The public health practice has made significant strides in the past decades through achievements such as increased life expectance and significant reductions in mortality levels. However, the practice is also experiencing new challenges. A notable example concerns the issue of health equity. There are dramatic increases in the unequal distribution of illnesses, diseases, and deaths within communities.
Health issues such as infant mortality, diabetes, cardiovascular disease affect some populations disproportionately than other groups based on socioeconomic and sociocultural factors including income and ethnicity. The existing health inequalities correlate with increasing economic and social inequalities due to widening gaps in income. Thus, the main sources of unequal health outcomes relate mainly to issues of discrimination in terms of gender, ethnicity, and class since these factors result in various disadvantages that exacerbate health inequities. The present paper offers an annotated bibliography about the challenge of health inequity in public health practice. The annotated bibliography will entail a summary of twelve articles addressing a different aspect of the topic and an evaluation regarding the suitability of the articles in addressing the topic.
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Achdut, N., & Sarid, O. (2020). Socioeconomic Status, Self-rated Health and Mental Health: The Mediation Effect of Social Participation on Early-late midlife and Older Adults. Israel Journal of Health Policy Research , 9(1). https://doi.org/10.1186/s13584-019-0359-8
The article takes a different view of health inequity by identifying the effect of socioeconomic status on different health outcomes. It emphasizes the importance of understanding the processes underlying social and economic issues concerning health care to find ways of addressing health-related issues including health inequities. The study also identifies the role of social participation in enhancing positive health outcomes and offers insights on the role of public health systems in implementing tailored interventions to different groups to improve their social participation, which in turn enhances positive health outcomes. The researchers used a quantitative study in which 4848 participants filled surveys. The survey data included various aspects of social participation practices. The authors then conducted an exploratory factor analysis for all the practices before constructing a structural equation modeling that explored different themes related to social participation.
Stakeholders can use the article to understand the multidimensional nature of issues related to health. The study findings show that social practices related to health are formal and informal. The practices are both crucial when attempting to promote health measures. Thus, public health practitioners should address gaps in health care by focusing on various issues concerning the socioeconomic factors of populations. The study shows that while these factors differ across populations, they share risks and unique resilience factors that can be used to advance health equity. Public health officials are encouraged to improve socioeconomic practices to promote health across populations.
The use of surveys and a large sample enhanced the reliability of the study findings significantly. Besides, the study involved a quantitative design, which in addition to using a large sample can be generalized to wider populations. The expertise of the researchers in the public health domain also demonstrates the credibility of the article.
Ezomo, O. T., Sun, D., Gronbeck, C., Harrington, M. A., & Halawi, M. J. (2020). Where Do We Stand Today on Racial and Ethnic Health Disparities? An Analysis of Primary Total Hip Arthroplasty From a 2011–2017 National Database. Arthroplasty Today , 6(4), 872–876. https://doi.org/10.1016/j.artd.2020.10.002
The article examines the issue of health inequity in joint arthroplasty to deepen the knowledge of ethnic and racial determinants of health inequities. The researcher achieved this through reviewing patients undergoing treatment for total hip arthroplasty based on the National Surgical Quality Improvement Program data. The article examined five ethnic minority groups and compared them with non-Hispanic whites. They found major outcomes to be related to the differences in 30-day adverse effects, length of stay, and utilization of total hip arthroplasty, perioperative features, comorbidities, and demographic features. The study involved 155, 870 patients of different ethnicities and race.
The article shows that ethnic and racial health inequities pose serious challenges in outcomes of serious illnesses such as total hip arthroplasty. While racial and ethnic health inequities are commonly utilized in measuring the overall health inequities, the study emphasizes the importance of considering each ethnic group independently to gain deeper insights on issues that affect each group. Besides, stakeholders can use the article findings to understand the role of social determinants of health in influencing health outcomes. Public health practitioners should consider integrating neighborhood, health care access, educational level, and socioeconomic levels into strategies focusing on addressing health inequities.
The study used a large sample size with a national representation, which ensured that the findings of the study reflect the general population. However, the information from the nationally representative data lacked data on patient socioeconomic status or attitudes, which are vital as they influence the use of health care resources and health outcomes. Besides, the database may not have captured enough data to address the health inequity topic given the complexity of the issue. Nevertheless, the study contributes to knowledge regarding the underlying causes of health inequities based on ethnicity and race.
