Race, Disability, and Social Determinants of Health

DEI Prof-spectives
  • Patricia Fortunato
  • 05 October 2023

World Health Organization (WHO) 75th Anniversary Image

Image Alternative Text: Depicted is the World Health Organization (WHO) 75th anniversary image. The image reads, "75" and "Health for All." Beneath these words is an image of a person in a bright-colored blue, orange, green, and purple patterned outfit with images of health and medical symbols. The image is via the WHO.

 

Written by:

Patricia Fortunato, Content and Program Manager, Clinical Research and Grants, NeuroMusculoskeletal Institute (NMI); and Mental Health and Suicide Prevention Training and Content Developer, Department of Psychiatry, Rowan–Virtua School of Osteopathic Medicine (Rowan–Virtua SOM) (fortun83@rowan.edu)

Thank you to staff and faculty colleagues across Rowan University, for collaborating and helping to provide input and resources for Disability Employment Awareness Month at go.rowan.edu/ndeam.

Together with all Rowan colleges and schools, we are committed to supporting neurodivergent people and people with disabilities; and overall diversity, equity, and inclusion across our campuses and communities.

 

Interested in contributing to the Rowan University DEI website/blog and/or social media? Please complete the following brief interest form and share with student groups and colleagues across all Rowan colleges and schools: go.rowan.edu/deicontent

 

According to the World Health Organization (WHO), health equity is attainable when all people can attain "their full potential for health and well-being."1 Health, and health equity, are correlated with conditions in which people are born, live, and work, in addition to biological determinants. Structural determinants (economic, political, legal) and social norms influence distribution of power further determined by conditions in which people are born, live, and work.2 Living conditions can be and are frequently worsened by discrimination based on sex, gender, race, ethnicity, disability, age, and/or other factors.1 Understanding health equity requires identifying and eliminating inequities.

 

World Health Organization Conceptual Framework for Action on the Social Determinants of Health

Image Alternative Text: Depicted is the World Health Organization (WHO) conceptual framework for action on the social determinants of health (SDOH). The figure is divided as structural and intermediary determinants, with structural determinants comprising societal, economic, and political context of a person's life, linking to their socioeconomic position.

A person's socioeconomic position determines intermediary determinants, including biological and/or behavioral factors, psychosocial circumstances, and the health care system, and likelihood of health conditions caused by poor living conditions. These living conditions can be linked to structural determinants if a person experiences loss of income, among other factors, reducing socioeconomic status.

The image is via the WHO.1

 

The term intersectionality was conceived in 1989 by Kimberlé Crenshaw,3 civil rights advocate and scholar of critical race theory; Black feminist theory; and race, racism, and the law. Intersectionality refers to the double bind of racial and gender prejudice that Black women experience.4–5 The term has since expanded to include identity aspects related to race and disability. The socio-historical relationship between race, gender, and disability in the United States perpetuates inequalities and disparate treatment that harm Black, Indigenous, and People of Color (BIPOC).6 Racially and ethnically minoritized people with disabilities continue to experience the prevalence of racism and discrimination, and thus increased disparities in access to longitudinal integrated, trauma-informed, and culturally responsive care; health and health care outcomes; and access to SDOH including employment.7–10

 

Of the 26% of adults living in the U.S. who experience disabilities, increased disabilities are prevalent among BIPOC.11 Data also indicates that BIPOC and people with disabilities experience disparities in access to and retainment of equitable and evidence-based care,12–14 reporting unmet health care needs at higher levels than white, non-Hispanic, and non-disabled people.15–16 Further barriers include BIPOC and people with disabilities experiencing underinsurement and un-insurement,17 experiences of undocumentation,18 and overall lack of culturally responsive care.19–20 BIPOC with disabilities can experience both racism and ableism; this racism and ableism further increases disparities in health outcomes.11 Further data indicates that people with intellectual and developmental disabilities (IDD) who identify as racial and ethnic minorities experience worse health outcomes compared to white patients with IDD;22–23 and disparities in health care access and utilization for women with IDD who identify as racial and ethnic minorities.24 Among BIPOC autistic children and those with autism spectrum disorder (ASD), disparities in diagnosis and care have resulted in delayed identification and misdiagnoses.25–27

 

People with substance use disorder (SUD) are designated protections from discrimination under the Americans with Disabilities Act (ADA).28 The ADA prohibits discrimination against people with SUD who are in recovery and who are not engaging in illicit substance use.28–29 The law does not prohibit employers from maintaining substance-free workplace policies, and it does not ensure protection to people who are currently using illicit substances. Per the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the United States Department of Health and Human Services (HHS), the ADA specifically makes it illegal for employers to discriminate against people with SUD who have already secured treatment for addiction and who are in recovery.30 Additional information is available on the SAMHSA website.

 

Still, across the U.S., persistent disparities in access to and retainment of evidence-based care for BIPOC with SUD stigmatize and marginalize lives and can result in disproportionate negative effects on communities and lack of access to SDOH.31–38 Solutions must be identified to reduce racial disparities in access to SUD treatment. Centering the experiences of BIPOC with SUD in the statewide and national discourse, and listening to and elevating BIPOC with SUD, is critical to increasing engagement and access.

 

*Educational information and supportive resources focused on stigma, substance dependence and SUD/addictions treatment, and related terms and issues are available at go.rowan.edu/recovery.

 

References

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  2. World Health Organization. (2021). It's Time to Build a Fairer, Healthier World for Everyone, Everywhere. Health Equity and its Determinants.
  3. Crenshaw, K. (2013). Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. In Feminist Legal Theories (pp. 23-51). Routledge.
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