Socioeconomic inequality drives inequities in health
In the updated Healthy People goals for 2030, the U.S. Department of Health and Human Services is bringing important social determinants of health — factors such as food and housing access, racism, and education — to the forefront of public health.
The Healthy People initiative, which sets quantifiable objectives for the United States each decade, was launched in 1979 to establish goals for improving public health. Healthy People 2030 is the fifth iteration of program objectives, and defines social determinants of health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The five types of SDOH include economic stability, education access and quality, healthcare, neighborhood and built environment, and social and community context.
When socioeconomic inequality exists in each of these areas, inequity in health also arises. For example, proficiency or lack of language and literacy skills can dramatically impact the communication between a patient and a healthcare provider. Polluted air and water in or near low-income communities creates more dangerous living conditions. Neighborhoods without grocery stores limit a person’s access to nutritious food, which can lead to a myriad of health concerns like heart attacks and diabetes.
Given these inequalities, Healthy People 2030 states that it’s not enough just to encourage people to make healthy decisions. Instead, organizations need to be established to reduce the inequality at the root of the problem, making healthy decisions attainable. By extension, improving public services such as education, transportation, and housing can directly benefit the health of every community member.
The focus on health equity and literacy in underprivileged communities is especially important during the COVID-19 pandemic, since health disparities for people in these communities have put them at higher risk of contracting or dying from the virus. These disparities have brought to light the racial and ethnic groups that are historically susceptible to infectious and chronic disease because of SDOH. The issue goes beyond the coronavirus; lower socioeconomic groups are disproportionately affected by other conditions as well, like cardiovascular disease.
Healthy People 2030 strives to raise awareness for these conditions and others. The goals also outline healthy behaviors like exercise and healthy eating, as well as behaviors to avoid, like tobacco and nicotine use. Specific goals include a mental health objective (80.1% of adults reporting good mental health) and a physical health objective (79.8% of adults). The goals are primarily focused on community well-being and quality of life, especially for vulnerable groups like children and the elderly, unlike the 2020 goals, which focused more on individual health. The program reports that many of the Healthy People 2020 goals were met, including basic goals surrounding heart disease and stroke. However, not every goal saw improvement over the decade. Obesity rates, for example, rose, putting more Americans at risk of diabetes and high blood pressure. The US also failed to meet the goal for the number of people vaccinated against the flu—the current baseline is 49.2%, with a Healthy People 2030 goal of 70%. The rates for the flu vaccine are particularly low in the same communities heavily impacted by COVID-19, presenting a challenge for future vaccinations against the coronavirus.