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Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 48994

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Special Issue Editor

Prof. Shervin Assari

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Guest Editor

Department of Family Medicine, Charles R Drew University, Los Angeles, CA 90059, USA
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pervasive health disparities and inequalities exist in almost all domains of health. Race, ethnicity, and economic status are among the major source of social inequalities in health. In the United States, African Americans, Hispanics, and Native Americans have worse health outcomes than other groups. There has been a considerable amount of knowledge generated recently on the mechanisms by which race, ethnicity, and other social determinants of health operate. Still, many un-answered questions remain.

The Special Issue "Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status" invites authors from disciplines such as public health, medicine, economics, psychology, demography, and sociology to submit their original and review articles that are related to inequalities and disparities in health. Papers from United States and all other countries are welcome.

Potential papers of interest include but not limited to the following:

1) Review papers;

2) Theoretical papers;

3) Differential effects, vulnerabilities, and sensitivities to same exposures across groups;

4) Differential exposures across groups;

5) Unequal effects of equal resources across groups;

6) Interactions between various social forces;

7) Tailored interventions for a specific group;

8) Policy papers;

9) Statistical, measurement, and methodological papers;

10) National studies;

11) Longitudinal studies;

12) Mediation and moderation papers;

13) Mental and behavioral health disparities;

14) Cross-country studies;

15) Intersectionality approach;

16) Life course approach;

17) Discrimination, racism, and segregation.

Prof. Shervin Assari
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Minority groups
Racial groups
Ethnic groups
Gender and sex differences
Socioeconomic position
Income
Educational attainment
Social determinants of health
Health inequality
Health disparities.

Published Papers (11 papers)

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Research

Jump to: Review

15 pages, 3616 KiB

Open AccessArticle

Can Health Disparity Be Eliminated? The Role of Family Doctor Played in Shanghai, China

by Jiaoling Huang, Qin Zhu and Jing Guo

Int. J. Environ. Res. Public Health 2020, 17(15), 5548; https://doi.org/10.3390/ijerph17155548 - 31 Jul 2020

Cited by 4 | Viewed by 2741

Abstract

Background: Globally, the elimination of health disparity is a significant policy target. Primary health care has been implemented as a strategy to achieve this target in China for almost 10 years. This study examined whether family doctor (FD) policy in Shanghai contributed to eliminating health disparity as expected. Methods: System dynamics modeling was performed to construct and simulate a system of health disparity formation (business-as-usual (BAU) scenario, without any interventions), a system with FD intervention (FD scenario), and three other systems with supporting policies (Policy 1/Policy 2/Policy hybrid scenario) from 2013 to 2050. Health disparities were simulated in different scenarios, making it possible to compare the BAU results with those of FD intervention and with other policy interventions. Findings: System dynamics models showed that the FD policy would play a positive role in reducing health disparities in the initial stage, and medical price control—rather than health management—was the dominant mechanism. However, in this model, the health gap was projected to expand again around 2039. The model examined the introduction of two intervention policies, with findings showing that the policy focused on socioeconomic status improvement would be more effective in reducing health disparities, suggesting that socioeconomic status is the fundamental cause of these disparities. Conclusions: The results indicate that health disparities could be optimized, but not eliminated, as long as differences in socioeconomic status persists. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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10 pages, 321 KiB

Open AccessArticle

The Influence of Racial Differences in the Demand for Healthcare in South Africa: A Case of Public Healthcare

by David Mhlanga and Rufaro Garidzirai

Int. J. Environ. Res. Public Health 2020, 17(14), 5043; https://doi.org/10.3390/ijerph17145043 - 14 Jul 2020

Cited by 29 | Viewed by 5638

Abstract

The study sought to analyse the influence of racial differences in the demand for public healthcare in South Africa, using the 2018 General Household Survey (GHS) data. This was completed to understand if race still plays a role in access to healthcare in post-apartheid South Africa. Logistic regression analysis revealed that race significantly explained the variance in demand for public healthcare, with White populations having the lowest probability of demand for public healthcare compared to other races. Consequently, the study noted that racial differences still play a critical role in affording one access to healthcare after assessing the situation obtaining in public healthcare. Therefore, the study recommends that the government of South Africa should create policies that encourage equal access to basic services in addressing racial inequality in the country. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

18 pages, 1150 KiB

Open AccessArticle

Socioeconomic Inequalities in Mortality among Foreign-Born and Spanish-Born in Small Areas in Cities of the Mediterranean Coast in Spain, 2009–2015

by Adriana Oliva-Arocas, Pamela Pereyra-Zamora, José M. Copete, Carlos Vergara-Hernández, Miguel A. Martínez-Beneito and Andreu Nolasco

