Health Disparities Persist, But Solutions Exist
Juneteenth, officially Juneteenth National Independence Day, is celebrated annually to commemorate the ending of slavery on June 19, 1865, when Major General Gordon Granger ordered the final enforcement of the Emancipation Proclamation in Texas at the end of the American Civil War. Some may wonder — “Wasn’t the Emancipation Proclamation issued in 1863? Weren’t all slaves freed in the U.S. then?” Actually, that’s a common misconception.
During the Civil War, emancipation came at different times in different parts of the country — enforcement of the Emancipation Proclamation relied heavily on the advance of the Union troops. And Texas, as the most remote state in the Confederacy at the time, had actually seen the expansion of slavery since the Union presence there was low. The enforcement of the Emancipation Proclamation was slow and inconsistent, and it was two years later before the end of slavery finally came in Texas.
“You would have thought when President Lincoln issued the final Emancipation Proclamation in 1863 that slavery — and inequity between the haves and have nots — would have been over. But it actually caused more of a divide,” says Aspire Culture Officer Dr. Gina Forrest. “Unfortunately, the structural and institutional racism caused by slavery is still embedded in our country. Just because we said ‘no more slavery’ didn’t necessarily change the thoughts and feelings toward formerly enslaved people. Their health, where they worked and where they played still did not matter.”
Health Disparities Separate and Divide
According to the U.S. Centers for Disease Control and Prevention (CDC), health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. Achieving this requires focused and ongoing societal efforts to address historical and contemporary injustices; overcome economic, social and other obstacles to health and healthcare; and eliminate preventable health disparities.
“When I think of health equity, I think of everyone being able to reach their highest status of health and well-being,” Dr. Gina says. “Health equity is at the core of our mission at Aspire, serving underserved communities with compassion. By prioritizing health equity, we acknowledge and actively work to mitigate disparities in healthcare access and outcomes. It’s our ethical duty to advocate for and facilitate equitable healthcare practices.”
Health disparities are those unavoidable — yet preventable — differences that affect an individual’s ability to achieve optimal health experienced by various populations disadvantaged by their race, gender, social or economic status, geographic location and environment.
The 2024 State Health Disparities Report, released by The Commonwealth Fund, states, “Profound racial and ethnic disparities in health, well-being and life expectancy have long been the norm in the United States. These disparities are especially stark for Black and American Indian and Alaska Native (AIAN) people, who live fewer years, on average, than white and Hispanic people and are more likely to die from treatable conditions, more likely to die during or after pregnancy and suffer serious pregnancy-related complications, more likely to lose children in infancy, and are at higher risk for many chronic health conditions, from diabetes to hypertension.”
Racial and ethnic disparities are pervasive across all states, including Indiana. As reflected in the Report’s “Health system performance scores, by state and race/ethnicity,” states received overall health system scores for each group representing aggregate performance across three domains: health outcomes; healthcare access; and quality and use of healthcare services. In Indiana, the race/ethnicity groups scored as follows: White - 64; Asian American, Native Hawaiian and Pacific Islander (AANHPI) - 61; Hispanic - 25; and Black - 14.
Illuminating the clear and deep disparities in health and healthcare leads to the question: Why do these disparities exist and persist? Unfortunately, says Dr. Gina, our society has created — and allowed — health inequities, when health outcomes differ across groups due to systemic, avoidable and unjust social and economic policies and practices that create barriers to opportunity.
Eliminating the Obstacles to Positive Outcomes
People’s living conditions are often made worse by discrimination, stereotyping and prejudice based on sex, gender, age, race, ethnicity or disability, according to the World Health Organization. Discriminatory practices are often already embedded in our institutional and systems processes.
“Through the policies and procedures we create, society has put in these roadblocks so people can’t reach their full potential,” Dr. Gina says.
Credit scores to get a mortgage; credit scores to buy a car; redlining in neighborhoods; test scores to get into college; college degrees to get a job; dress codes in the workplace — we see societal roadblocks everywhere. And they are all challenges we face toward achieving health equity.
“It’s all those social drivers of health — from employment and housing to legal issues, trauma, racism and violence,” Dr. Gina says. “If we work to eliminate those inequities, or at least reduce them, there is the possibility to achieve a better and greater health outcome.”
The Social Drivers of Health (SDoH) are the conditions in which people live, work, grow, age and play. These conditions influence a person’s overall health. The SDoH categories are broken down into economic stability, education, neighborhood and physical environment, community, food, and healthcare access and quality.
“Health disparities usually exist because people don’t have access to or there is a barrier to accessing what they need. Addressing those social drivers of health helps reduce health disparities,” says Aspire Vice President of SDoH Mike Keevin. “Think about a person who is homeless and living on the street. They may not have access to food, and living on the street is unsafe. This can cause stress and have a negative impact on their mental health.”
When individuals aren’t having their basic daily needs met, their health and well-being suffers, which creates a domino effect in the other areas of their life.
“Take a look at Maslow’s hierarchy of needs. If you don’t have your physiological needs of water, food, shelter and sleep met, that’s all you’re going to think about every day,” Dr. Gina says. “You’re only thinking about today and surviving today. Those societal barriers can make it extremely difficult for individuals to move past the base level of attaining their basic needs.”
“Think about someone who may have lost their driver’s license due to a past event in their life,” Keevin says. “Accessing legal services may help them regain their license so they can travel to their job. This mobility may open up a better job that wasn’t accessible before, and this new income and mobility may help them access healthier foods. The new job also provides insurance, so they can afford going to the doctor. You can see how addressing the Social Drivers of Health can create positive momentum in a person’s life.”
That is why Aspire offers community programs like housing assistance, employment support, rehabilitation services, crisis intervention and Deaf services to help individuals cope more effectively in their environment.
Be an Ally
At the global, federal and state levels, action needs to be taken to improve health equity:
by the health sector to ensure high-quality and effective services are available, accessible and acceptable to everyone, everywhere when they need them;
by health and other sectors to act on the wider structural determinants of health to tackle the inequitable distribution of power and resources, and to improve daily living conditions; and
the health sector needs to take the lead in monitoring health inequities through monitoring health outcomes and health service delivery — as well as working with other sectors to monitor people’s living conditions.
There is also work we can do on an individual level.
“We need to challenge ourselves to truly be an ally to the community and specifically those most affected by health inequities and disparities,” Dr. Gina says. “When your kids are in school, are you advocating for every child or just your own? If you see something racial or homophobic or sexist, are you doing or saying something about it? Can you post something on social media and bring light to a situation that is happening? Can you engage others in a cause?”
“One person can change a lot,” she continues. “You can encourage conversations with others and make a difference in the public attitude. It only takes one person to make a difference.
