Abstract
This analysis develops indices of (1) modifiable social determinants of health and (2) social determinant inequity and applies the indices to the black population in US states. It uses state data available between 2013 and 2018 stratified by black and white race on six social determinants covering a range of topics (high school non-completion, incarceration, non-home ownership, poverty, unemployment, and voter non-registration). Determinants are ranked by state on (1) limited determinant access by blacks and (2) on black-white determinant differences, i.e., inequity. For each state, ranks are summed for each determinant and determinant differences. Greater determinant access and greater equity are found in southern states. More limited access is found in northeastern and western states; lowest ranked of access is found in some midwestern states. Greatest equity is found in southern states; greatest inequity is found in midwestern states. Indices are associated with state rates of black self-reported health. Indices of social determinant access and inequity can be developed and applied to states for US minority populations. The indices promote attention to the differential distribution of social determinants, suggest the consequences of structural racism, and indicate targets for the redress of inequity.
Similar content being viewed by others
References
Galea S, Tracy M, Hoggatt KJ, DiMaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101(8):1456–65.
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995:80–94.
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.
Reskin B. The race discrimination system. Annu Rev Sociol. 2012;38:17–35.
Hahn RA, Truman BI, Williams DR. Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States. SSM-Popul Health. 2018;4:17–24.
Snyder TD, De Brey C, Dillow SA. Digest of education statistics 2016, NCES 2017-094. National Center for Education Statistics, 2018.
Nellis A. The color of justice: racial and ethnic disparity in state prisons. Sentencing Project, 2016.
Atlas NE. Homeownership United States. 2017.
Foundation, K. Poverty rate by race/ethnicity. 2017.
Williams DR, Mohammed SA. Racism and health II: a needed research agenda for effective interventions. Am Behav Sci. 2013;57(8):1200–26.
Hahn RA. Survival in adversity: trends in mortality among blacks in the United States, 1900–2010. Int J Health Serv. 2020:002073142092528.
Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Sci Med. 2009;69:307–16.
Smedley BD, Stith AY, Nelson AR, Institute of Medicine, Committee on understanding and eliminating racial and ethnic disparities in health care. Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press; 2003.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hahn, R.A. Access to Social Determinants of Health and Determinant Inequity for the Black Population in US States in the Early Twenty-First Century. J. Racial and Ethnic Health Disparities 8, 433–438 (2021). https://doi.org/10.1007/s40615-020-00799-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40615-020-00799-3