Title: Social determinants of health

Health disparities in the USA

Here is an excerpt from a reportage by the CBC news network concering the disparities caused by the COVID-19 pandemic in the USA.

Watch the video carefully. Focus on the ways the pandemic affected people of different proffessions and origins.

Video taken from: https://www.youtube.com/watch?v=VCnBgaGJMKc

Cases of health disparities during the COVID-19

Here is an informative video by the World Economic Forum concerning some health disparities caused by the COVID-19 pandemic.

Watch the video carefully. Focus on the five parameters mentioned in the video that led to health disparities, as well as examples from each one of them.

Video taken from: https://www.youtube.com/watch?v=6leuxxEDM-E

Causes and consequences of health disparities

Here are some adapted excerpts from the Centers for Disease Contron and Prevention concerning the origins of health disparities.

Read the text carefully. Focus on the reasons leading to health disparities and the outcomes they have on people's health.

Health disparities

Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health. […] Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment. Many populations experience health disparities, including people from some racial and ethnic minority groups, people with disabilities, women, people who are LGBTQI+ (lesbian, gay, bisexual, transgender, queer, intersex, or other), people with limited English proficiency, and other groups. […] Communities can prevent health disparities when community- and faith-based organizations, employers, healthcare systems and providers, public health agencies, and policymakers work together to develop policies, programs, and systems based on a health equity framework and community needs.

Factors Affecting Health Equity (Social Determinants of Health)

Social determinants of health are the conditions in the places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes. Long-standing inequities in six key areas of social determinants of health are interrelated and influence a wide range of health and quality-of-life risks and outcomes. Examining these layered health and social inequities can help us better understand how to promote health equity and improve health outcomes.

Social context, discrimination, and racism

A person’s social and community context includes their interactions with the places they live, work, learn, play, and worship and their relationships with family, friends, co-workers, community members, and institutions. […]  Social and community context also includes discrimination – or the unfair treatment of people or groups based on characteristics such as race, gender, age, or sexual orientation. Discrimination exists in many systems in society including those that are meant to protect well-being or health such as health care, housing, education, criminal justice, and finance. Discrimination often has a negative effect on the people and groups who experience it and some people who belong to groups that historically have experienced discrimination, such as people with disabilities, people experiencing homelessness, and people who are incarcerated or detained. As a result, people who have experienced discrimination may be affected by layered health and social inequities. […] Racism is a system, which is supported and maintained through institutional structures and policies, culture, values, and individual behaviors. […]

Access to Healthcare

People with disabilities and people from some racial and ethnic minority groups, rural areas, and populations with lower incomes are more likely to face multiple barriers to accessing health care. For example, there are barriers related to socioeconomic status, such as lack of insurance, transportation, childcare, or ability to take time off work, which can make it hard to go to the doctor. Cultural differences between patients and providers as well as language barriers affect patient-doctor interactions and health care quality. […]

Neighborhood and Physical environment

People from racial and ethnic minority groups are disproportionately affected by difficulties finding affordable and quality housing. […] Historical discriminatory practices (e.g. avoiding of renting apartments to immigrants) have limited housing options among racial and ethnic minority groups to neighborhoods and residences that have school districts with inadequate funding, higher crime rates, and poorly resourced infrastructure. These conditions may make illnesses, diseases, and injuries more common and more severe among these groups. In addition, access to nutritious, affordable foods may be limited for these groups, and they may experience more environmental pollution within their neighborhoods.

Workplace conditions

Not all workers have the same risk of experiencinf a work-related health problem, even when they have the same job. Occupational health inequities are avoidable differenced in work-related disease incidence, mental illness, or morbidity and mortality that are closely linked to [...] organizational factors, such as the lack of worker safety measures, and the limited or no health insurance benefits.

Education

People, who have been historically marginalized, such as people from racial and ethnic minority groups, people with disabilities, and people with lower incomes, are disproportionately affected by inequities in access to high-quality education. […] Lower-quality education is common for residents of lower income neighborhoods, and can lead to lower literacy and numeray levels, lower high school completion rates, and barriers to college or university entrance. In addition to educational barriers, limited access to quality job training or programs tailored to the language needs of some racial and ethnic minority groups may limit future job options and lead to lower paying or less stable jobs.

Income and economic status

People from racial and ethnic minority groups and other historically marginalized groups also face greater challenges in getting higher paying jobs with good benefits due to less access to high-quality education, geographic location, language differences, discrimination, and transportation barriers. People with limited job options often have lower incomes, experience barriers to wealth accumulation, and carry greater debt. […] Such financial challenges may make it difficult to manage expenses, pay medical bills, and access affordable quality housing, education, nutritious food, and reliable childcare.

Text taken from: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html (adapted)

Economic and social disparities during the COVID-19 pandemic

Here is an excerpt from an academic text by Anastasia Zisi and Sotiris Htouris which was published in the greek scientific journal 'Review of Social Research' in 2020. The excerpt is about the social and economic disparities during the COVID-19 pandemic.

Read the text carefully. Focus on examples of social and economic disparities during the COVID-19 pandemic, and how the pandemic affected them. Also, focus on cases of health disparities in diseases other than the COVID-19, and the role that digital technologies had in the pandemic.

