Although the science is still evolving, it is hypothesized that the chronic stress associated with being treated differently by society is responsible for these persistent differential birth outcomes ( Christian, 2012 El-Sayed et al., 2015 Strutz et al., 2014 Witt et al., 2015). The impact of structural inequities follows individuals “from womb to tomb.” For example, African American women are more likely to give birth to low-birthweight infants, and their newborns experience higher infant death rates that are not associated with any biological differences, even after accounting for socioeconomic factors ( Braveman, 2008 Hamilton et al., 2016 Mathews et al., 2015).
N.y. courts seek root out is code#
Such structural inequities give rise to large and preventable differences in health metrics such as life expectancy, with research indicating that one's zip code is more important to health than one's genetic code ( RWJF, 2009). Because the quality of neighborhoods and schools significantly shapes the life trajectory and the health of the adults and children, race- and class-differentiated access to clean, safe, resource-rich neighborhoods and schools is an important factor in producing health inequity. So, for example, the effect of interpersonal, institutional, and systemic biases in policies and practices (structural inequities) is the “sorting” of people into resource-rich or resource-poor neighborhoods and K–12 schools (education itself being a key determinant of health ( Woolf et al., 2007) largely on the basis of race and socioeconomic status. These multiple determinants are the conditions in which people live, including access to good food, water, and housing the quality of schools, workplaces, and neighborhoods and the composition of social networks and nature of social relations.
The social, environmental, economic, and cultural determinants of health are the terrain on which structural inequities produce health inequities.
N.y. courts seek root out is drivers#
Policies that foster inequities at all levels (from organization to community to county, state, and nation) are critical drivers of structural inequities. Structural inequities are the personal, interpersonal, institutional, and systemic drivers-such as, racism, sexism, classism, able-ism, xenophobia, and homophobia-that make those identities salient to the fair distribution of health opportunities and outcomes. The dimensions of social identity and location that organize or “structure” differential access to opportunities for health include race and ethnicity, gender, employment and socioeconomic status, disability and immigration status, geography, and more. Health inequities are systematic differences in the opportunities groups have to achieve optimal health, leading to unfair and avoidable differences in health outcomes ( Braveman, 2006 WHO, 2011). HOW STRUCTURAL INEQUITIES, SOCIAL DETERMINANTS OF HEALTH, AND HEALTH EQUITY CONNECT Box 3-1 includes the definitions of structural inequities and the social determinants of health. The second, and more fundamental root cause of health inequity, is the unequal allocation of power and resources-including goods, services, and societal attention-which manifest in unequal social, economic, and environmental conditions, also called the social determinants of health.
The first is the intrapersonal, interpersonal, institutional, and systemic mechanisms that organize the distribution of power and resources differentially across lines of race, gender, class, sexual orientation, gender expression, and other dimensions of individual and group identity (see the following section on such structural inequities for examples). The report identifies two main clusters of root causes of health inequity. Health inequity, categories and examples of which were discussed in the previous chapter, arises from social, economic, environmental, and structural disparities that contribute to intergroup differences in health outcomes both within and between societies.
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