The Socio Ecological Model in Healthcare

Prince George’s County, Maryland: Psychosocial Factors and Health Inequities

Morbidity and Mortality

Infant Mortality by Race/Ethnicity

Infant mortality rate declined by 16% from 2008 to 2017 (Infant Health Fact Sheet, 2018). Infant mortality rate for blacks was 12.0 deaths for every 1000 black babies born in 2017 but 8.2 according the Community Needs Assessment (2018). It was 5.2 for every 1000 Hispanic babies born in 2017. Overall, it was 8.2 for every 1000 babies born in 2017 (Infant Health Fact Sheet, 2018).

County

State

Nation

Whites

Blacks

Asian

Hispanic

NA/PI

Other

Death Rates/Life Expectancy by Race/Ethnicity

Death rate/life expectancy for the county is 690.4/79 overall. For blacks it was 735.2, with life expectancy of 75, from 2015-2019. For whites it was 719.3 with life expectancy of 80 over the same time span. For Hispanics it was 410.5/82. For Asians it was 387.8/85 (HDPulse, 2022; World Life Expectancy, 2022).

County

State

Nation

Whites

Blacks

Asian

Hispanic

NA/PI

Other

Obesity by Race/Ethnicity

The adult obesity rate is 33.8% in this county (Open Data Network, 2022). The information on obesity by race/ethnicity for the county is the following: 34.6 for whites, 38.9 for blacks, 20.9 for Hispanics. For the entire state of Maryland, for blacks it is 38.6 and for whites it is 28.9, and for Hispanics it is 30.9, so the numbers are slightly higher for whites and blacks in the county vs. the state (America’s Health Rankings, 2022).

County

State

Nation

Whites

Blacks

Asian

Hispanic

NA/PI

Other

Diabetes by Race/Ethnicity

Information on diabetes deaths for the county shows 87 deaths per 1000 blacks, 65 for whites, and 34 for Asians (Live Stories, 2022). Diabetes is the leading cause of death for blacks and Asian non-Hispanics in the county (Community Needs Assessment, 2018). Overall, for the county 13.7% of White, non-Hispanic (NH) and 13.4% of Black NH residents are estimated to have diabetes, while only 2% Hispanic have diabetes (Community Needs Assessment, 2018).

County

State

Nation

Whites

Blacks

Asian

Hispanic

NA/PI

Other

Heart Disease by Race/Ethnicity

Black nonHispanic residents have a higher rate of Emergency Department visits for Heart Disease, but White, non-Hispanic residents have a higher mortality rate (White non-Hispanic men have the highest mortality rate at 250.1 per 100,000 in 2012-2014) (Community Needs Assessment, 2018; America’s Health Rankings, 2022).

County

State

Nation

Whites

Blacks

Asian

Hispanic

NA/PI

Other

Community Indicators vs. State Indicators

Diabetes is the leading cause of death in the county and the following chart shows how that compares to the rest of the state and to the US as well, according to race/ethnicity.

Existing Health Disparities

One existing health disparity is found in infant mortality and that may be due to lack of access to care and to socioeconomic status as well as culture, with regard to white communities vs. black communities vs. Hispanic communities. For instance, the infant mortality rate for black infants is nearly double that of white infants in the county and more than double that nationwide. While there are many factors that contribute to this disparity, it is clear that access to quality healthcare plays a role. Black and Hispanic women are more likely to be uninsured than white women, and they are also more likely to live in communities with limited access to quality healthcare. In addition, socioeconomic status is a key factor in health outcomes. Black and Hispanic women are more likely to live in poverty than white women, and they are also more likely to experience other social disadvantages, such as racism and discrimination. These factors can all contribute to poorer health outcomes for black and Hispanic infants.

Additionally, culture and education can play a part. Different cultures have different beliefs about health and illness. For example, some cultures may view certain illnesses as punishment from a higher power, while others may believe that sickness is simply a part of life. These beliefs can influence how people approach their own health and the health of their loved ones. They may be less likely to seek medical help or follow treatment plans if they believe that there is nothing that can be done to improve their condition. As a result, healthcare disparities continue to persist in our society.

Education is another key factor that contributes to healthcare disparities. People who are not familiar with the healthcare system may be hesitant to seek out care or may not know where to go for help. Language barriers can also make it difficult for people to communicate with their providers and understand important information about their health. As a result, they may delay or forego treatment altogether.

Analysis

Social and structural factors that may exist in the county could be rooted in racism and discrimination, which may be institutionally and systemically prevalent in many areas of society without people realizing it. This can lead to lower-quality healthcare for blacks, as well as reduced access to essential resources like food and safe housing. Additionally, poverty is more common among blacks in Prince George's County, which can also impact health outcomes. Poverty can lead to poor nutrition and increased stress levels, both of which can contribute to higher rates of infant mortality. While there is no easy solution to address these disparities, it is important to acknowledge the role that social and structural factors play in creating them. Only by understanding the root causes of the problem can we hope to find ways to reduce the disparity in infant mortality rates between blacks and whites in Prince George's County.

Health determinants are the circumstances in which people are born, grow, live, work, and age, which can impact health outcomes. For example, poverty is a health determinant that has been linked to poorer health outcomes. Studies have found that black women are more likely to experience poverty than white women, which could partially explain why black infants are more likely to die than white infants. Additionally, racism is another health determinant that has been associated with poorer health outcomes. Black women have historically experienced racism in the form of discrimination and violence, which can lead to chronic stress and poor mental and physical health. Consequently, addressing health determinants such as poverty and racism could help to reduce healthcare disparities among whites and blacks with respect to infant mortality differences.

There are a number of "upstream factors" that contribute to healthcare disparities between whites and blacks with respect to infant mortality. One significant factor is the socioeconomic status of the mother. Mothers who are of lower socioeconomic status are more likely to experience poorer health outcomes for their infants. This is due to a number of factors, including lack of access to quality healthcare, poor nutrition, and increased stress levels. Another important factor is education. Mothers who have higher levels of education are more likely to be knowledgeable about prenatal care and how to keep their babies healthy. They are also more likely to have the resources to access quality healthcare. Finally, racism is a significant upstream factor that contributes to healthcare disparities.

When examining these differences through the lens of the socio-ecological model, it is clear that a variety of factors at different levels contribute to this disparity. At the individual level, health behaviors and access to care are both important factors. For example, black women are more likely to smoke during pregnancy and are less likely to receive prenatal care than white women. At the interpersonal level, racism and discrimination play a role in creating healthcare disparities. Black women may receive poorer quality care from providers or be less likely to have their concerns addressed by medical staff. At the institutional level, systemic problems like unequal funding for public health initiatives or understaffing of hospitals in predominantly black neighborhoods can contribute to healthcare disparities. Finally, at the societal level, structural inequalities like poverty or lack of access to transportation can make it difficult for black women to get the care they need during pregnancy and after childbirth. By understanding how these various factors interact, we can begin to address healthcare disparities among whites and blacks with respect to infant mortality.