Economic and social disparities during the COVID-19 pandemic

The current text is presenting how already-existing disparities were maximized due to the COVID-19 pandemic, and new disparity forms were established. […] These disparities include the high risk of exposure to the disease for vulnerable social groups that live or work under dangerous conditions. They, also, include the high risk of disease transmission in unhealthy dwellings, dense-populated areas, moist or overcrowded neighborhoods, as well as limited access to fundamental goods (e.g. clean water). Other kinds of disparities include the psychological and social consequences of the pandemic, the restriction measures and social distancing, which have been observed to be higher within social groups facing social exclusion, infected people, and jobless people. […] The extreme economic conditions in the society (increase of unemployment, decrease in incomes and available working positions) […] are some of the most determinant consequences of the modern pandemic […].

Great inequities appeared in the society, such as:

a) Households lacking important well-fare conditions in their houses, are facing several difficulties daily (cold, moisture, overcrowded houses, inability to access healthcare services, homelessness),

b) Households with members […] facing the risk of unemployment […] and suffer from uncertainty about making an living.

c) One-member households that are facing loneliness and social distancing more severely

d) Households with many members, or households with disabled member which are staying home without having the necessary support from social services. […]

Health disparities against vulnerable social groups

[…] There are plenty of scientific findings that support the severity of COVID-19 with non-communicable diseases, such as […] hypertension, diabetes, and respiratory diseases. These ones are linked to social parameters which are, in turn, connected with limited physical exercise, obesity, unhealthy housings, unhealthy nutrition, stress, and unhealthy work conditions. For these reasons, people of low income have stronger tendencies to have these diseases […]. Consequently, the most economically vulnerable parts of the population are facing a higher risk of COVID-19 infection, late detection, or improper treatment. […] The COVID-19 disease is mainly infecting people having underlying health issues, like the ones mentioned above, as well as communities that cannot enact the precautionary measures, due to overcrowding and inability to access medical equipment. Thus, the paces of the disease spread and infection are accelerating within these communities and social groups. […]

The COVID-19 pandemic hits all the social groups that do not have access to the services of healthcare system […] and are excluded by the health policy. The African Americans and other minorities in large cities of the USA, have been so severely hit by the COVID-19 pandemic that are having the larger numbers of positive COVID-19 cases and COVID-19 deaths than the rest of the population. […] Minority groups (e.g. refugees, immigrants and people of low income) comprise the necessary low paid workers, who work in customer service positions without effective protection. Thus, the risk of exposure to the virus is increased, and the overcrowding and bad sanitation condition of dwelling hinders the proper enactment of social distancing rules. […]

The experience of Ebola epidemics is recent to several African countries. The 2014 Ebola epidemic posed an acute public health threat, and devastated the households and the healthcare systems of three of the poorest African countries, namely Sierra Leone, Liberia, and Guinea. The Ebola epidemic revealed the inability of a healthcare system to respond to a health crisis. […] The new pandemic of COVID-19 has lead poor African Countries to warn: ‘We are going to die of hunger, before even getting infected’. […] It is clear that the pandemic is going to have more long-term consequences to poor and unskilled people as compared to richer ones, in a way that the already existing inequities will be maximized. […] Households with disabled people, and women and children facing domestic violence, are, also, going to face more difficulties. […] In 23 March 2020 the Human Rights Department of the United Nations made an announcement about the high risk of domestic violence against women and children, under the new quarantine conditions, while worldwide evidence supported this rise. […] Moreover, the overall COVID-19 cases in Roma camps in Greece revealed the overall vulnerability of these groups, which is connected to other factors, including unhealthy living conditions, and the failure of incorporation initiatives.

Establishment of new kinds of disparities due to the digital gap

[…] There is a digital gap concerning the disproportionate access to digital media (e.g. computers, smartphones) and the competences of handling digital technologies both at a personal and family level, and the level of entire nations. The pandemic amplified the digital development of many countries, but amplified, also, the digital disparities against the poorest parts of the population and countries of lower development […] in digital technologies, since digital technologies were a core part of education, work, and health during the COVID-19 pandemic. […]

Text taken from: https://ejournals.epublishing.ekt.gr/index.php/ekke/article/view/23229 (translated and adapted)

Social disparities during the COVID-19 in Greece

Here are three infographics by the Hellenic Statistical Authority. They present statistical data from Greece conserning dwelling size, access to the Internet, and population's health contition.

Study the infographics carefully. Focus on ways these data could shape to Greek people's life during the COVID-19 pandemic, especially in terms of health disparities.

Dwelling size

[Image: Infographic with statistical data about dwelling size in Greece]

Access to the Internet

[Image: Infographic with statistical data about Internet access in Greece]

Underlying health condition

[Image: Infographic with statistical data about self-reported health condition in Greece]

Infographics taken from: https://www.statistics.gr/el/infographic-menoume-spiti-5, https://www.statistics.gr/el/infographic-menoume-spiti-2, https://www.statistics.gr/el/infographic-menoume-spiti-8

Contributors of the Digital Learning Object