Hatton, C. (2016). Moving from Health Disparities to Health Inequities - and Why It Matters. Developmental Medicine & Child Neurology , 58(7), 660–661. https://doi.org/10.1111/dmcn.13085
The article contributes to the issue of health inequity by examining children and family health AS indicators of poor mental health. The authors use the Strengths and Difficulties Questionnaire to obtain data from parents and teachers comparing children with visual impairment with those without the impairment. The researchers found that children with impairment have more issues compared to children without impairment. The differences between the two groups are stark and pervasive. The article demonstrates that the differences arise due to underlying differences in childhood adversity and socio-economic indicators.
The study shows that the risk of health issues among children can be decreased significantly if stakeholders implement policies that focus on enhancing the socio-economic position of children and families besides decreasing the exposure of children to adversity at an early age. The article uses large nationally representative data, which enhanced the reliability of the findings. However, the number of children with a specific impairment was small and the survey questions were inadequate for identifying the impairments. The use of a representative sample of participants, the variety of data used, and the potential of longitudinal data enhanced the credibility and reliability of the study and offered deeper insights into the health inequities in childhood.
Jackson, S. E., Hackett, R. A., & Steptoe, A. (2019). Associations between Age Discrimination, Health, and Wellbeing: Cross-sectional and Prospective Analysis of the English Longitudinal Study of Ageing. The Lancet Public Health , 4(4), e200–e208. https://doi.org/10.1016/s2468-2667 (19)30035-0
The authors in this article state that the public health domain has failed to acknowledge the relationship between discrimination and health inequity. The article considers discrimination as involving different behaviors, policies, and practices that perpetuate inequities among defined groups. The authors analyzed age-based discrimination among adults to gain a deeper insight into the role of discrimination in health inequity. The participants were involved in a longitudinal study of ageing. The sample size was 7731 adults with a mean age of 67 years. The researchers asked the participant structured questions regarding their experiences of discrimination. They also adjusted the questions to account for differences in wealth, sex, and age. The findings showed that discrimination was more prevalent among people with limiting long term physical or mental illness than among those without the conditions. The researchers also engaged in a 6-year follow-up.
The findings are vital since they demonstrate the prevalence of experienced discrimination in the health care sector. While there is a complex relationship between experienced discrimination, health status, socioeconomic status, and age, the study results suggest that discrimination causes both immediate mental distress and long term physical and mental health outcomes. Stakeholders can use the findings to understand the way discrimination influences different individual identity levels. Factors such as unemployment, socioeconomic status, and gender reinforce discrimination, which highlights the importance of developing and implementing multifaceted interventions to address the issue. The study used a large sample size in its analysis. The authors also followed-up on the participants 6 years later, which enhanced the reliability of the findings. The expertise of the authors in the field of public health also demonstrates the credibility of the article.
It is challenging to achieve health equity and eliminate disparities using conventional public health practices alone. Besides, practitioners cannot achieve health equity by addressing the consequences of inequity without addressing the underlying causes. The aforementioned studies show that the causes are embedded in economic, political, and social policies in addition to institutional practices and influence the potential for diseases or health. Addressing health inequity requires implementing long-term approaches with multiple organizations and agencies that affect health outcomes. Public health practitioners can contribute by raising public awareness of the issue, advocating for effective policies, and engaging with communities. Agencies should also embrace technology and innovation to ensure continued improvement.
Nafiu, O. O., Mpody, C., Kim, S. S., Uffman, J. C., & Tobias, J. D. (2020). Race, Postoperative Complications, and Death in Apparently Healthy Children. Pediatrics , 146(2), e20194113. https://doi.org/10.1542/peds.2019-4113
The article examines racial differences in health outcomes to determine the role of health inequities in such differences. Based on the article, African Americans patients achieve poor surgical outcomes than their White colleagues because of health inequities in the context of high preoperative comorbidity issues among African American patients. Therefore, the researchers conducted a retrospective study in which they analyzed the National Surgical Quality Improvement Program with a focus on pediatric information. They then performed a risk-adjusted logistic regression among 172,549 children participants. The study shows that even for healthy children, racial differences are related to a higher risk of postoperative mortality and complications among African Americans compared to their White counterparts. The authors suggest that stakeholders should consider solutions beyond racial differences when addressing health inequity issues.
The article also shows that race is a crucial determinant of health outcomes. Being an African Americans was related significantly to higher rates of health issues and mortality. Public health practitioners can use the findings of the study to understand the risks posed by racial differences in health outcomes among children and the underlying processes causing the risks. The large sample size with national representation enabled the researchers to conduct extensive analyses, which enhanced the reliability of the findings. Besides, the authors are qualified in their respective field.
Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLOS ONE , 10(9), e0138511. https://doi.org/10.1371/journal.pone.0138511
The article focuses on the issue of racism and its role in health inequity. The authors acknowledge that racism affects health outcomes in various ways such as through affecting access to education, housing, and employment among others. The article also offers a comprehensive background regarding studies that have explored racism as a vital determinant of health. The article adds examining the relationship between racism and various health outcomes. Researchers collected data from 293 empirical studies before analyzing it using descriptive statistics. The findings show various ways through which racism is related to poor health outcomes. The researchers also found that ethnicity contributes significantly to adverse health outcomes.
Public health practitioners can use the article to gain insights about racism as a determinant of health and the ways it is related to health inequity. The study demonstrates the significant association between racism and multiple health outcomes including mental, physical, and general health aspects. Besides, it offers insights regarding the long-term effects of racism on health, which offers new understandings for public health practitioners. Stakeholders can use these insights to implement comprehensive interventions that eliminate the negative effects of racism on health.
The article presents a rigorous and comprehensive descriptive analysis that examines multiple aspects of the topic. Even though the sample is not very large, the rigorous analysis increases the reliability of the study findings. Besides, the analysis focuses on different populations, includes comparative analysis, and involves a deeper analysis, which offers deeper insight regarding the topic. The authors also use a rigorous technique when determining the studies to be included in which they examine each article critically to identify its suitability for the analysis.
Pauly, B. B., Shahram, S. Z., Dang, P. T. H., Marcellus, L., & MacDonald, M. (2017). Health Equity Talk: Understandings of Health Equity among Health Leaders. AIMS Public Health , 4(5), 490–512. https://doi.org/10.3934/publichealth.2017.5.490
The article highlights the importance of reducing health inequities in public health practice across the world. It also identifies various ways in which public health leaders are addressing the issue and reorienting the public health sector towards health equity. Therefore, the authors sought to investigate ways of applying the health equity approaches during health care system renewal. The article used 15 focus groups together with semi-structured interviews involving 55 leaders in the public health sector. They analyzed the data through comparative analysis to identify ways leaders construct healthy equity based on their actions and understanding. They also identified the major themes related to the discussion of health equity, accessibility issues, health determinant issues, and population health.
Public health stakeholders can use the findings of the article to gain insights into the kind of knowledge that leaders in the public health sector require to introduce health equity aspects into the sector and implement the needed transformation to reorient health care systems towards health equity. Stakeholders can also use the article to understand the potential benefits of promoting equity in healthcare to reduce inequities and the involved barriers or challenges when implementing health equity measures. The article also offers insights into the complexity of the health equity topic due to the influence of various factors in society and at public health institutions. Stakeholders can use this knowledge to inform their responses to health inequity issues.
The use of focus groups and interviews enhanced the reliability of the study findings even though the sample was small. Besides, the researchers are experts and respected professionals in the public health field. Overall, the article offers crucial insights concerning the complexity of the issue of health inequity and the need to ensure leaders possess the necessary skills to implement health equity aspects in public health practice.
Plamondon, K. M., Caxaj, C. S., Graham, I. D., & Bottorff, J. L. (2019). Connecting knowledge with action for health equity: A Critical Interpretive Synthesis of Promising Practices. International Journal for Equity in Health , 18(1). https://doi.org/10.1186/s12939-019-1108-x
The article examines evidence-based practices that promote health equity. It shows that most public health stakeholders understand all aspects of health inequities and have the tools to address the issue. However, obsolete policies based on neoliberal ideologies hinder them from promoting health equity. The authors argue that stakeholders in the healthcare domain must use evidence to implement comprehensive interventions that address social, economic, political, and health aspects among others to solve underlying causes of health inequities. The researchers used a qualitative design in which they extracted descriptive data before identifying potential evidence-based practices for facilitating health equity. The article content can be used in public health practice to help explain why most of the implemented programs to address health inequity issues fail. In particular, the article discusses various ways of promoting health equity and the importance of dealing with the origins of health inequity.
The researchers also offers recommendations about the strategies that stakeholders can use to ensure that they develop evidence-based practices, mobilize resources based on transparent and informed understanding, and implement effective strategies. The emphasis on the political and social aspects when addressing health inequity is crucial as it demonstrates the comprehensive nature of health-related issues and the need for inclusive strategies to address them. The article is credible and reliable given that the authors are qualified experts in the public health domain. The authors are also affiliated with credible higher education institutions. Even though the study design included a small sample, the researchers offered a descriptive analysis that identified the different aspects of health inequity.
