Abstract
Excerpted From: Ruqaiijah Yearby, The Social Determinants of Health, Health Disparities, and Health Justice, 50 Journal of Law, Medicine & Ethics 641 (Winter 2022) (78 Footnotes) (Full Document)
For over twenty years, federal and state governments in the United States have tried to track and eliminate health disparities by addressing the social determinants of health (SDOH), which are social and economic conditions outside an individual's control that limit an individual's ability to reach their full health potential. In 2022, the federal government explicitly recognized that structural discrimination--macro-level conditions such as residential segregation--limits the conditions and well-being of less privileged groups, which keeps these groups from reaching their full health potential. However, federal and state governments have failed to adopt measures to eradicate structural discrimination in policies and plans aimed at addressing the SDOH and eliminating health disparities. Instead, they have adopted the health in all policies (HiAP) approach to integrate policy responses across sectors and used health impact assessments (HIA) to ensure decisions regarding laws and policies consider the health impacts.
Recent research has shown that the adoption of HiAP and use of HIAs has not resulted in broad changes in the SDOH or actual reductions in health disparities. Furthermore, neither the HiAP nor the HIA require the government to address structural discrimination, which research shows is one of the root causes of health disparities. For example, historical and modern-day structural discrimination in employment has limited racial and ethnic minority individuals' economic conditions by segregating them to low wage jobs that lack benefits, such as paid sick leave and health insurance. This has been associated with health disparities. Health justice provides a community-driven approach to transform the government's efforts to address the SDOH and eliminate health disparities.
Based in part on principles from the reproductive justice, environmental justice, food justice, and civil rights movements, health justice includes three guiding principles: 1) truth and reconciliation; 2) community-driven structural change; and 3) financial supports. By using these principles, the government can improve their efforts to address the SDOH and eliminate health disparities by acknowledging the problem of structural discrimination; empowering less privileged groups to create and implement structural change; and providing support to redress harm.
The purpose of this commentary is to review my revised SDOH Framework, which includes structural discrimination as one of the root causes of health disparities, and discuss why governments should adopt the principles of health justice to address structural discrimination and eliminate health disparities. This commentary proceeds as follows: Part II outlines my revised SDOH Framework, which includes many of the integral factors causing health disparities, such as structural discrimination and the law. Using home health care workers as a case study, Part III examines historical and modern-day examples of structural discrimination that have limited less privileged groups' access to higher wages and benefits, which is associated with health disparities. Finally, Part IV discusses how the government (federal and state) can address structural discrimination and eliminate health disparities through truth, reconciliation, and community-driven structural change maintained with financial support.
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Structural discrimination has resulted in centuries of unequal social and economic conditions for less privileged groups, which has limited their ability to reach their full health potential. This will take generations to fix. A 2016 research study found that “if the average wealth of a Black family continued to grow at the same pace it had over the past three decades, it would take Black families 228 years to amass the same amount of wealth White families had in 2016. That's just 17 years shorter than the 245-year span of slavery in this country. For the average Latino family, it would take 84 years to amass the same amount of wealth White families had in 2013--that's the year 2097.” Thus, it is going to take a long time, even generations, of intentional work to eradicate structural discrimination and eliminate health disparities. During this time, governments must acknowledge the problem of structural discrimination; empower less privileged groups to create and implement structural change; and provide support to redress harm.
Ruqaiijah Yearby, J.D., M.P.H., is the Co-Founder and Faculty Affiliate, Institute for Healing Justice &Equity as well as Kara J. Trott Professor in Health Law (Chair) Moritz College of Law, The Ohio State University; B.S. (Honors Biology), University of Michigan; J.D., Georgetown University Law Center; M.P.H., Johns Hopkins School of Public Health.