Int. J. Environ. Res. Public Health 2020, 17(13), 4672; https://doi.org/10.3390/ijerph17134672 - 29 Jun 2020

Cited by 3 | Viewed by 1728

Abstract

Many studies have analysed socioeconomic inequalities and its association with mortality in urban areas. However, few of them have differentiated between native and immigrant populations. This study is an ecological study of mortality by overall mortality and analyses the inequalities in mortality in these populations according to the level of deprivation in small areas of large cities in the Valencian Community, from 2009 to 2015. The census tract was classified into five deprivation levels using an index based on socioeconomic indicators from the 2011 census. Rates and relative risks of death were calculated by sex, age, level of deprivation and country of birth. Poisson regression models have been used. In general, there was a higher risk of death in natives at the levels of greatest deprivation, which did not happen in immigrants. During the 2009–2015 period, there were socioeconomic inequalities in mortality, particularly in natives, who presented a higher risk of death than immigrants. Future interventions and social policies should be implemented in order to reduce inequalities in mortality amongst socioeconomic levels and to maintain the advantage that the immigrant population enjoys. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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14 pages, 1636 KiB

Open AccessArticle

Educational Inequalities in Self-Rated Health in Europe and South Korea

by Minhye Kim, Young-Ho Khang, Hee-Yeon Kang and Hwa-Kyung Lim

Int. J. Environ. Res. Public Health 2020, 17(12), 4504; https://doi.org/10.3390/ijerph17124504 - 23 Jun 2020

Cited by 1 | Viewed by 2278

Abstract

While numerous comparative works on the magnitude of health inequalities in Europe have been conducted, there is a paucity of research that encompasses non-European nations such as Asian countries. This study was conducted to compare Europe and Korea in terms of educational health inequalities, with poor self-rated health (SRH) as the outcome variable. The European Union Statistics on Income and Living Conditions and the Korea National Health and Nutrition Examination Survey in 2017 were used (31 countries). Adult men and women aged 20+ years were included (207,245 men and 238,007 women). The age-standardized, sex-specific prevalence of poor SRH by educational level was computed. The slope index of inequality (SII) and relative index of inequality (RII) were calculated. The prevalence of poor SRH was higher in Korea than in other countries for both low/middle- and highly educated individuals. Among highly educated Koreans, the proportion of less healthy women was higher than that of less healthy men. Korea’s SII was the highest for men (15.7%) and the ninth-highest for women (10.4%). In contrast, Korea’s RII was the third-lowest for men (3.27), and the lowest among women (1.98). This high-SII–low-RII mix seems to have been generated by the high level of baseline poor SRH. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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7 pages, 279 KiB

Open AccessArticle

Improving the Health of the Homeless and How to Achieve It within the New NHS Architecture

by Paul Batchelor and James Kingsland

Int. J. Environ. Res. Public Health 2020, 17(11), 4100; https://doi.org/10.3390/ijerph17114100 - 08 Jun 2020

Cited by 9 | Viewed by 3302

Abstract

The publication of the National Health Service (NHS) Long Term Plan sees the creation of Primary Care Networks as the most appropriate solution to help improve overall health and address health inequalities. A key segment of society that suffers from poor health is the homeless. While the potential for the group to benefit from the NHS reform policy programme in England exists, it requires stronger collaborative working between the health and social care sectors Not least the new arrangements provide opportunities to tackle existing disease as well as the determinants of future ill health. However, if the policy vision is to be achieved, relations between the two sectors must occur and cross sector boundaries be broken down. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

8 pages, 296 KiB

Open AccessArticle

Chronic Disease, the Built Environment, and Unequal Health Risks in the 500 Largest U.S. Cities

by Kevin M. Fitzpatrick and Don Willis

Int. J. Environ. Res. Public Health 2020, 17(8), 2961; https://doi.org/10.3390/ijerph17082961 - 24 Apr 2020

Cited by 9 | Viewed by 3356

Abstract

Health is increasingly subject to the complex interplay between the built environment, population composition, and the structured inequity in access to health-related resources across communities. The primary objective of this paper was to examine cardiometabolic disease (diabetes, cardiovascular diseases, stroke) markers and their prevalence across relatively small geographic units in the 500 largest cities in the United States. Using data from the American Community Survey and the 500 Cities Project, the current study examined cardiometabolic diseases across 27,000+ census tracts in the 500 largest cities in the United States. Earlier works clearly show cardiometabolic diseases are not randomly distributed across the geography of the U.S., but rather concentrated primarily in Southern and Eastern regions of the U.S. Our results confirm that chronic disease is correlated with social and built environment factors. Specifically, racial concentration (%, Black), age concentration (% 65+), housing stock age, median home value, structural inequality (Gini index), and weight status (% overweight/obese) were consistent correlates (p < 0.01) of cardiometabolic diseases in the sample of census tracts. The paper examines policy-related features of the built and social environment and how they might play a role in shaping the health and well-being of America’s metropolises. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

