Health Disparities Factors

Why This Matters

Health disparities aren't random—they follow predictable patterns rooted in how society distributes power, resources, and opportunity. When you're studying public health, you're being tested on your ability to identify why certain populations experience worse health outcomes and how these factors interconnect. The exam will ask you to trace the pathways between social conditions and health, not just list demographic categories.

Think of health disparities as the measurable outcomes of social determinants of health—the conditions in which people are born, grow, live, work, and age. These factors operate at multiple levels: individual, interpersonal, community, and systemic. Don't just memorize which groups experience disparities—know what mechanisms create them and how they compound over a lifetime.

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Structural and Systemic Barriers

These factors reflect how institutions and policies create unequal access to health-promoting resources. Systemic barriers are embedded in laws, practices, and organizational structures that disadvantage certain groups regardless of individual behavior.

Socioeconomic Status

• Income and wealth determine access to nearly every health resource—from nutritious food to safe housing to quality healthcare, economic position shapes daily health decisions
• Chronic stress from economic instability triggers physiological responses that increase risk for cardiovascular disease, diabetes, and mental health disorders
• Intergenerational poverty compounds health effects, as children born into low-SES families face developmental disadvantages that persist into adulthood

Race and Ethnicity

• Systemic racism operates through multiple pathways—residential segregation, employment discrimination, and unequal school funding all contribute to health disparities
• Weathering hypothesis explains how chronic exposure to discrimination accelerates biological aging in racial minorities, leading to earlier onset of age-related diseases
• Medical mistrust stems from historical abuses (like the Tuskegee study) and ongoing experiences of bias, reducing healthcare utilization even when services are available

Access to Healthcare

• Insurance status is the strongest predictor of whether someone receives timely care—uninsured individuals are more likely to delay treatment until conditions become emergencies
• Provider shortages in underserved areas create geographic barriers even for those with insurance coverage
• Preventive care gaps among underserved populations lead to late-stage diagnoses and higher mortality rates for treatable conditions

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Geographic and Environmental Determinants

Where you live shapes what health resources you can access and what hazards you're exposed to. Place-based disparities reflect the uneven distribution of both health-promoting amenities and environmental risks.

Geographic Location

• Rural-urban divide affects provider availability, with rural areas averaging fewer physicians, specialists, and mental health professionals per capita
• Transportation barriers in rural and low-income urban areas prevent residents from reaching healthcare facilities, pharmacies, and healthy food sources
• Emergency response times vary dramatically by location, affecting survival rates for heart attacks, strokes, and trauma

Environmental Factors

• Environmental racism describes the pattern of locating polluting industries, waste facilities, and highways in communities of color and low-income neighborhoods
• Built environment influences health behaviors—access to sidewalks, parks, and grocery stores shapes physical activity levels and dietary patterns
• Housing quality affects respiratory health, injury risk, and mental well-being through factors like mold, lead paint, and overcrowding

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Identity-Based Disparities

These factors relate to how social identity categories intersect with healthcare systems and cultural norms. Discrimination, stigma, and lack of culturally competent care create barriers specific to marginalized identity groups.

Gender

• Reproductive health needs require gender-specific services, and restrictions on these services disproportionately affect women's health outcomes
• Gender bias in medicine leads to underdiagnosis of conditions like heart disease in women, whose symptoms often present differently than the male-based diagnostic criteria
• Masculinity norms discourage men from seeking preventive care and mental health services, contributing to higher rates of suicide and later-stage cancer diagnoses

Sexual Orientation

• Minority stress model explains elevated rates of anxiety, depression, and substance use among LGBTQ+ individuals as responses to chronic discrimination and stigma
• Culturally competent care remains limited, with many providers lacking training in LGBTQ+ health needs and creating unwelcoming clinical environments
• Legal and policy barriers in some regions restrict access to affirming care, insurance coverage, and partner recognition in medical decision-making

Disability Status

• Physical accessibility barriers in healthcare facilities prevent many disabled individuals from receiving routine care, including basic screenings
• Communication barriers affect deaf, blind, and cognitively disabled patients who may not receive information in accessible formats
• Ableism in healthcare leads to diagnostic overshadowing, where providers attribute all symptoms to the disability rather than investigating other conditions

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Life Course and Individual Factors

These factors operate across the lifespan and influence how individuals interact with health systems. Age and education shape both health literacy and accumulated exposure to risk and protective factors.

Education Level

• Health literacy increases with education, enabling individuals to navigate complex healthcare systems, understand medical information, and advocate for themselves
• Employment pathways link education to jobs with health insurance, paid sick leave, and safer working conditions
• Critical period effects mean that educational disadvantages in childhood have lasting impacts on adult health, independent of later achievements

Age

• Cumulative disadvantage means that disparities widen across the lifespan as early exposures compound over time
• Multiple chronic conditions become more common with age, requiring complex care coordination that many healthcare systems handle poorly
• Developmental vulnerabilities affect young people differently—adolescents face unique mental health challenges while children are more susceptible to environmental toxins

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Quick Reference Table

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Self-Check Questions

1. Which two factors best illustrate how place-based determinants create health disparities, and what distinguishes their mechanisms?

2. A patient experiences discrimination from providers, chronic stress from social stigma, and limited access to culturally competent care. Which health disparity factors could explain this pattern, and how do they overlap?

3. Compare and contrast how socioeconomic status and education level influence health outcomes. What pathways do they share, and where do they diverge?

4. If an FRQ asks you to explain why a specific racial/ethnic group has higher rates of hypertension, which factors would you discuss and how would you connect them?

5. Using the life course perspective, explain how health disparities in childhood (related to SES or education) might manifest as chronic disease disparities in older adults.