Moonesinghe Ramal, Bouye Karen, Penman-Aguilar Ana
Office of Minority Health and Health Equity, Center for Disease Control and Prevention, 4770 Buford Highway, Mailstop K77, Atlanta, GA 30341, USA.
Int J Environ Res Public Health. 2014 Dec 16;11(12):13074-83. doi: 10.3390/ijerph111213074. Print 2014 Dec.
The World Health Organization defines social determinants of health as "complex, integrated, and overlapping social structures and economic systems" that are responsible for most health inequities. Similar to the individual-level risk factors such as behavioral and biological risk factors that influence disease, we consider social determinants of health such as the distribution of income, wealth, influence and power as risk factors for risk of disease. We operationally define health inequity in a disease within a population due to a risk factor that is unfair and avoidable as the difference between the disease outcome with and without the risk factor in the population. We derive expressions for difference in health inequity between two populations due to a risk factor that is unfair and avoidable for a given disease. The difference in heath inequity between two population groups due to a risk factor increases with increasing difference in relative risks and the difference in prevalence of the risk factor in the two populations. The difference in health inequity could be larger than the difference in health outcomes between the two populations in some situations. Compared to health disparities which are typically measured and monitored using absolute or relative disparities of health outcomes, the methods presented in this manuscript provide a different, yet complementary, picture because they parse out the contributions of unfair and avoidable risk factors.