12 pages, 1104 KiB

Open AccessArticle

The Influence of Income and Livelihood Diversification on Health-Related Quality of Life in Rural Ethiopia

by Abir Majbauddin, Shinji Otani, Atsushi Tsunekawa, Nigussie Haregeweyn, Misganaw Teshager Abeje, Zerihun Nigussie, Intekhab Alam, Qing Qing, Toshio Masumoto and Youichi Kurozawa

Int. J. Environ. Res. Public Health 2020, 17(8), 2709; https://doi.org/10.3390/ijerph17082709 - 15 Apr 2020

Cited by 5 | Viewed by 2825

Abstract

Examining health-related quality of life (HRQOL) in a rural setting can be beneficial for improving rural household policies and fostering public health promotion. The objective of this study was to measure the HRQOL and associated socioeconomic characteristics as well as test the reliability of the Amharic version of SF-8 (eight-item short form of HRQOL survey). A cross-sectional study was employed in three agroecologically different sites in rural Ethiopia, involving 270 household heads (218 male and 52 female) with a mean age ± standard deviation of 49 ± 12.88 years. The survey material consisted of a structured questionnaire for socioeconomic characteristics and SF-8 for HRQOL. The mean physical and mental component summary score of the whole sample was 30.50 ± 12.18 and 34.40 ± 7.26, respectively, well underneath the instrument average of 50. The SF-8 items showed excellent internal consistency in terms of both Cronbach’s α coefficients and item–total correlation. In stepwise multiple linear regression, the low-income group had worse self-perceived physical health than the higher-income groups. Likewise, a diversified livelihood had a profound influence on positive self-perceived physical health. These findings imply that developing and distributing wide-ranging socioeconomic and public health policies is crucial for effective health promotion in rural communities. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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12 pages, 826 KiB

Open AccessArticle

Spatial Variability of Health Inequalities of Older People in China and Related Health Factors

by Mengqi Yang, Mark W. Rosenberg and Jie Li

Int. J. Environ. Res. Public Health 2020, 17(5), 1739; https://doi.org/10.3390/ijerph17051739 - 07 Mar 2020

Cited by 9 | Viewed by 2676

Abstract

China is facing serious population aging issues because of many unintended consequences of the economic reforms that began in the 1980s and with social policies such as the “one child” policy. Understanding the spatial distribution of the health status of older people has attracted more and more attention in many countries, including China. By employing descriptive analysis, this study uses data from the Chinese Population Censusand Statistical Year Bookto explore the health inequalities of older people at the national level. Based on the Getis-Ord Gi*, this study finds that the uneven spatial distribution of socio-economic status results in health inequalities for older people at the national level. The geographic distribution of life expectancy was correlated with a number of important demographic, socio-economic, and environmental variables. For further research, investigations should be conducted among individuals at micro-geographic scales. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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26 pages, 2493 KiB

Open AccessArticle

Disparity in Risk Factor Severity for Early Childhood Blood Lead among Predominantly African-American Black Children: The 1999 to 2010 US NHANES

by Deniz Yeter, Ellen C. Banks and Michael Aschner

Int. J. Environ. Res. Public Health 2020, 17(5), 1552; https://doi.org/10.3390/ijerph17051552 - 28 Feb 2020

