Academic journal article Generations

Equity and Social Determinants of Health among Older Adults

Academic journal article Generations

Equity and Social Determinants of Health among Older Adults

Article excerpt

What creates health disparities and what policy options are available for ameliorating them?

Attention to the challenges faced by older adults of color in the United States was first highlighted by a report in 1964 from the National Urban League, Double Jeopardy: The Older Negro in America Today (National Urban League, 1964). At the time, it was groundbreaking just to document the gap in health and wealth between older African Americans and whites, a gap that was particularly acute in old age. In the subsequent half-century, we have expended a lot of effort to further specify the existence of health disparities by race and ethnicity.

The 1985 United States Department of Health and Human Services (HHS) Secretary's Taskforce Report on Black and Minority Health was the first signal of top governmental-level concern with health differences by race, with the clearest documentation being the mortality gap for African Americans. Forty-two percent of cumulative deaths by age 70 among African Americans were shown to have been avoidable if African Americans' mortality profile matched that of whites (Heckler, 1985). And in 2003, the Institute of Medicine report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, clearly documented the healthcare system's under-treatment and poorer treatment of African Americans (Smedley, Stith, and Nelson, 2003).

We now have the annual National Healthcare Disparities Report, mandated by Congress, that provides snapshots of access and quality inequities by race and ethnicity. The most recent edition shows that African Americans and Latinos receive lower quality healthcare in 40 percent of the indicators measured, American Indians/Alaska Natives in one-third of the indicators, and Asian Americans in one-quarter. There were many more than 100 quality points tracked, such as the receipt of colon cancer screening by those older than age 50 and hospital admissions for uncontrolled diabetes (Agency for Healthcare Research and Quality [AHRQ], 2014).

Reducing Health Inequities with Prevention

Health inequities are the result of avoidable differences between populations that affect less powerful groups in society. They stem from a pattern of health determinants, outcomes, and resources associated with broader social inequities. When patterns of social exclusion, blocked opportunities, or unequal returns on effort are common to a population, the resulting differences in health status and healthcare are inequitable (Wallace, 2012).

Most attention to the causes of health inequities among older adults has focused on the medical system, which has its greatest impact on health outcomes after a person becomes ill. But preventing illness has the greatest potential for reducing health inequities, as well as for reducing the need for expensive medical care. Because exposures to many risk factors for disease and disability are unequally distributed across groups, it is important to address social and political factors. Heart disease is the leading cause of death in old age for all groups and there are clear differences in cardiovascular disease rates by income and race or ethnicity. Policy efforts to reduce the average sodium content of commonly consumed packaged foods are one cost-effective approach for reducing blood pressure and cardiovascular disease at the population level (Morrison and Ness, 2011). Similarly, policy efforts exist to improve population-level physical activity, promote balanced diets, and reduce smoking, each of which has a salutatory impact on the risks for cardiovascular disease as well as multiple other health conditions.

Efforts to promote health are not adopted evenly across populations, and groups at the highest risk often are the last to benefit from the societal changes and new technologies. Smoking rates are a good example of the trend of more advantaged populations benefitting first from new knowledge and social patterns. Smoking rates peaked in the mid-1960s in the United States, just before the Surgeon General's report confirming that tobacco smoking led to cancer and other health problems. …

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