The Disparity in Health Among Americans

Some Americans are less likely than others to receive timely care for many illnesses. This includes diabetes, heart disease, stroke, and cancer. These health disparities have been documented for dozens of years, but we have seen them more clearly in the past few years with the uneven effects of the coronavirus pandemic. COVID-19 disproportionately affects low-income, elderly, disabled and immunocompromised people. But also, has hit American Indian/Alaska Native, Black and Latino or Hispanic communities much harder.

In fact, America has had structural and systemic bias almost from the beginning, which was borne of racism and discrimination.

This is a great opportunity for education and for change.

Kellie Woodson about health disparities

By Kellie Woodson

As an instructional designer, I use my expertise in teaching and learning to create learning experiences on a wide variety of health topics. Whether I’m developing a course on breast cancer genetics or oral health, a significant part of the process is partnering with experts in the field to develop courses that are informative, engaging and effective.  Many of these courses are written for frontline health workers. So they must also motivate participants to make positive changes in their communities.

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Overcoming Barriers to Healthy Choices

A typical course educates about health conditions and teaches strategies to effectively guide others in making healthier choices. To do this, we need to acknowledge the barriers to healthy living that many people face.

For example, we know that regular health checks and healthy eating are important to overall health. But visiting the doctor or grocery store can be challenging for individuals who are disabled, elderly, or living in rural areas.

The courses I write challenge participants to acknowledge and reflect on others’ realities that they might otherwise take for granted.

How does a person struggling with mobility travel to regular doctor’s visits?

How can someone make healthier food choices if they only have access to neighborhood convenience stores?

Does the disproportionate number of tobacco advertisements in low-income communities affect smoking rates in these areas?

How does one’s education level affect their ability to complete an application for financial healthcare assistance?

How does a person who struggles to get around their own home travel to regular doctor’s visits? [Tweet this]

Health Disparities Are Far More Complex Than Personal Choices

For many individuals, factors like age, disability, geographical location and education level pose significant barriers to staying healthy. These barriers, in turn, increase health disparities, or preventable differences in the rate of disease and access to health services among specific groups of people.  While health disparities affect all people, they’re more common among minorities and the socio-economically disadvantaged.

For example, some consider tobacco a personal choice. But the evidence shows it’s more complicated than that. You need to consider the structural powers pushing someone into using tobacco, becoming addicted to nicotine and not quitting.

When writing a tobacco cessation course for the state of Washington’s Community Health Worker Training program, I learned that African Americans, Asian Americans, members of the LGBT community and American Indians use tobacco products in disproportionate numbers compared to other groups in Washington.

Across the nation, individuals with lower income and education levels are also more likely to use tobacco.  These disparities increase tobacco-related illness and disease. And they don’t end there. A recent study shows:

  • Patients with the highest burden of disease and health disparities were least likely to be referred to smoking cessation services.
  • Older patients were more likely to be referred to cessation counseling within the health center instead of the quitline.
  • Engagement in smoking cessation services is lower in the low-income population compared to the general population.
  • Having insurance coverage was associated with greater engagement in smoking cessation services.

The lack of quality health care means that individuals living in rural areas, those who live at or below the poverty line and those with lower education levels are more likely to die because of tobacco-related disease.

Looking at tobacco use and dependence as a structural problem exposes how deeply disparities affect other people.

Health Disparities Reach Farther Than You Think

Health disparities aren’t simply the result of groups of people making bad choices. Disparities are systemic, complex and cyclical in nature. For example, immigrants have high rates of mental disorders and trauma due to the hardships they experienced during migration.  Racism and oppression often result in trauma-related mental illness. To make matters worse, marginalized groups of people often avoid diagnosis and treatment, which further perpetuates these disparities. Consider these statistics:

  • American Indians and Alaska Natives have infection rates over 3.5 times higher than non-Hispanic whites, are over four times more likely to be hospitalized as a result of COVID-19, and have higher rates of mortality at younger ages than non-Hispanic whites.
  • Asian-American women over age 65 have the highest suicide rate of all similarly-aged women in the United States.
  • LGBTQ youth are four times as likely to attempt suicide than their peers.
  • Only about 9% of physicians practice in rural America.
  • People who live and work in low socioeconomic circumstances have an increased risk for mortality, unhealthy behaviors, reduced access to health care and low quality of care.
  • Due to trauma experienced before and after immigration to the United States, Southeast Asian refugees have an increased risk for posttraumatic stress disorder.
  • Native Hawaiians and Pacific Islanders are 30 percent more likely to be diagnosed with cancer than whites.
  • Close to a third of Hispanics get regular health care, including those with chronic health conditions.
  • African-American adults with cancer are significantly less likely to survive prostate cancer, breast cancer and lung cancer than their white counterparts.

These alarming statistics only represent a small fraction of the disparities that exist in our country. Remember that health disparities are found in every group in the U.S. and in every part of the body.

Educated Workers and Communities

Being a frontline health worker is not just about giving guidance and advice. It’s a call to action and advocacy. These people and their employers know their community members better than anyone else. And they understand the communities’ challenges, weaknesses and strengths. As they educate and guide clients to achieving better health, they have the responsibility to acknowledge health disparities and why they exist. This understanding will help them to better anticipate their client’s needs and respond appropriately and effectively.

Health workers take different paths to solve problems. Many take it upon themselves to create much-needed resources and programs in their communities. Others see themselves as organizers who unite members of the community to create solutions where none exist. Whatever the response, you are in the position to make a tremendous impact.

The goal is to build communities where social determinants never affect one’s ability to be healthy.

Education Can Help Address Health Inequity

The future of health care is about education. Providing professional development training, including training about health disparities, can help all workers build rapport with their clients who come from all walks of life.

It should be our goal to require training for our staff members and to help them understand why it’s a necessity.

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Kellie Woodson is an expert in teaching, learning, and instructional design with content area specialization in health, science, and mathematics. She has extensive experience developing curriculum and learning programs for schools, organizations, and national and international publishers. 

Originally published August 16, 2016, updated September 12, 2022.