Public Health Approaches

Article excerpt


Hurricane Katrina was a natural disaster that caused much preventable death and misery, especially in New Orleans. More than a thousand people died because of the hurricane and the aftermath, drawing international attention. But the disaster did not affect everyone equally.

The news media covered the impact on the African American community comprehensively. African Americans were hit hard because they were more likely to have low incomes and therefore have fewer resources to flee their higherrisk neighborhoods. The public discussion of this situation briefly rekindled attention on racial disparities that continue to plague the nation. The news media, however, only fleetingly noted that the majority of the victims of the disaster were elderly. Older adults were disproportionately victims of the storm because they were more likely to succumb from heat, dehydration or the exacerbation of chronic medical conditions.


A comparable storm washes over the United States every day. It is the storm of disparities in education, housing, employment and medical care that leaves African American elders with worse health than older whites across almost all measures of health status, including disease, disability and self-assessed health. Older Latinos have lower rates than nonLatino whites of some diseases, most notably heart disease and stroke, but also higher fates of diabetes, disability and poor self-rated health.

Poverty is strongly associated with poor health across all measures in old age, and women have more chronic conditions and disability than men despite their greater life expectancy. The scope of this daily disaster in terms of preventable death and disability is much larger than that of the flooding caused by broken levees-but because the causes and consequences of broader health disparities happen every day, day in and day out, it is not as newsworthy as an episodic catastrophe.

The good news is that health disparities in later life are preventable. The United States has two official health promotion and disease prevention goals for the year 2010: to increase the quality and years of healthy life, and to eliminate health disparities. The first goal echoes the common gerontological saying that we strive to add life to years, not only years to life. The second should also be part of every gerontologist's credo. Health disparities are inequitable and unfair differences between populations that have different levels of social advantage, especially those based on race, ethnicity, gender or income. Health disparities further imperil the life chances of members of these groups that live under disadvantaged circumstances in American society.

A public health approach to health disparities in old age starts with a focus on the health of specific populations, such as a racial group, a neighborhood or a whole nation. Where clinical disciplines tend to focus on healing sick individuals in the designated population, public health tries to foster conditions that promote the health of the overall community or group.


The concern for population-level health makes equity a key part of a public-health approach to health and aging. Because older people have the highest rates of illness and the highest use of medical-care services, they are particularly affected by inequity in health services and health status. Because healthstatus disparities in old age often stem from lifelong circumstances-cumulative social and economic burdens that tend to impair health and well-being in later life-they raise questions about the most effective focus of society's efforts to ameliorate resultant problems.

A growing body of research is documenting the importance of good nutrition, exercise, exposure to healthy environments and other factors beginning in childhood.

Certainly, preventing a problem from occurring in the first place is preferable to remediation or cure later. …