health action. American journal of public health, 92(5), 758–768. DOI: https://doi.org/10.2105/ajph.92.5.758.
- 12. Swope, C. B., & Hernández, D. (2019). Housing as a determinant of health equity: A conceptual model. Social science & medicine (1982), 243, 112571. DOI: https://doi.org/10.1016/j.socscimed.2019.112571.
- 13. Baah FO, Teitelman AM, Riegel B. Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health-An integrative review. Nurs Inq. 2019;26(1):e12268. doi:10.1111/nin.12268
- 14. Krahn GL, Walker DK, Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. Am J Public Health. 2015;105 Suppl 2(Suppl 2):S198-S206. doi:10.2105/AJPH.2014.302182
- 15. Berchick ER, Barnett JC, and Upton RD. Current Population Reports, P60-267(RV), Health Insurance Coverage in the United States: 2018, U.S. Government Printing Office, Washington, DC, 2019.
- 16. The Annie E. Casey Foundation. Unequal Opportunities in Education [online]. 2006 [cited 2020 Jun 24]. Available from: https://www.aecf.org/m/resourcedoc/aecf-racemattersEDUCATION-2006.pdf.