How do we reduce health disparities? Typically, American politicians have identified the healthcare system as the primary determinant of the public’s overall health. Today, this fixation on the healthcare system can be observed in debates between Democrats and Republicans, each of whom have different ideas on how to make healthcare more accessible. Though we can agree improving access to healthcare is important, debates over the health of the American public should take into account the social conditions associated with unfavorable health outcomes. If we are to improve the health of the American public, then it is imperative to reduce inequalities related to socioeconomic status.
Medical sociologists Jo Phelan and Bruce Link argue in their theory of fundamental causes that if we are to resolve health inequalities, then it is necessary to understand why they persist. Phelan and Link explain how varying levels of socioeconomic status prevents or enables people from utilizing resources (e.g., income, knowledge, etc.) that protect them from unfavorable health outcomes. For example, if two people suffer from a respiratory disease, a person with a greater socioeconomic status will be more likely to have access to medical treatment and be able to maintain a lifestyle conducive to respiratory health than a person with a lower socioeconomic status.
Death rates, for example, are strongly related to socioeconomic position. In fact, the risk of death for those categorized as being in the lowest socioeconomic level has been shown to be two to three times as high as that of people occupying the highest socioeconomic level. Similarly, another study revealed homicide was strongly related to educational attainment. According to this study, homicide rates for black and white Americans were markedly lower for Americans who had some college education or more than those who did not graduate from high school. In essence, the research shows that improving the overall socioeconomic status of Americans will result in greater life expectancy.
Issues of health inequality are further complicated when you account for racial and ethnic backgrounds. Experiences of racial discrimination have been shown to harmfully impact the health of black Americans. You may be wondering how discrimination is capable of harming health outcomes, but the research suggests that experiences of interpersonal discrimination affect levels of stress, which has been shown to alter a person's physiological functioning.
Residential segregation is also a huge impediment to the health of black and white Americans. By virtue of residential segregation, poor whites live in markedly better communities than their black counterparts. The same relationship can be found between middle-class whites and middle-class blacks. Residential segregation is an important factor in health outcomes because of its negative impact on socioeconomic status, limiting educational and employment prospects. As a result, residential segregation fosters high concentrations of poverty and low wage rates. All of these factors — educational level, employment status, neighborhood quality and income — are associated with disparities in health.
While some of these associations are correlations (and not direct causations), it is important to account for the social conditions that foster unfavorable health. By understanding the social conditions that are often associated with bringing about noxious illnesses, policymakers can work to prevent those conditions from coming about. In turn, preventing these conditions will likely reduce the prevalence of numerous illnesses, improving the overall health of the American public.
Though improving access to health coverage is important, Republicans and Democrats miss the point by focusing most of their health policy debates on this alone. It it would be more effective to prevent issues from coming up in the first place than it would be to simply increase medical coverage once health issues have arisen. While I support the Republicans and Democrats' shared goal of making healthcare more accessible, they must expand the scope of health policies by introducing comprehensive pieces legislation that aim to effectively produce a more educated public, diminishes poverty and its impact and reduces America's de facto segregation.
Alexander Adames is an Opinion columnist for The Cavalier Daily. He can be reached at a.adames@cavalierdaily.com.
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