Module 2: Health Inequity
Health inequity is defined as differences in health between groups of people that are avoidable, unfair and unjust. They are affected by three factors: social, including race, gender, class, sexual orientation, immigration status, etc.; economic, including institutional systems of advantage and disadvantage, etc.; and environmental, including safe access to food and exercise, crime, pollution and school institutions, systems, etc.
Culture shapes how we live. When a disease spreads through large parts of the world’s population, we cope culturally and biologically. As individuals, our bodies react biologically with responses like stress and anxiety. But as members of our culture or subcultures we react culturally. Our reactions are based in our personal histories, environments, upbringing and how we view illness and health.
The COVID-19 pandemic disproportionately affects immigrant and minority, marginalized and underrepresented communities. Due to social marginalization and systemic oppression, research indicates that members of these groups are more likely to live in multigenerational households; often work in front-facing jobs, such as grocery-store clerks; and take public transportation to get to jobs, resulting in higher rates of exposure. There also appears to be limited access to testing, a lack of culturally and linguistically appropriate public health information and underlying illnesses, such as diabetes and heart disease that disproportionately affect certain minorities. Because these factors put immigrants and minorities at a greater risk of infection and death from COVID-19, health inequity leads to inequitable outcomes.
- Define health inequity.
- Acquire additional resources for a toolbox responding to health inequity.
- Apply the skills and tools acquired in this module to a case vignette.
Step 1: Let’s Get Started
This step briefly introduces health inequity and provide specific objectives that will move you closer to your goals.
Step 2: Time to Engage
The information in this step is accessible and provides a general introduction to health equity. You can listen to a podcast on your morning walk, download a resource to help your client or get a short audio summary of an article that caught your eye before fully engaging with the reading.
Step 3: Creating a Stronger Foundation
This list of materials and resources provides a more detailed description of how to apply of the tools introduced in Step 2 and requires a deeper analysis of the topic through documentaries, research articles, trainings and books. Some of the tools, like research articles and books, may have a cost attached and we recommend that your organization provide them and that you share them with other team members. Tools like trainings may require you to engage for longer periods of time than the initial resources.
Step 4: Your Turn
This step encourages you to apply what you have learned through a case vignette. We recommend that you explore the gaps present within the vignette and implement any new skills acquired through this module. Consult with others on your team to explore multiple ways to address the issues, especially as you take your role within your organization and your experience, skills and worldview into account. We provide reflection questions from the following perspectives: individual learning and beliefs, organizational learning and systemic. You can use the questions to have discussions with others and think through all the facets that are relevant to your work.
Rita was a caseworker at an integrated mental health and substance use treatment clinic and moved to another town for a few years to take care of her elderly parents. Upon her return, she was re-hired and started looking up some of her previous clients. She was especially eager to see Keonte, a youth soccer star she worked with to help him and his family.
Keonte had changed in the course of three years. He had gone from a star athlete to being withdrawn and having a diagnosis of obesity. He had been suspended from school and failed one grade level. The trouble began when the youth soccer league closed because it was no longer a safe place to practice and there was a lack of reliable transportation to the field. More recently, Keonte suffered a minor injury that was never treated and had several family members who died preventable deaths during the COVID-19 pandemic.
Rita and Keonte were happy to see each other, but Rita burst into tears when he left. She had many ideas to provide Keonte the help he needed, but she felt resentful that the sudden decline in his health was so preventable.
- Rita became emotional witnessing the results of health inequity. How do you deal with your emotional reactions to inequity? (individual learning and change)
- Inequity can often be the result of neglect or receiving less effective treatment for minor problems. A little problem turns into a big one over time. How does your organization ensure that everyone gets the preventive care they need? (organizational change)
- There are societal forces at work against Keonte starting with inequitable policies in school in terms of suspension that start at Pre-K for Black and African American preschoolers. What role do schools play in enhancing or detracting from health? (systemic change)