02.06.2023 | Kommentarer

Advancing Health Equity by Tackling Socio-cultural Determinants of Health

1        Introduction

Your identity or place of worship or residence should not stand in the way of excellent health. Until recently, equality of health has been the bedrock for formulation of policies in health care. Nowadays, health care policy makers and managers in both developed and developing nations have realized that health equity is a better alternative that recognizes that no two persons within a population have equal circumstances, hence realizing these differences places the need to allocate exact resources and opportunities to everyone to reach an equal outcome. There have been wide claims that when everyone can achieve full potential for health and wellbeing, health equity has been realized (World Health Organization (WHO), 2023).

It is worth pointing out that certain factors can increase the vulnerability of some people to attaining good health, such factors include mental, physical, social, cultural related factors, amongst others. However, sometimes it is difficult to understand the cause of health disparities between people. Often, the underserved populations are pressured to choose between taking care of their health or that of their loved ones.

This article aims to assess evidence on the issue of health equality and equity, to facilitate understanding of cultural and social determinants of health and their effects on achieving equitable health outcomes.

2        Health equality

In many debates, equality has been the central topic, two questions usually arise (Equal to what? On what ground?). The term equality is used as a form of comparison between objects or persons, for instance, such term could be used in comparing health status, social status, educational standard, and many more. In health, it has been seen as a source of health disparities between persons or populations or nations. This concept has been criticized by many scholars because it fails to acknowledge that different individuals or groups or nations did not start the race from the same starting point. Also, imagine giving three different people of different heights, age, and ability the same type of ladder to pick mangoes from a mango tree. We face a similar situation in healthcare. There are people who can easily access resources and services they need, and others who struggle to get the basics, like healthcare. This implies that certain groups of people are more at risk of dying from preventable and treatable diseases. Many gaps in healthcare are caused by a lack of access to various resources and are rooted in unfairness. A person’s education, income, employment status, and housing all have an impact on their health. When non-medical factors contribute to differences in health, we refer to it as health disparity. For example, black Americans are more likely to die to preventable and treatable illnesses as compared to their white counterparts, this is what we call racial inequity, unfair and unequal distribution of healthcare resources along racial lines.

In addressing health inequality, some people proposed giving the same assistance to everyone regardless of the socio-cultural circumstance of the persons. But that does not work in practice, because some people need more support or different forms of support than others. This type of approach is known to produce varying outcomes, meaning that these individuals will never achieve an equal outcome considering their disparities. This is the reason public health professionals are focusing on equity.

3        Defining equity

The term ‘equity’ has emerged as an alternative to ‘equality’, and it is more promising to solve the issue of health disparities between people.  An equity approach strives to give everyone the chance to live their healthiest possibly live but gives extra attention to those who face ill health because of lack of access or opportunities. The Centers for Disease Control and Prevention (CDC) (2022) revealed that everyone has a fair and decent chance to achieve their highest degree of health when there is health equity. WHO (2023) provided support for this by stating that equity is the absence of unfair, preventable, or redressable discrepancies between groups of individuals, whether those groups are characterized by social, economic, demographic, or geographic factors, or by other aspects of inequality (such as gender, ethnicity, handicap, or sexual orientation).To do this, society must continuously work to: address past and present-day injustices; remove barriers to health and healthcare such as economic, social, and other front; and eliminate health inequalities that can be avoided (Office of Disease Prevention and Health Promotion, 2021). Thus, to achieve health equity there is need to change the system and policies that embrace equality, which favors more advantaged people than those that are disadvantaged, which creates generational health injustice, unfairness, and disparities.

3.1       Factors Affecting Health Equity

As pointed out earlier, there are varieties factors that affect the goal of achieving health equity within a given population. One of such factors is broadly termed social determinants of health and includes things like age, race, income, education, disability, gender, political systems, social norms, social policies, and development objectives, amongst others. It defined the elements that influence a variety of health risks and outcomes in the settings where people live, learn, work, play, and worship (Centers for Disease Control and prevention, 2022). These conditions, if not taken care of, have a huge influence on many different hazards and effects for one's health and quality of life. We can better understand how to promote health equity and enhance health outcomes by looking at these complex social and health disparities (Centers for Disease Control and Prevention, 2022). It has been widely recognized that these factors influence how healthy people are, for example, the widening income disparities between people or races is a fundamental cause of health inequality. For instance, in South Africa, it has been reported that addressing racial disparities, hunger, income inequality, and unemployment will probably lessen income-related health inequalities in South Africa during the COVID-19 pandemic given the significance and magnitude of these factors in determining socioeconomic inequalities in poor health (Nwosu, & Oyenubi, 2021). Thus, poor financial capability is a serious setback in achieving health equity because low-income households will lack the capability and capacity to access recommended healthy foods and nutritional supplements, and in some countries such as United stated of America, where health insurance is needed to gain access to adequate health care, such people will be deprived from good healthcare.