Rideout, K., & Oickle, D. (2016). Integrating Equity into Environmental Health Practice: Findings of a Pilot Study. Environmental Health Review , 59(1), 35–39. https://doi.org/10.5864/d2016-009
The article involves a pilot study that examines the intersection between social determinants of health and health equity. The authors argue that while governments are aware of the existence of health inequities, they do not fully understand the way health equity and the involved social issues influences the entire public health practice. Thus, the authors engaged in a focus group study involving public health practitioners in which they explored topics such as social barriers, the reaction of practitioners, and knowledge or resource gaps that adversely affect public health responses. Ultimately, the researchers identify the relationship between health equity and the entire public health practice.
Stakeholders can use the article to expand their scope of knowledge and find ways of integrating ecological and social determinants of health in public health practice to promote equity. Specifically, the article shows how social and environmental factors can lead to health inequity and ways in which public health institutions can eliminate adverse factors and promote and enhance health equity. The article recommends that public health agencies must incorporate social determinants of health and health equity into development programs for public health practitioners to strengthen the required skills and knowledge and promote the health equity roles of the practitioners. Knowledgeable practitioners will identify and react to equity-related issues and contribute to addressing the issue of health inequity.
The article is credible because the authors are qualified experts in public health. The study also involved two focused groups, which offered a larger sample that enhanced the quality and reliability of the findings. A credible body also approved the research, which supports the reliability of the study and its findings. While the study findings are not generalizable to a wider population owing to the use of a qualitative study design, it offers a wider view of the various aspects of the health inequity topic.
Rivenbark, J. G., & Ichou, M. (2020). Discrimination in Healthcare as a Barrier to Care: Experiences of Socially Disadvantaged Populations in France from a Nationally Representative Survey. BMC Public Health , 20(1). https://doi.org/10.1186/s12889-019-8124-z
The articles address the issue of discrimination as a determinant of health inequity. The authors state that people in socially disadvantaged populations experience different health challenges. In particular, they identify discrimination based on religion, ethnicity/race, immigration, and genders as examples of health inequity challenges. Based on this understanding, the researchers examine how the experience of discrimination in the health care environment acts as a source of health inequity. The authors used a nationally representative survey of 21,761 participants in France encompassing immigrants to explore rates of discrimination in the healthcare environment, the proportion of foregoing healthcare, and the way discrimination contributes to health inequities in foregoing care across populations. The findings showed that rates of discrimination within both types of care to be high among women, Muslims, and immigrants from overseas or Africa. The experience of discrimination for all the aforementioned groups accounted for a substantial percentage of health inequities in foregone care.
The findings of the study can be used to understand how discrimination affects the health outcomes of socially disadvantaged groups. A majority of people in these populations face high discrimination risks, which limits their access to healthcare or compels them to avoid health care. Discrimination plays a crucial role in healthcare use among socially disadvantaged groups because these groups are readily discriminated against based on their appearance besides facing multiple forms of discrimination. The affected groups represent large sections of the population, which demonstrate a significant burden. Stakeholders should consider discrimination issues when designing and implementing health policies and interventions. Nevertheless, the study was based on a cross-sectional design, which limited its ability to determine the underlying causes of discrimination in healthcare. However, the findings of discrimination and its adverse influence in healthcare are similar to studies in other environments.
Shah, G., & Sheahan, J. (2015). Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction? International Journal of Environmental Research and Public Health , 13(1), 44. https://doi.org/10.3390/ijerph13010044
The article identifies health inequities as crucial public health challenges. Health inequities concern differences in the health status and quality of healthcare within population subgroups. The differences arise mainly due to factors such as socioeconomic status, age, sexual orientation, ethnicity, and race. The researchers examined the degree to which local public health systems engage in activities focused on addressing health inequities. The articles used surveys to collect data before performing a logistic regression of the examined activities. The findings demonstrate that most public health system lack measures to address health inequities. The main barrier that hinders the implementation of measures to address the issue entails low infrastructural capacity within public health agencies at the local level.
The article reinforces the idea that health inequities relate to economic, political, and social inequities. It also shows that most public health agencies are inadequately prepared to address health inequity issues because of insufficient infrastructural abilities. Issues such as budget cuts, staff reductions, and resource shortages contribute to the inadequacy. The article recommends that public health agencies consider sharing resources across jurisdictions to enhance their economies of scale. Agencies should also rely on their informatics ability by implementing ICT innovations and using such infrastructures to address health inequity issues. The researchers also suggest that agencies should consider establishing robust ICT infrastructures as a cost-efficient strategy to address the issue.
The article used comprehensive data sources spanning several years. The data were obtained from local government departments and it enabled researchers to engage in a rigorous analysis that informed their conclusions and recommendations. In turn, this improved the reliability of the results and demonstrated its applicability in other settings. The researchers are qualified experts in the field of public health.
