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Dr. James Weinstein Improving Health Equity and Health Care The Social Determinants of Health

Dr. Weinstein writes:

Equality and equal opportunity are deeply rooted in our national values, wherein everyone has a fair shot to succeed with hard work.

That said, there remain unacceptable disparities and inequities in our society and around the world. Until we deal with the social economic determinants of health we will not move the curve to the right and we will remain below the 50th percentile in many national health indicators.

In this model we address the current structural inequities and biases as well as, socioeconomic and political drivers of health inequities. The unaddressed persistence of racism, might allow parts of a nation to move our current health equity distribution to the right, but only for some of the people, not all of the people. . . .

Most all of the ‘‘social determinants’’ are very pragmatic and easily understood but have been more difficult to implement than need be. Being educated is essential on a journey to health equity. Food and housing, which many take for granted, is simply not so, especially for those who live in the shadows of our great society. Safe places, ones’ physical environment, and housing are essential components for a healthy, equitable society. Growing up next to a factory where sulfur dioxide levels that exceed environmental protection agency (EPA) requirements, absent open spaces to play, and the inability to walk to school without fear of being shot; obviously have immeasurable negative, lifelong consequences. Fortunately, most of us fail to appreciate the consequences of such inequities, as they aren’t part of our normal environment. Having decent health services, decent wages, are simply not available in many of our nation’s largest and best known cities, as many rural parts of this great nation.

As we’ve rebuilt, re-gentrified our cities, we’ve increased the tax base for any given city, all-the- while, simultaneously moving those less fortunate into diaspora. In so doing we displace those who can least afford to be moved to remote areas; lacking the necessary transportation to even consider jobs, now located at distances far from their place of housing. Therefore, the committee added, transportation to the traditional, eight ‘‘social determinants.’’ Absent new bus/train routes there is no chance these communities have equitable opportunities.

Our future is our children. Growing up in structurally inadequate areas with few safe spaces to play, nor accessible routes to walk or bike paths to school have a devastating long- term impact. Similarly, their neighborhoods may be food deserts; having small food outlets and fast-food restaurants that sell unhealthy food and sugar drinks. They lack fresh and healthy foods at affordable prices. Thus, addressing our country’s obesity epidemic is also a fight for health equity.

Editorial, Dr James N. Weinstein, Editor-in Chief, Spine
How Do We Move Beyond Regression to the Mean? Improving Health and Health Care PDF
Volume 43, Number 2, pp 73–75

National Academies of Sciences, Engineering, and Medicine, Communities in Action: Pathways to Health Equity (2017) committee report.

The Report at a Glance www.nationalacademies.org/promotehealthequity.

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