Understanding Health Disparities: A Case Study of Jane and June

Melissa Mills, BSN

When you meet a new patient, do you consider all the things that affect their health choices and overall health status? Of course, there are those things like race, sex, and age that the patient has no control over. But, have you ever considered those things that they do have some control over and how deeply it can affect a patient's health?

Let's Meet Jane and June

You have two white female patients. Both are 47 years old and newly diagnosed with diabetes. It catches your attention that these two patients are so similar on the surface. Let's see what we find when we dig deeper.

Jane

Jane lives in an affluent part of your city, has been married for 20 years, is a non-smoker, drinks socially only, and is an attorney. She lives in a single-family home with her spouse and three children. She has access to a private health insurance policy through her employer and can pay all of her bills each month.

She attends a local gym for exercise and purchases food at an organic grocery. She struggles with her weight and does make poor food habits at times due to her busy lifestyle. She has a personal history of hypertension and a family history of Type II Diabetes. She takes a daily anti-hypertensive and sees her family physician annually and as needed.

June

June lives in public housing. She is divorced but lives with her boyfriend and his parents. She has three children that live with them, along with two of his five children. She states that she has been married three times and all her children have different fathers. She is a smoker, drinks a pack and half a day, and admits to recreational drug use at times. She has no insurance and is in between jobs right now.

They often attend a local food pantry for staples and receive food stamps. She has a personal history of hypertension and a family history of Type II Diabetes. She takes no medications and does not have annual check-ups. She tells you multiple times that she needs to go home because she has no way of paying for this care.

You can see the obvious differences, but what role does this play in their ability to care for themselves?

Understanding Health Disparities

A type of difference in health that is closely linked with social and economic disadvantage is known as a Health Disparities. These differences negatively affect groups of people who have more social and economic obstacles than others. These are "preventable" differences in the burden of disease, injury, violence, or even health opportunities.

These obstacles can be related to race, ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location. Sometimes, things like cognition, sensory, and physical disabilities can be liked it health disparity as well.

Health disparities can be related to many factors. But, in the US, most health disparities are linked back to what is known as social determinants.

What are social determinants of health?

All of the factors that contribute to your overall state of health are known as determinants of health. Researches recognize five social health determinants in the U.S.

Economic Stability - Economic stability hinges on your ability to pay for health care and good health decisions? Things that determine your economic stability include employment, access to food, access to steady housing, and poverty.

Education - All U.S. citizens are guaranteed a basic education. However, not all people complete high school. This affects your ability to access healthcare in many ways. Specific areas of education that are health determinants include early childhood education and development, enrolling in post-secondary education, high school graduation, and language and literacy.

Social and Community Context - How and where you live impacts your ability to care for yourself. It also impacts your ability to access healthcare services. If you choose to live in a rural community that has no local hospital, this could affect your ability to survive emergency situations or illnesses.

Social and community context also includes other topics like participation in community organizations, discrimination, incarcerations, and social cohesion.

Health and Health Care - Even though all people in the U.S. are entitled to healthcare, many remain uninsured or underinsured. This social determinant includes access to health care, access to primary care, and health literacy.

Neighborhoods and Environment - If you have limited access to food, your overall health status will suffer. Other areas related to this social determinant includes your environment, such as living in an area with high crime and violence rates. Your environmental conditions and quality of your housing impact your ability to be healthy.

Revisiting Jane and June

You were likely able to identify most of the social determinants, simply because you have been in nursing for awhile and it becomes second nature. It is important as a nurse to consider these things from time to time and truly understand the barriers that patients encounter.

Jane is likely going to do better with the new diagnosis of diabetes compared to June. She has a support system, access to healthcare, higher education, and access to food. June may struggle from day one with understanding and managing her new diagnosis due to her lack of education, access to healthcare and lack of consistent and healthy food sources.

Have you ever seen health disparities in action in your practice? Can you think of a patient that you knew was likely doomed to be a "frequent-flyer" to the hospital due to their social determinants of health? Leave your thoughts, comments, and stories below. Would love to hear them.