The social, environmental, economic, and cultural determinants of health are the terrain on which structural inequities produce health inequities. Policies that foster inequities at all levels (from organization to community to county, state, and nation) are critical drivers of structural inequities. Structural inequities are the personal, interpersonal, institutional, and systemic drivers-such as, racism, sexism, classism, able-ism, xenophobia, and homophobia-that make those identities salient to the fair distribution of health opportunities and outcomes. The dimensions of social identity and location that organize or “structure” differential access to opportunities for health include race and ethnicity, gender, employment and socioeconomic status, disability and immigration status, geography, and more. Health inequities are systematic differences in the opportunities groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes ( Braveman, 2006 WHO, 2011). HOW STRUCTURAL INEQUITIES, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH EQUITY CONNECT This literature is discussed below in the sections on structural inequities and the social determinants of health. Furthermore, there is mounting evidence that focusing programs, policies, and investments on addressing these conditions can improve the health of vulnerable populations and reduce health disparities ( Bradley et al., 2016 Braveman and Gottlieb, 2014 Thornton et al., 2016 Williams and Mohammed, 2013). For the purposes of this report, the social determinants of health are: education employment health systems and services housing income and wealth the physical environment public safety the social environment and transportation.Ĭontext contribute to health inequities. The social determinants of health are the conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Structural inequities refers to the systemic disadvantage of one social group compared to other groups with whom they coexist, and the term encompasses policy, law, governance, and culture and refers to race, ethnicity, gender or gender identity, class, sexual orientation, and other domains. The fields of public health and population health science have accumulated a robust body of literature over the past few decades that elucidates how social, political, economic, and environmental conditions and It is important to understand the underlying causes and conditions of health inequities to inform equally complex and effective interventions to promote health equity. The factors that make up the root causes of health inequity are diverse, complex, evolving, and interdependent in nature. Box 3-1 includes the definitions of structural inequities and the social determinants of health. The second, and more fundamental root cause of health inequity, is the unequal allocation of power and resources-including goods, services, and societal attention-which manifest in unequal social, economic, and environmental conditions, also called the social determinants of health. The first is the intrapersonal, interpersonal, institutional, and systemic mechanisms that organize the distribution of power and resources differentially across lines of race, gender, class, sexual orientation, gender expression, and other dimensions of individual and group identity (see the following section on such structural inequities for examples). The report identifies two main clusters of root causes of health inequity. Health inequity, categories and examples of which were discussed in the previous chapter, arises from social, economic, environmental, and structural disparities that contribute to intergroup differences in health outcomes both within and between societies.
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