What Factors Influence Health Equity - or Inequity?

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Article contributed by: Chad Downey, BS 
Associate Director, Project and Proposal Operations
Chair, RTI-HS Diversity and Inclusion Advisory Council
Co-chair, RTI Black Employee Resource Group

This is part one of a three-part series on improving health equity in research. Read the other two articles here:
Part 2: Advancing Health Equity: The Crucial Role of Pharma and Medtech Developers
Part 3: Explore Neighborhood-level Health Inequities Now With RTI Rarity™

Health inequities occur when economic, political, and social systems create barriers to access and care—barriers that predominantly affect people from historically under-served communities. In the world of health equity research, understanding how multiple social identities and systems of oppression intersect and shape people’s health outcomes is key to identifying and addressing health disparities.

View our recorded webinar on addressing challenges in health equity researchSocioeconomic status, race, ethnicity, geographic region, cultural community, gender identity, sexual orientation, and education are a few of the factors involved in barriers to care. Thus, advancing health equity necessarily means that research must recognize and explore the multiple drivers of people’s healthcare experiences and outcomes. If it does not, critical information needed to address health disparities could be missed. We must look at the whole picture.

Cultural Influences

An essential framework for advancing health equity is understanding how cultural influences and learned behaviors are affected by historical systemic injustices like racism. I grew up Black and Southern Baptist in the Deep South, a region whose racist history runs deep. The foods I ate growing up in the South can be traced back to the culinary traditions of enslaved people taken from West and Central Africa, and these foods anchor much of Black Southern culture. As with many other cultures, our cuisine reminds us of family history and cherished times spent with loved ones in the kitchen, around the dining table, and at church. It is truly comfort food. However, we now know that foods cooked in animal fats and containing high amounts of salt and processed sugars do not make for healthy eating.

Cultural Competencies

To comprehensively address health outcomes for historically marginalized patient populations, researchers and care providers need to understand the sociocultural influences that impact human health. For example, how does a 60-year-old physician from New York, who is statistically most likely to be White or Asian, develop the cultural awareness to guide a young Black man from the Deep South, whose roots are similar to mine, towards healthier, sustainable dietary practices? How do we have those conversations that create meaningful, trust-building connections and motivate patients in a resonant way? This example illustrates how ingrained cultural practices rooted in historical inequities are a significant health burden and the importance of cultural competency as a critical health equity focus for healthcare organizations, researchers, and professionals.

Socioeconomic Status

Socioeconomic status (a mix of factors such as income, education, occupation, and wealth) greatly affects people’s access to optimal healthcare. Geographic location is another, often related factor. Imagine a person who lives in a small, rural region with only 1 community hospital compared with an urban-dwelling counterpart who may have access to multiple specialist hospitals, comprehensive care centers, and providers. We could say that residents in rural areas such as this just need better hospitals. However, what if there is a general distrust of the healthcare system among these residents? What if the area's tax base cannot support a newer, better hospital? By adopting a wider lens that considers multiple intersecting factors and influences, we can develop better solutions for addressing health disparities.

All these pieces are parts of the health equity puzzle. But strategies focusing on only 1 piece are unlikely to effectively address health inequality across the board. There needs to be focused calibration on the specific factors that shape our identities and consequently affect our healthcare experiences and outcomes. As scientists, we must consider that a solution is not likely to be one size fits all.

Health equity-focused strategies should be designed as comprehensively as feasible to best meet the needs of underserved patient populations. Preconceived ideas and lack of awareness about people or communities with whom we do not interact regularly can cause us to not consider their needs or to disregard those needs altogether. But examining our biases and identifying the sociocultural barriers to equitable access and care are steps in the right direction. Listening to, understanding, and empathizing with individuals and patient populations is vital to effectively addressing health disparities and creating a more inclusive healthcare system for all.

Learn more about RTI Rarity to Support Clinical Trial Diversity Requirements

Recent research on health equity coauthored by RTI Health Solutions experts

Disparities in respiratory syncytial virus (RSV) diagnosis, outcomes, and risk factors by race, ethnicity, and other social determinants of health: a systematic literature review. Khan SBektas M

Advancing equity, diversity, inclusion, and belonging in patient centered drug development with patient preference research. Poulos CMansfield CBussberg CJHicks JCDowney C.

The impact of social determinants of health on meningococcal vaccination awareness, delivery, and coverage in adolescents and young adults in the United States: a systematic review. Masaquel C, Schley K, Wright KMauskopf J, Parrish RA, Presa JV, Hewlett, Jr. D. 

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