Cited by 43 | Viewed by 11539

Abstract

There is no safe detectable level of lead (Pb) in the blood of young children. In the United States, predominantly African-American Black children are exposed to more Pb and present with the highest mean blood lead levels (BLLs). However, racial disparity has not been fully examined within risk factors for early childhood Pb exposure. Therefore, we conducted secondary analysis of blood Pb determinations for 2841 US children at ages 1–5 years with citizenship examined by the cross-sectional 1999 to 2010 National Health and Nutrition Examination Survey (NHANES). The primary measures were racial disparities for continuous BLLs or an elevated BLL (EBLL) ≥5 µg/dL in selected risk factors between non-Hispanic Black children (n = 608) and both non-Hispanic White (n = 1208) or Hispanic (n = 1025) children. Selected risk factors included indoor household smoking, low income or poverty, older housing built before 1978 or 1950, low primary guardian education <12th grade/general education diploma (GED), or younger age between 1 and 3 years. Data were analyzed using a regression model corrected for risk factors and other confounding variables. Overall, Black children had an adjusted +0.83 µg/dL blood Pb (95% CI 0.65 to 1.00, p < 0.001) and a 2.8 times higher odds of having an EBLL ≥5 µg/dL (95% CI 1.9 to 3.9, p < 0.001). When stratified by risk factor group, Black children had an adjusted 0.73 to 1.41 µg/dL more blood Pb (p < 0.001 respectively) and a 1.8 to 5.6 times higher odds of having an EBLL ≥5 µg/dL (p ≤ 0.05 respectively) for every selected risk factor that was tested. For Black children nationwide, one in four residing in pre-1950 housing and one in six living in poverty presented with an EBLL ≥5 µg/dL. In conclusion, significant nationwide racial disparity in blood Pb outcomes persist for predominantly African-American Black children even after correcting for risk factors and other variables. This racial disparity further persists within housing, socio-economic, and age-related risk factors of blood Pb outcomes that are much more severe for Black children. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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11 pages, 908 KiB

Open AccessArticle

Patterns of Change in Employment Status and Their Association with Self-Rated Health, Perceived Daily Stress, and Sleep among Young Adults in South Korea

by Eun-Sun Lee and Subin Park

Int. J. Environ. Res. Public Health 2019, 16(22), 4491; https://doi.org/10.3390/ijerph16224491 - 14 Nov 2019

Cited by 11 | Viewed by 2663

Abstract

We identified distinct trajectories of temporal changes in employment status and investigated their association with self-rated health, perceived stress, and sleep. Data pertaining to 1228 respondents (age: 17–31 years) were extracted from the Korea Youth Panel (YP2007) survey (3rd–9th wave) datasets. Participants were either paid employees (permanent or precarious) or currently unemployed but seeking a job at baseline. Latent class growth analyses were employed to extract different classes based on the annual change in employment status (permanent/precarious/unemployed). Logistic regression analyses were performed using extracted classes as predictor variables and health-related variables at the final time-point as outcome variables. Five trajectories of employment status change were identified: stability sustained; gradually deteriorated; swiftly alleviated; gradually alleviated; instability sustained. Compared with the stability sustained group, the gradually deteriorated and gradually alleviated groups showed higher odds of perceived stress. The gradually deteriorated, instability sustained, and gradually alleviated groups showed significantly higher odds of shorter sleep than the stabilized group. We highlight the adverse health effects of prolonged unstable employment and the need for interventions to mitigate these effects. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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Review

Jump to: Research

14 pages, 707 KiB

Open AccessReview

Mental Health of Refugees and Torture Survivors: A Critical Review of Prevalence, Predictors, and Integrated Care

by Hiba Abu Suhaiban, Lana Ruvolo Grasser and Arash Javanbakht

Int. J. Environ. Res. Public Health 2019, 16(13), 2309; https://doi.org/10.3390/ijerph16132309 - 28 Jun 2019

Cited by 75 | Viewed by 9285

Abstract

Civilian war trauma and torture rank among the most traumatic life experiences; exposure to such experiences is pervasive in nations experiencing both internal and external conflict. This has led to a high volume of refugees resettling throughout the world with mental health needs that primary care physicians may not be screening for and prepared to effectively address. In this article, we review the literature on demographics, predictors, mental health outcomes of torture, and integrated care for the mental health needs of refugees. We searched PubMed and PSYCINFO databases for original research articles on refugees and mental health published in the English language between 2010 and present. Nine percent of 720 adults in conflict areas in Nepal, with predominance of literate married males, met the threshold for Post-Traumatic Stress Disorder (PTSD), 27.5% for depression, and 22.9% for anxiety. While, PTSD rate has been documented as high as 88.3% among torture survivors from Middle East (ME), Central Africa (CA), South Asia (SA), Southeast Europe (SE). Depression was recorded as high as 94.7% among 131 African torture survivors and anxiety as high as 91% among 55 South African torture survivors. Torture severity, post-migration difficulties, and wait time to receive clinical services were significantly associated with higher rate of mental health symptoms. Mental health screening is not a standard component of initial physical exams for refugees, yet these individuals have had high trauma exposure that should inform clinical care. Integrated care models are lacking but would greatly benefit this community to prevent progression to greater severity of mental health symptoms. Full article

(This article belongs to the Special Issue Social Inequalities and Health Disparities Due to Race, Ethnicity, and Economic Status)

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