Understanding health disparities

Abstract

Health inequities have been increasing in the United States and creating unacceptable gaps in the distribution of illness, healthcare, and longevity. Disparities are embedded in the history and culture of societies. They are matrixed in the structure of social, economic, and political institutions, and are expressed in various forms of disenfranchisement. Changes in health policy alone will not reduce or eliminate disparities. The life-course perspective is a tool for understanding health disparities across income, racial, and ethnic groups, particularly disparities that originate in childhood. The life-course model proposes that health disparities exist across the life span but childhood is a critical period in their development. Unique interactions occur at each life stage which can create risks for subsequent layers of disparities. Obesity in early childhood is an example of how being overweight increases the risk in adulthood of mortality and morbidity from coronary heart disease, colorectal cancer and arthritis. The single most substantial source of health disparities in the U. S. is poverty. The colonias are one of the U.S.-Mexico border regions’ largest pockets of poverty. Our knowledge of the mechanisms and pathways of disparities has been limited because we have focused on static rather than on process variables. Longitudinal data confirm that health disparities change as individuals move through the life course. A broad, dynamic, interactive social systems approach is suggested for understanding how inequalities are formed, maintained, and change.