Furthermore, in addition to the social determinants of health mentioned above, it is important to take into consideration historical and cultural elements that affect health and well-being in one way or the other. Culture is that human aspect of life that is acquired through interaction and socialization, which makes an individual act unconsciously and competently in accordance with the beliefs and values of a particular group of people. Arnault (2018) defined culture as a set of evolving moral standards that influence how members of a particular ethnic group behave. It is also transferable from one generation to another; learnt from birth and are easily influenced by environmental factors and availability of resources. Cultural determinants of health include factors such as religious and spiritual beliefs, traditional norms and beliefs, language, foods, and drinks, also health care practices.

3.2       Approaches to Promote Health Equity

Health equity has been the envisaged method to actualize equal outcome in health and well-being. A collective effort is needed to achieve this, everyone has a role to play. You, as a member of a community or an institution should be actively involved in promoting equitable access to resources that will help people maintain and manage their mental and physical health, by ensuring they have access to essential information, goods, services, and inexpensive health care. More so, communities, organizations, and employers of labor, health care policy makers and managers, and others are not left out in this struggle, they should act by promoting access to health care, and promoting opportunities for the disadvantaged persons and communities. Particularly, by preventing anything that will encourage discrimination of any sort. It is important to show awareness of cultural diversity and respect other peoples’ culture when they demand health care. Population health can be significantly influenced by making these ideas clearer, providing precise and useful metrics to quantify socioeconomic and demographic health determinants, as well as strategies to address disparities in health and health care (Lee, Kim, Lee, & Fawcett, 2020).

WHO stipulated that knowledge, monitoring, and analysis make up the backbones for actualization of health equity within a given population. It further stated that monitoring should form the central idea for any efficient health care system, because through observation, it becomes possible to collect, analyze, and report data by age, sex, education level, income level, handicap, and other criteria. It is totally impossible to exclude data in the quest to have visual information on how and why health inequality exit. In addition, to better understand cause-and-effect relationships, or how these other determinants contribute to health disparities, data must also be linked with information on other determinants such as education (WHO, 2023). More so, to really achieve health equity for all, we strongly urge academicians and innovators to incorporate community engagement into the creation of data-driven, modern solutions for every sector of society (Brewer et al., 2020).

4        Conclusion

This article has looked at the issue of health disparity between persons or populations and suggested the use of equity in healthcare to close the gap. It has been uncovered that in the fight to exclude health inequalities, there are social and cultural determinants that stand on the way to success for all inclusion health outcome. These obstacles are things like personal, social, financial, structural, environmental, policies, and culture that influence health and health outcomes.

Ultimately, to this end, despite the importance of redistribution of health resources, it is as well essential to take into consideration health disparities between people within a population, hence utilize a sure alternative of ‘health equity’ where allocation of health resources is based on need and circumstance of the people concerned. Bearing this in mind, formulation, implementation, monitoring, and evaluation of healthcare should be provided in such a way that respects human rights and cultural diversities, disability, economic status, and considers gender equality, so that everyone can achieve equal health outcomes. Thus, public health agencies need to be proactive in tackling health differences that are avoidable, unnecessary, and unjust, and work to improve everyone’s health.

References

• Arnault D. S. (2018). Defining and Theorizing About Culture: The Evolution of the Cultural Determinants of Help-Seeking, Revised. Nursing research, 67(2), 161–168. https://doi.org/10.1097/NNR.0000000000000264
• Brewer, L. C., Fortuna, K. L., Jones, C., Walker, R., Hayes, S. N., Patten, C. A., & Cooper, L. A. (2020). Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. JMIR mHealth and uHealth, 8(1), e14512. https://doi.org/10.2196/14512
• David T. Takeuchi, Tiziana C. Dearing, Melissa W. Bartholomew, and Ruth G. McRoy (2018): Equality and Equity: Expanding Opportunities to Remedy Disadvantage
• Lee, H., Kim, D., Lee, S., & Fawcett, J. (2020). The concepts of health inequality, disparities and equity in the era of population health. Applied nursing research : ANR, 56, 151367. https://doi.org/10.1016/j.apnr.2020.151367
• Nwosu, C. O., & Oyenubi, A. (2021). Income-related health inequalities associated with the coronavirus pandemic in South Africa: A decomposition analysis. International journal for equity in health, 20(1), 21. https://doi.org/10.1186/s12939-020-01361-7
• Office of Disease Prevention and Health Promotion. (2021). Healthy People 2020: Disparities. U.S. Department of Health and Human Services. Retrieved 13^th May, 2023, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities
• The Center for Disease Control and Prevention (CDC) (2023); https://www.cdc.gov/healthequity/whatis/healthequityinaction/index.html. Retrieved 16^th May 2023.
• World Health Organization (WHO) (2023). https://www.who.int/health-topics/health-equity#tab=tab_1. Retrieved 16^th May 2023.