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MEDICAL YEAR
IN REVIEW

The Study of

Health Disparities

By Vincent P. Fonseca, MD, MPH, FACPM

If we are to improve the health of all ities, the social determinants of health are born, grow, live, work, and age.
Texans, that is, support population health (SDOH). For example, one of the most basic con-
improvement at the state level, we must ad- We find health disparities are almost cepts in health is self-perceived health sta-
dress health disparities. everywhere we have data to examine. We tus. Self-perceived health status can be
Health disparities are preventable differ- often see disparities by race/ethnicity since categorized as excellent, very good, good,
ences in the burden of disease, injury, vio- that is often captured in health-related data fair, or poor. In the 2014 Texas BRFSS (Be-
lence, or in opportunities to achieve optimal systems. Unfortunately, in Texas and the havioral Risk Factor Surveillance System),
health that are experienced by certain pop- rest of the country, race/ethnicity isn't the 15% of non-Hispanic Whites had fair/poor
ulations. Race or ethnicity, sex, sexual iden- real cause of the disparity but is a proxy for health compared to 25% of Hispanics. His-
tity, age, disability, socioeconomic status, the root causes: food insecurity, housing in- panics' rate of fair/poor health was 67%
and geographic location all contribute to an stability, transportation problems, poverty, higher than Whites.
individual’s ability to achieve good health. low educational attainment, unemployment Here’s an example of the complex inter-
To address health disparities, we must go or unsafe jobs, or unsafe neighborhoods actions of SDOH. Neighborhoods with
upstream and address the real causes of the (violence or pollution), poor access to af- concentrated poverty and concentrated low
disparities (e.g., disparities in diabetes out- fordable, high quality health services, and educational attainment, 2 of the root causes
comes related to differences in lifestyle). others. These are called the social determi- of health disparities (SDOH), are also
Even more upstream of the real causes of nants of health. The social determinants of neighborhoods with loose dogs. They also
the disparities are the root causes of dispar- health are the conditions in which people are neighborhoods with schools that are

14 San Antonio Medicine • December 2019