The differences in health status and disease burden (e.g., lower quality of life, financial costs, and death) exist among specific populations based on social or demographic factors such as race and income.
Social Determinants of Health
The conditions in which people are born, grow, live, work and age (e.g., air quality, schools, parks, jobs, housing conditions, etc.).
Health equity is when every person has a fair and equal opportunity to be as healthy as possible and no one is disadvantaged in achieving optimal health due to social factors.
Health inequities are the systematic, avoidable, unfair, and unjust differences in health status across population groups that follow larger patterns of inequality in society.
These were the findings of researchers from Northern Arizona University’s Southwest Health Equity Research Collaborative, in collaboration with multisectoral leaders from across northern Arizona, who recently published results from their statewide rural health equity survey (RHES) in “A Multisectoral Approach to Advance Health Equity in Rural Northern Arizona: County-Level Leaders’ Perspectives on Health Equity” in BMC Public Health.
“Multisectoral collaboration is essential in shaping the health and wellbeing of the communities in which we live, learn, work, play, and grow,” said lead author Dulce Jiménez, SHERC research coordinator. “Our work explored how regional leaders from different sectors, all important to community health, understand the social determinants of health and health equity.
In the publication, researchers from SHERC’s Community Engagement Core (CEC) examined the root causes of health inequity in northern Arizona, in the state and throughout the nation, which are the underlying social, economic and environmental inequalities that create different living conditions.
According to the researchers, discrimination based on class, race, ethnicity, immigration status, gender, sexual orientation, disability and other “-isms” influences the distribution of resources and power, which creates an unequal distribution of beneficial opportunities and negative exposures for people who are underrepresented, resulting in health inequities.
The study’s authors include Jiménez; Samantha Sabo, associate professor for the Center for Health Equity Research (CHER) and the Department of Health Sciences, and co-lead of the SHERC CEC; Mark Remiker, Alexandra Samarron Longorio and Carmenlita Chief, all senior research coordinators; Melinda Smith, CHER graduate assistant and doctoral student in the NAU interdisciplinary health program; Heather Williamson, associate professor in the NAU Department of Occupational Therapy and CHER; Nicolette Teufel-Shone, CHER associate director, professor in the Department of Health Sciences, and co-lead of the SHERC CEC.
“Establishing a common understanding of health equity can support effective and sustainable partnerships across sectors — helping partners of diverse personal and professional backgrounds align the visions and goals of organizations and communities and leverage their expertise and resources in improving community wellbeing and strengthening health equity,” Jiménez said.
The RHES survey
The goal of the RHES was to understand multisectoral leaders’ perspectives and strategies for action on the social determinants of health and the root causes of health inequity in the largely rural, culturally diverse region of northern Arizona.
Specifically, the RHES assessed knowledge, attitudes, and actions among 206 county-level leaders representing five counties and 13 distinct sectors. Leaders came from sectors representing: community health and economic development; health and human services; law, justice, and public safety; parks and recreation; policy; early childhood development; transportation; food systems; housing; education; arts, music, and culture; planning and zoning; and cultural resources management.
The online survey contained 48 questions, including 17 open-ended questions, and asked leaders to describe the primary community they serve, including how resources are distributed and the root causes of health inequity within their community.
Multi-sectoral leaders know and care about the social determinants of health and the root causes of health inequity affecting their communities
Researchers found that multisectoral leaders varied in their understanding of the social determinants of health—which is defined as the conditions in which people are born, grow, live, work and age—and in their understanding of the root social, economic, and environmental causes of health inequity experienced by their communities. Leaders who took the survey were actively engaged in creative community-focused strategies to address health inequities locally and regionally.
When northern Arizona leaders from different sectors were aware of the drivers of health inequity, especially the SDoH facing the communities they serve, they were able to describe the interplay of complex systems of oppression that place people of color and individuals living in poverty at a greater disadvantage. These disadvantages can lead to adverse health outcomes in their communities.
Despite variability in how leaders from different sectors understand the concept of health inequity, they expressed a strong desire to change the status quo across their region.
Ultimately, the results of this assessment suggest that although multisectoral leaders recognize SDoH and to some extent the root causes of health inequity, and are motivated to collaborate to create positive change, they may not have a common understanding of what health equity is and how to advance health equity through policy, program, and practice goals.
Addressing health equity locally and regionally
According to the publication, without a shared understanding of health equity, partners who work together may struggle to participate in important conversations, develop policy and practice goals, and allocate resources to address health inequities.
“Collaboration and a clear vision of health equity are core criteria in advancing policy, program, and practice goals for change,” Sabo said. “It was inspiring to learn from multisectoral leaders of northern Arizona. We found that northern Arizona community leaders understand the importance of and engage in multisectoral collaborations in improving health equity for all and are motivated to tackle the issue together.”
The researchers believe there will be a critical shift in the understanding of justice, fairness, and power structures as the national focus evolve from a health disparities focus to SDoH and finally to an intentional commitment to health equity.
“The survey provided a baseline to assess collective capacity across sectors in addressing health inequity in northern Arizona and inform multisectoral action for improving community health,” Jiménez said. “What we learned from leaders through the survey will serve as the basis for a productive dialogue about the unique contributions that each sector can activate to strengthen health equity in the region.”
This research received funding from the Southwest Health Equity Research Collaborative at Northern Arizona University (U54MD012388), which is sponsored by the National Institute on Minority Health and Health Disparities (NIMHD).