To achieve health equity, healthcare must take steps to remove obstacles to health.
The barriers and obstacles facing our clients are collectively called the Social Determinants of Health, SDoH. The Social Determinants of Health focus on five areas;
- socioeconomic status (education, income, occupation);
- neighborhood and physical environment (housing, built environment, toxic environmental exposures);
- food environment (food insecurity, food access);
- health care (access, affordability, quality); and
- social context (social cohesion, social capital, social support).
The American Diabetes Association identified healthy inequity, specifically understanding of social and environmental factors of diabetes, accounts for 50 to 60 percent of health outcomes.
The stark nature of recent reports has made it clear reducing the medical and human cost of diabetes care will require professionals working in this field to understand how bias, stigma, and the SDoH are impacting engagement, medical care, and policy.
Understanding how the SDoH can be impacted by race is a complex process. Dr. Williams created an analogy to visualize racism as similar to building a house. In the article, The House that Racism Built,
Williams, et al., define racism “As an organized system, premised on the categorization and ranking of social groups into races and devalues, disempowers and differentially allocates desirable societal opportunities and resources to racial groups regarded as inferior.” Williams states, “Research finds that although socioeconomic status, SES predicts variations in health status within each racial group, racial disparities persist at every level of SES.” The point Williams and his colleague are making is poverty does not cause racism. This means racism is separate from poverty and conversations which do not consider the historical, intergenerational, persistent-institutional, and personal trauma of racism and intersecting forms of gender, sex, and size oppression are unlikely to establish the necessary interpersonal trust needed in healthcare.
Williams DR, Lawrence JA, Davis BA, Vu C. Understanding how discrimination can affect health. Health Serv Res. 2019 Dec;54 Suppl 2(Suppl 2):1374-1388. Doi: 10.1111/1475-6773.13222. Epub 2019 Oct 29. PMID: 31663121; PMCID: PMC6864381.