Health inequities have become a major problem in the United States. Hofrichter stresses in Tackling Health Inequities Through Public Health Practice:
A Handbook for Action ( 2006) that, "The awareness of the existence of inequities in health, health status and health outcomes between racial and ethnic groups in America is as old as the nation itself" (Hofrichter, 2006,P. vii). As will be discussed in this paper, these inequalities have a wide range of repercussions, including social and psychological implications. A definition of health disparity is: "... The difference in the incidence, prevalence, morbidity, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups" ( Samuels, 2005).
There is also a consensus in the literature that inequalities in health and healthcare throughout the world are on the increase. This is largely due to the increasing gap between rich and poor within many industrialized countries. This is especially the case with regard to the United States, where "...income inequality in the U.S. is greater than in any other industrialized country in the world"(Hofrichter, 2006, p. 15). The above facts are linked to the widening gap in healthcare and access to healthcare in the country. Statistics also tend to support this view; for example, "... The U.S. ranks 29th in life expectancy for men, 21st for women; it ranks 28th in infant mortality (Hofrichter, 2006, P. 15).
As a result of these findings there has been a greater sense of concern and urgency in the country about addressing these inequalities and disparities in healthcare. This need for change and to rectify the present imbalances is stressed by the fact that "...severe health inequities are increasing significantly, with serious implications for the nation's well-being" (Hofrichter, 2006,P. vii). As a recent federal health report on the issue of health disparities states, there is little doubt that "Differences in income, gender and race influence Americans' likelihood of being healthy, sick or dying prematurely..." (Health disparities persist in U.S., report shows, 2011)
Taking the above into account, Hofrighter goes on to sketch the importance of recognizing social inequalities that can be linked health issues. He notes for instance that this has implications for local health departments (LHDs).
Health inequities -- which result from an unequal structuring of life chances -- are systemic, avoidable, unfair and unjust differences in health status and mortality rates, as well as in the distribution of disease and illness across population groups. They are sustained over time and generations and beyond the control of individuals.
(Hofrichter, 2006, p. vii)
There is a general consensus that these "unjust differences" therefore need to be rectified and the disparities reduced. Hofrichter goes on to state that these inequalities are the result of persistent and accumulating social practices. These include negative aspects such as economic and social insecurity, racial and gender inequality, lack of participation and influence in society, as well as, "…unfavorable conditions during childhood, absence of quality and affordable housing, unhealthy conditions in the workplace and lack of control over the work process, toxic environments, and inequitable distribution of public goods" (Hofrichter, 2006, p. vii).
The following discussion of the situation in Louisville will explore and expand on these views and insights. The analysis will focus on the African-American population of the city and on the prevalence of diabetes among the people of West Louisville.
2. Overview: Louisville
The city of Louisville is the largest metropolitan area in the state of Kentucky. More than 700,000 residents of the state live in Louisville (Troutman, 2006, p. 186). The minority demographics of the city are as follows: about nineteen percent of the residents of the city are African-American and five percent are Latino. (Troutman, 2006, p. 186).
In reality the city can be divided into two distinct sections. The east end of the city is more affluent and prosperous, while the west section of the city is largely composed of "economically deprived" African-Americans (Troutman, 2006, p 186). This distinction of location can be translated into differences or disparities in healthcare and access to healthy living standards. As Troutman emphasizes, " Because of the socioeconomic status of Louisville's west end, the people that live there are not getting the healthcare that they need to live long healthy lives" (Troutman, 2006, p. 186).
This disparity in terms of race and class is not, as Troutman, and other researchers point out, is not an exception to the rule and similar disparities and inequalities can be found in many other American cities. However, another concern that further problematizes the situation in Louisville as well as in many other areas is gender prejudice and the health problems that women face. Gender differences therefore further compound the disparities based on race and class.
The following discussion will therefore revolve around the disparities between those residents of lower social and economic class compared to those in the higher social and economic brackets of the community. Furthermore, the psychological as well as the social aspects of these disparities as they are reflected in treatment and access to health care will be discussed. Following on from this will be an exploration of the role of physical exercise and how this can help to reduce these differences and disparities of health between these different groups.
Before discussing these selected variables in depth one first has to establish the extent of the disparity in health care between the western and the eastern parts of Louisville. Troutman's analysis of health disparities in the city produces the following results:
The age adjusted death rate from all causes for African-Americans was 1209.5/100,000 compared to 941.3/100,000 for whites
African-Americans had higher death rates for four of the six leading causes of death in Louisville.
(Troutman, 2006, p. 186)
In terms of specific ailments and health conditions it was found that heart diseases among African-Americans in the city were 357.6 compared to 297.4 for whites (Troutman, 2006, p 187). The rate for diabetes among African-Americans living in the West side of the city was an alarming seventy-four percent higher than for whites. Other figures that attest to the disparity in health between the two sections of the city included the fact that, "The infant mortality rate was twice the rate for African-American babies as compared to whites"(Troutman, 2006, p 187-188). It was also found that, "Age adjusted death rates from cancer among African-Americans was almost twice the rate of whites at 92.8/100,000 vs. 55.9/100,000" (Troutman, 2006, p 187-188).
An interesting aspect of Troutman's study was the link between lower rates for health and healthcare and other negative social factors, such as crime. For example, Troutman found that the homicide rate for African-Americans was six times higher the rate of homicides among whites and that African-Americans in the city had much higher rates of diseases such as syphilis, gonorrhoea and HIV / AIDS "(Troutman, 2006, p.188). There are of course many other variables that contribute to these figures but what they also imply is that people who feel marginalized and who do not receive equitable health support are more likely to deviate in a social sense. One could also link these facts to the finding that African-American men had the highest smoking rate in Louisville, and this is in a state with the highest smoking rate in the nation. (Troutman, 2006, p.188)
3. Diabetes among African-Americans in Louisville.
A number of reports and studies attest to the fact that African-Americans as an ethnic group ".... disproportionately experiences illness, violence-related injuries and premature death" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity). This is a view that is consistent with the findings from studies of Louisville and particularly with regard to the western and mainly African-American section of the city. These include serious diseases such as cancer and diabetes, among others.
The health disparities are also linked to social and other inequalities, for example, in the mainly African-American neighborhood of the city "..., 39% of residents 25 years and older have not earned a high school diploma. The median household income is $21,906, compared to Louisville's $40,793" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity).
There is also a high level of alcohol abuse in this area, which in turn has serious health and sociological ramifications. For example, studies have found that alcohol abuse contributes to violent crime in the area; this in turn has the concomitant effect of impeding proper access to healthcare. As one expert notes, " Violence or the fear of it makes it harder for Louisville residents to eat healthful food and be active and also undermines efforts to create and sustain health-promoting food and activity environments" (Eliminating social and economic barriers to good health and safety: Louisville Center for Health Equity). Therefore, one could speak of a cycle of negative factors beginning with marginalization which leads to poor health outcomes.
A major health issue linked to deprived communities is diabetes. Diabetes and particularly…