Stefko, R., Gavurova, B., Ivankova, V., & Rigelsky, M. (2020). Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries—Empirical Study. International Journal of Environmental Research and Public Health, 17(10), 3555. https://doi.org/10.3390/ijerph17103555
The article studies the way economic factors affect gender health inequalities within the OECD countries. The study focused on issues such as mortality and life expectancy to measure the relationship between economic factors and gender health inequalities. The researchers conducted descriptive analysis, analysis of associations, and analysis of differences before performing regression analysis. Based on the article, gender differences concerning economic measures demonstrate positive outcomes for women than for men. Besides, the researchers found that gender health inequities correlate with economic measures. Specifically, decreased gender inequities relate to increased economic prosperity. The article also shows that the decrease affects men more than women. Overall, the study demonstrates the role of economic policies in addressing health inequities in public health practice across populations.
The findings of the article show that population health is a vital component of any country. Stakeholders can use the article to understand the significant relationship between economic prosperity and health. The article stresses the importance of considering social and economic factors when attempting to implement policies aimed at addressing different health issues including health inequity. Stakeholders are required to evaluate health indicators and health inequities when evaluating the economic prosperity of their countries. While men suffer more from health inequities than women do, health policies must be focused on reducing the overall health inequities.
The study was based on a quantitative design involving descriptive statistics, which enhanced its reliability. The researchers also included a large sample as they studied all the countries in the OECD. They also obtained reliable data and used reliable analysis tools. In combination, these measures ensured reliability. The authors are also experts in economic domains, which demonstrates their credibility concerning the economic aspects of health.
References
Achdut, N., & Sarid, O. (2020). Socio-economic status, self-rated health and mental health: the mediation effect of social participation on early-late midlife and older adults. Israel Journal of Health Policy Research , 9 (1). https://doi.org/10.1186/s13584-019-0359-8
Ezomo, O. T., Sun, D., Gronbeck, C., Harrington, M. A., & Halawi, M. J. (2020). Where Do We Stand Today on Racial and Ethnic Health Disparities? An Analysis of Primary Total Hip Arthroplasty From a 2011–2017 National Database. Arthroplasty Today , 6 (4), 872–876. https://doi.org/10.1016/j.artd.2020.10.002
Hatton, C. (2016). Moving from health disparities to health inequities - and why it matters. Developmental Medicine & Child Neurology , 58 (7), 660–661. https://doi.org/10.1111/dmcn.13085
Jackson, S. E., Hackett, R. A., & Steptoe, A. (2019). Associations between age discrimination and health and wellbeing: cross-sectional and prospective analysis of the English Longitudinal Study of Ageing. The Lancet Public Health , 4 (4), e200–e208. https://doi.org/10.1016/s2468-2667(19)30035-0
Nafiu, O. O., Mpody, C., Kim, S. S., Uffman, J. C., & Tobias, J. D. (2020). Race, Postoperative Complications, and Death in Apparently Healthy Children. Pediatrics , 146 (2), e20194113. https://doi.org/10.1542/peds.2019-4113
Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a Determinant of Health: A Systematic Review and Meta-Analysis. PLOS ONE , 10 (9), e0138511. https://doi.org/10.1371/journal.pone.0138511
Pauly, B. B., Shahram, S. Z., Dang, P. T. H., Marcellus, L., & MacDonald, M. (2017). Health Equity Talk: Understandings of Health Equity among Health Leaders. AIMS Public Health , 4 (5), 490–512. https://doi.org/10.3934/publichealth.2017.5.490
Plamondon, K. M., Caxaj, C. S., Graham, I. D., & Bottorff, J. L. (2019). Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices. International Journal for Equity in Health , 18 (1). https://doi.org/10.1186/s12939-019-1108-x
Rideout, K., & Oickle, D. (2016). Integrating equity into environmental health practice: findings of a pilot study. Environmental Health Review , 59 (1), 35–39. https://doi.org/10.5864/d2016-009
Rivenbark, J. G., & Ichou, M. (2020). Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey. BMC Public Health , 20 (1). https://doi.org/10.1186/s12889-019-8124-z
Shah, G., & Sheahan, J. (2015). Local Health Departments’ Activities to Address Health Disparities and Inequities: Are We Moving in the Right Direction? International Journal of Environmental Research and Public Health , 13 (1), 44. https://doi.org/10.3390/ijerph13010044
Stefko, R., Gavurova, B., Ivankova, V., & Rigelsky, M. (2020). Gender Inequalities in Health and Their Effect on the Economic Prosperity Represented by the GDP of Selected Developed Countries—Empirical Study. International Journal of Environmental Research and Public Health , 17 (10), 3555. https://doi.org/10.3390/ijerph17103555
