8.5 The Cumulative Effect of Inequalities on Health

Learning Outcomes

By the end of this section, you should be able to:

• 8.5.1 Define health equity and health inequity.
• 8.5.2 Describe health disparities in the context of SDOH.
• 8.5.3 Describe the cumulative impact of inequalities on individual and population health.

Social determinants of health contribute to preventable health disparities, and these disparities may result in health inequities, “differences in health status or health resources between different population groups, arising from the social conditions” (WHO, 2018, para. 2). Health inequities are more than just a lack of equal access to necessary resources; they are a result of an unjust system.

Equality refers to situations where each individual is given the same resources or opportunities. Equity recognizes that everyone is not the same and distributes the exact resources or opportunities needed by each individual to reach an equal outcome among individuals (Milken Institute School of Public Health [MISPH], 2020). The World Health Organization defines equity as the “absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, geographically or by sex, gender, ethnicity, disability, or sexual orientation” (WHO, 2021, p. 2). Equity is needed to address the historical injustices that have perpetuated structural racism and discrimination. It is a means to address the imbalance and injustice in our social systems. Social justice refers to overhauling social systems with the goal of sustainable, equitable access into the future (MISPH, 2020).

To achieve health equity, rather than treating everyone in the same way, individuals and communities need to be given resources and opportunities that align with their circumstances (MISPH, 2020). According to the CDC, achieving health equity requires an enduring effort to address historical and contemporary injustices to surmount obstacles to health care and eliminate health disparities (CDC, 2022g). To reduce health disparities, individual needs should be addressed holistically.

The SDOH have a greater influence on health outcomes than clinical care. Clinical care impacts only 20 percent of health outcomes, whereas socioeconomic factors account for 47 percent of health outcomes, and health behaviors account for 34 percent of overall health outcomes (Whitman et al., 2022). Social determinants have a much greater impact than biology or medicine. Within these social factors, there are many inequities. Addressing these differences in SDOH is a step toward health equity (CDC, 2022a). Racism and other SDOH are central drivers of health disparities and inequities within BIPOC communities, creating inequities in access to housing, education, wealth, and employment, thereby placing these individuals at higher risk for poor health (CDC, 2022a). The SDOH are at the root of many health inequities resulting from the unequal conditions in the social and physical environment. It is widely accepted that to influence the health of a population, there needs to be a focus on improving social conditions and addressing those SDOH (CDC, 2022a). Just as nurses assess for medication allergies and medical history, the SDOH need to become a part of every conversation as a foundation to holistically provide appropriate care and services to individuals and families in need.