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Class Ethnicity Health Medicine United States Vulnerability

Social vulnerabilities and determinants of health

By Victoria Frohnhofer, BA

“Drawing attention to the central role of human freedoms in health is a statement of philosophical position and a call to social action. ”[1](Marmot)

Ethnic minorities, socially vulnerable people or marginalized groups are terms, which are often associated with struggle. The struggle to find housing, the struggle to vote (if the possibility exists) or the struggle to receive appropriate health care to name a few of these. This struggle has continued into the global COVID-19 pandemic, making it more threatening to certain groups of people than others. 75% of people who died of COVID-19 in Washington D.C. up until June 2020 were of African American descent.[2] This reality within the capital shows just how different realities can be, depending on how much melanin your skin contains. Different reasons have led to this palpable scenario. However, these reasons have been apparent long before the year 2020.

The Crux of Health and Wealth

One may think that health is solely determined by wealth, however this conclusion is a bit too linear. The complexity behind linkage of health and wealth comes with the addition of political or socio-economic progress as well as inequities. Because progress is not produced homogeneously, inequities are a side effect of it. Inequity is therefore what determines health perhaps even to a much greater extent than just wealth does,[3] even though wealth is one of the biggest forms in which inequity can be seen. For this reason, the gaps of health within even wealthy countries can be seen in crisis much more clearly. It is the amount of inequity within a country, which determines the health of its citizens, not how large its GDP (gross domestic product) is. Crisis such as the Covid-19 Pandemic have made this painfully apparent.           

Nevertheless, the GDP is important for tracking the growth and development of wealth of a country. The GDP is able to show the income of a nation as well as the proportion of its productivity within one year[4]. It is certainly a limited form of measurement for a country’s wealth since many factors are left out of the calculation or are up for interpretation. The reason for this is that wealth is defined within the GDP only in an economic way. However, other factors such as the environmental wealth of a nation, the wealth of education, health or diversity within a nation are neglected. As explained below, this is especially interesting when observing the United States of America for the reason of its ethnic diversity. However, by using the GDP, it is possible to examine the relationship between wealth and health to a certain degree and enable us to analyze how and were these two aspects of life seem to relate.

Disparity in Diversity

Socioeconomic differences and the social gradient in health[5] are, amongst other things, determining health in most countries. The social gradient in health is a concept which recognizes the correlation between inequities between social classes and population health.[6] The United States makes for a compelling example because of its ethnic diversity and its use of statistical measurements on the basis of these multiple ethnic groups. It is in this country with the highest GDP globally[7] in 2019, that ethnicity still plays perhaps the largest role in one’s health. Being of African American descent in the United States automatically places your life expectancy on the lowest scale[8] compared to other ethnicities. With ethnicity as the major determinants of health within this exceedingly wealthy nation, it is clear that the overall economic wealth of a nation does not automatically produce health in all of its citizens.                                       

It must be said that ethnicity, economic wealth and therefore health are nevertheless interconnected. Even though the economic wealth of a nation may not automatically produce health in its citizens, the lack of personal financial wealth can very well be the cause of a lack in health. An example is the African American community, for whom the poverty rate was more than 10% higher in 2010 than for other US Americans.[9] Reasons for this high amount of African Americans living below the poverty line are that many African Americans work in the low wage sector and in general, earn lower wages than Americans of other ethnicities, regardless of their workplace.[10] This increases the chance of falling below the poverty line. Thus, by understanding that there is an interconnection between low income and low health,[11] it becomes clear that the African American community faces a much greater struggle in obtaining and preserving their health. The most recent health crisis in the United States, the COVID-19 Pandemic, has made this inequity once more exceedingly visible through a death toll that was different for specific ethnic groups.

Feasibility vs. Possibility 

Considering the knowledge we have in todays global world regarding the correlation between health, wealth as well as ethnicity, the inequity within a nation such as the United States of America is logical and at the same time disheartening. Therefore, it is necessary to view the possibilities that a nation with the largest GDP has to implement political and economic changes in order to produce a shift in this inequity. The fact that this inequity has been a known issue for decades, makes it even more confounding as to why this predicament has not yet been tackled in a sustainable way. One may even hypothesize that it has suited successive governments not to eliminate the factor of ethnicity as a determinant of health. As a result, the possibilities of advancement in health for African Americans are limited, making social vulnerability a continued determinant of health.

References

Bloom, David E. “The Health and Wealth of Nations” American Society for the Advancement of Science, vol. 336 (18th February 2000), pp. 1207-1209.

Deaton, Angus “The Great Escape – Health, Wealth, and the Origins of Inequality”. Princeton: Princeton University Press, 2013.

Kosteniuk, Julie G, and Harley D. Dickinson. “Tracing the social gradient in the health of Canadians: primary and secondary determinants. Social Science & Medicine vol. 57;2 (July 2003), pp. 263-276.

Marmot, Michael “Health in an unequal world: social circumstances, biology, and disease”. The Lancet, vol. 336 (9th December 2006), pp. 2081-94.


Websites:                    

https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020)

https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)


[1] Michael Marmot “Health in an unequal world: social circumstances, biology, and disease” The Lancet, vol. 336 (9th December 2006), 2081-94.

[2] https://coronavirus.dc.gov/release/coronavirus-data-june-5-2020 (5.12.2020).

[3] Angus Deaton The Great Escape – Health, Wealth, and the Origins of Inequality. Princeton, Universtiy Press, 2013.

[4] Ibid.

[5] Marmot, 2006.

[6] Julie Kosteniuk and Harley D. Dickinson “Tracing the social gradient in the health of Canadians: primary and secondary determinants” Social Science & Medicine vol. 57;2 (July 2003), 263-276.

[7] https://data.worldbank.org/indicator/NY.GDP.MKTP.CD?locations=US&most_recent_value_desc=true (2.1.2021)

[8] Deaton, 2013.

[9] Ibid. (see Figure on p.180)

[10] Ibid.

[11] David E. Bloom “The Health and Wealth of Nations”. American Society for the Advancement of Science, vol. 336 (18th Febuary 2000), 1207-1209