Community Health Equity

What is a Health Disparity?

It is a difference in health outcomes between groups of individuals.

What is Health Inequity?

Health disparities are considered health inequities when they are the result of unfair and systematic social, political, economic, and environmental policies and practices.

Some Important Questions on Health Inequity

Why do social and educational disparities exist?

Why is it that residents in one neighborhood live on average 20 years longer than residents in a neighborhood only 6 miles away? (2010 Health Disparities Report Card)

Why are mortality rates for heart disease three times higher for those with a high school education or less than mortality rates for college graduates? (2010 HDR)

Why are those living in a household with an annual income of $15,000 or less twice as likely to report having diabetes than those from a household where the income is $75,000 or more? (2010 HDR)

An Explanation

The health of Baltimore City residents has improved markedly over the last decade. The rate of death due to all causes has declined by 22% since 2000. Declines in death rates have been observed in major demographic groups (men, women, blacks, and whites). Yet, the gaps between these groups have remained largely unchanged.

It took years for the gaps to grow to where they are today. Generally, it’s assumed that people with higher levels of education and income have greater access to and control over health-promoting resources and opportunities. However, the mounting evidence from national scientific research indicates that where you live matters.

Things such as access to healthy foods, healthy housing, healthcare, safe neighborhoods, education and employment opportunities, and transportation – often collectively referred to as social determinants of health – play as important a role in keeping us healthy as they do in making us sick. By increasing educational and economic opportunities for all, we can significantly reduce or eliminate disparities and help people live longer, healthier lives. All city policies affect health, including housing, education, labor, finance, transportation, recreation and planning/zoning policy. It is vital that health inequities be tackled through inter-agency cooperation.

These problems are not unique to Baltimore City. They are found in cities across the country as well. Communities with the lowest educational attainment and income routinely have the worst health outcomes.

In Baltimore City, individuals residing in communities with the highest income outlive those living in communities with the lowest income by an average of 10 years, though in some neighborhoods the disparity is as high as 20 years (2010 HDR). Similarly, in communities where individuals attain the highest levels of education, the average life expectancy is 9 years greater.

More Details from the 2010 HDR

During the last decade in Baltimore City, many disparities have not only gone without improvement, but some have actually gotten worse. Compared to the rest of Maryland, Baltimore fared significantly worse on 13 of the 14 indicators for which we had comparable data, including heart disease, infant mortality, and asthma.

According to our analysis, blacks fared worse than whites on 21 of the 29 indicators in Baltimore City. For example, African American babies born here die at a rate twice as high as white babies. If we look at birth outcome disparities between blacks and whites, this disparity gets a “C”. However, if we compare the birth outcomes of different income or education levels, we see that the disparity is actually much worse.

To further illustrate the impact that income and education have, let’s look at the city-wide mortality rate from all causes, which is more than 2 1/2 times greater for people with a high school education or less than for individuals with a bachelor’s degree or higher.

The correlation between education and disease is especially pronounced when looking at HIV/AIDS deaths. The rate of death is 7.5 times greater for blacks than for whites, while the rate of death is 11.5 times greater for those with a high school education or less compared to those with a bachelor’s degree or higher. This pattern is consistent throughout the report.

Collectively, these are the reasons Baltimore City received an overall “D” for health disparities. We can achieve health equity when all people, regardless of their social position, grouping or where they live, have fair access to the resources and opportunities necessary for promoting and preserving health throughout their life.

What Went Into the 2010 Health Disparities Report Card?

  • 29 health indicators, such as life expectancy and heart disease, were reviewed.
  • Each indicator was assigned a grade based on the difference between the size of the disparity between the groups that were compared (statistical analysis).

This report, released in 2010, was the first comprehensive examination of health disparities in Baltimore. The grades in the report were based on the size of the disparities between the best-off and worst-off groups in 2008.