The Importance of Place
Disparities are about more than the people, they are also about the place. Remember we looked at the influence of geography on multiple health services measures: hospital beds, Medicaid eligibility, uninsurance rates and more. While overall life expectancy in the United States has improved, racial and socioeconomic disparities in mortality and health status have widened. Many Americans fail to receive treatments of proven benefit -- a burden that falls most heavily on racial and ethnic minorities, and low-income populations. As numerous studies have documented, income and race are important determinants of both the health care patients receive and of patients' health care outcomes.
These disparities are particularly striking when examined across US states and regions; it's not only who you are that matters, but also where you live. Indeed, many studies that report racial disparities based on national samples do not account for the tremendous variation across regions and procedures. The rate of leg amputation -- a devastating complication of diabetes and peripheral vascular disease -- is four times greater in blacks than in whites; but rates of amputation vary nearly tenfold across regions. For evidence-based services, such as screening mammography and appropriate testing for diabetes, disparities across regions are substantially greater than the differences by race; there are some regions where blacks receive equal or better care than whites but where care for all patients is less than ideal.
Geographic variations in health care are responsible for a substantial component of the observed racial disparity in care, since blacks live disproportionately in parts of the country that have low-quality hospitals and providers. Hospitals and regions of the country also vary enormously in the extent to which disparities are present. Health care disparities are the result of both unequal treatment within a hospital or by a given provider, and unequal treatment because of where people live. These findings highlight the importance of understanding health and health care within a local context -- and of efforts to explore and address the underlying causes of disparities within and across regions.
From www.dartmouthatlas.org/keyissues/issue.aspx?con=2942
Wealth
Often we speak about income in terms of income by household or per capita (per person). There is increasing data supporting the idea of income inequality as an important measure in understanding health disparities. What is someone's income relative to other members of the population? How is income distributed across a population? Are there widening gaps between the rich and the poor? What about the wealthy and the middle class?
Median income by household for 2009-2011 was $50,443. Inspect the map below to see which states are above and below this household income.
Social Mobility
Social mobility is the movement of individuals between socioeconomic groups. For our purposes think of vertical mobility. How likely is a person to be able to move from one socioeconomic group to another? Movement can be downward (down the social hierarchy) or upward (advancement). Mobility is seen as a proxy for opportunity within the social system.
Relative income is an important concept. Please watch this talk by Richard Wilkinson entitled "How Economic Inequality Harms Societies."
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How Economic Inequality Harms Societies
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