The reasons behind persisting health disparities across socioeconomic class in America are not fully understood. A 1.2:4.0 mortality rate ratio exists among people in the lowest socioeconomic class and those in the highest socioeconomic class (Cohen, Farley, & Mason, 2003). The difference in mortality ratios indicates that socioeconomic status plays a significant role not only in mortality rates, but also in the quality of life across socioeconomic classes.
In the year 2012, a report by the New York City (New York City Health Department, 2012))Health Department indicated that hospitalization rates in neighborhoods with high poverty levels more than tripled the rates of neighborhoods with lower poverty levels (New York City Health Department, 2012). The differences in hospitalization rates strongly indicate that socioeconomic status is directly or indirectly related to quality of health. Health disparities in the developed world are influenced by medical knowledge, economic status, availability of ambulatory care and a variety of physical and social elements (Cohen, Farley, Mason, 2003, "New Dimensions in Women's Health, Fifth Edition", 2016, New York City Health Department, 2012).
The underlying elements within and across socioeconomic status that influence quality of health can be found by comparing differences in lifestyle, social support, and the physical environment (Cohen, Farley, Mason, 2003). The quality of health of NYC citizens at the time of the 2012 NYC health report is indicative of a society that was lacking in medical knowledge, social support, safe and nurturing physical environments, and healthy lifestyle choices. The absence of the above mentioned elements is evident by comparing the low ambulatory care sensitive (ACS) hospitalization rates of NYC’s upper east side against the high ACS hospitalization rates of Highbridge-Morrisania.
Of the five most common ACS hospitalization conditions indicated in the NYC’s department of health report, congestive heart failure, diabetes and hypertension rank highest in terms of hospitalization percentage. The prevalence of these diseases in societies with low socioeconomic status can be linked to low physical exercise among populations of similar neighborhoods. Conditions such as congestive heart failure, diabetes and hypertension are known to be preventable and manageable through physical exercises as simple as walking or jogging.
In her TED talk, Dr. Anthony mentions the differences in the physical lifestyles of people in Indiana suburbs against those of people in her native Detroit neighborhood. In Indiana it was a norm to witness people running, walking or jogging down the street, a phenomenon that was absent in Detroit due to police harassment, and deteriorating and unsafe neighborhoods (TED). A study by Cohen, Farley, and Mason (2003) found a link between deteriorated neighborhoods and decreased physical activity.
Depreciated neighborhoods hinder the growth of healthy behaviors such as walking, jogging and running, all of which are preventative mechanisms for several diseases and health conditions. In the case of NYC, it can be established that high poverty neighborhoods of highbridge-Morrisania do not promote such healthy behaviors. Deteriorated neighborhoods associated with decreased physical activity are a significant contributor to cardiovascular disease and mortality (Cohen, Farley, Mason, 2003).
Social support measured via social interaction has also been found to increase longevity (Cohen, Farley, Mason, 2003). Increased social interactions promote positive psychological and mental health which have been linked to improved recovery rates and reduced hospitalization. However, due to high insecurity and crime neighborhoods with high poverty levels have low social interactions and consequently low levels of social support. Threatening conditions such as deteriorating neighborhoods and high crime rates make residents feel more distrustful and powerless and are consequently unable to develop positive social relationships (Cohen, Farley, Mason, 2003).
The disparities present in NYC hospitalizations in the year 2012 can be explained by physical and social elements of the NYC neighborhoods. Other than physical and social influences of health quality, affordability of care plays a significant role, especially in the quality of women’s health. Health disparities are borne even more by women due to their longer life expectancy and increased economic expectations by both family and medical insurers.
Despite the increasing economic contribution of women in America, women living in low socioeconomic neighborhoods are disproportionately disadvantaged in their ability to afford and or access quality health care. The health disparities of women living high poverty neighborhoods are seen in the form of inadequate childcare, inadequate education, no access to resources, and poor or non-existing social support systems ("New Dimensions in Women's Health, Fifth Edition", 2016). As a consequence of the health disparity faced by women, 24% of nonelderly women compared to 16% of non-elderly men went without care in the YEAR due to financial constraints ("New Dimensions in Women's Health, Fifth Edition", 2016).
Health disparities in America exist in two major ways. Firstly, disproportionately among neighborhoods with high poverty levels and secondly, disproportionately among women. Improving health disparities can be achieved by increased ACS and preventative care. The report by NYC health department notes that 15% of assessed hospitalizations were avoidable through ACS outpatient treatments (New York City Health Department, 2012). Moreover, improving the living conditions of high poverty neighborhoods will promote healthy behaviors and consequently reduce mortality.
References
Anthony, R. S. (2012, October). Renaisa S. Anthony:A reciepe for health equity in the 21st
century [video file]. Retrieved from https://youtu.be/ywQJGnzQKGs
Cohen, D., Farley, T., & Mason, K. (2003). Why is poverty unhealthy? Social and physical
mediators. Social Science & Medicine, 57(9), 1631-1641. http://dx.doi.org/10.1016/s0277-
9536(03)00015-7
New Dimensions in Women's Health, (2016). Womenshealth.jbpub.com. Retrieved
12 May 2016, from http://womenshealth.jbpub.com/5e/chapter_outlines.cfm
New York City Health Department,. (2012). Preventing hospitalizations in New York City. New
York: New York City Department of Health. Retrieved from
http://www.nyc.gov/html/doh/downloads/pdf/survey/survey2012hospitalizations.pdf
