In my initial post in this series, GOing Into the World, I make the case that the Gospel is a message of hope and salvation for the whole of creation and every dimension of what it means to be human; creatures created in the image of God. God’s love and concern for all humanity, but especially for the poor and the powerless, is affirmed by Jesus at the beginning of his earthly ministry: "The Spirit of the Lord is upon me, because he has anointed me to proclaim good news to the poor. He has sent me to proclaim liberty to the captives and recovering of sight to the blind, to set at liberty those who are oppressed, to proclaim the year of the Lord’s favor." (Lk 4:18,19) Jesus’ association with, and affinity for the marginalized throughout his ministry leaves little doubt about God’s concern for the welfare of all, but especially our neighbors who struggle daily with inadequate resources and the consequences of an uneven playing field. Thus I believe concern for the poor and the marginalized must be reflected in Christian practice, i.e., our way of being in the world.
Social disparities exist, have existed and will exist. Nevertheless, that fact should not be a rationale for dismissing why they exist and careful consideration of the degree to which disparities impact the lives of our neighbors. The term health disparities (HD) refers to preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged groups, and communities. Please note that HD and health care are not synonymous. While you might not have heard much about HD prior to the pandemic, HD have come into sharp focus for many as a consequence of the pandemic.
COVID-19
The widespread transmission of COVID-19 has shown a glaring spotlight on pre-existing health disparities among non-white Americans prior to the pandemic. A Brookings Institution study published recently demonstrated that the age-adjusted COVID-19 death rate for African Americans is 3.6 times that for whites, and for Latinos, 2.5 times higher than Anglos. A NY Times article titled, Who is Most Likely to Die from the Coronavirus makes a compelling case that an individual's risk of dying from COVID-19 infection is related to a number of factors, including pre-existing chronic disease diagnoses, e.g., diabetes, hypertension, obesity. The data further demonstrate that the likelihood of suffering from poor health depends upon income level and location. Note that the prevalence of diabetes among the poorest 10% in Chicago was 73.5% above the median, while the prevalence among the richest 10% was 63.9% below the median; differences in the prevalence of diabetes is less pronounced in other cities in the country, e.g., Albuquerque, N.M. For Houston the prevalence of diabetes is 42.6% above, and 32.2% below the median for the poorest and richest in the city respectively. Quoting from the article:
"Why does this occur? Wealthy people enjoy a range of advantages that lead to better health. They can afford better diets, and better housing and working conditions; they are less exposed to dangerous environments; they experience less stress and engage in more physical activity; and they have better access to health care services. This all adds up to what researchers call a “socioeconomic gradient in health” — wealthier people experience better health than those making less money, at every point on the income scale."
N.B. Having, or gaining wealth is not, in itself, wrong or condemned by Judeo-Christian scripture or theology. In the context of this post, wealth, i.e., assets, as well as income, is a metric for classification of individuals or families in a geographic region and or over a given period of time.
SOCIAL DETERMINANTS OF HEALTH
Given the data highlighted above it is not surprising that life expectancy, pre-pandemic, varies by zip code within a given locality. For example, in Houston, life expectancy in the 77021 area is 70.8 years, while in 77005, approximately 10 miles to the west, it is 83.5 years. (See What Your Neighborhood Says About Your Life Expectancy in Texas) Of note, the median income in 77005 and 77021 assessed between 2014-2018 was $189,00 and $37,318 respectively.
Differences in health and health outcomes, life expectancy being one measure, have been correlated with factors referred to in the aggregate as social determinants of health (SDH). These determinants include: healthy behaviors, clinical care, social and economic factors and physical environment. Of these social and economic factors and healthy behaviors are weighted as the most significant factors determining health outcomes; clinical care and physical environment having a lower predictive value. (See Health Ranking Model for more details.)
Social and economic factors include: education, employment, income, family and social support and community safety; healthy behaviors include: tobacco use, diet, exercise, alcohol and drug use and sexual activity.
If one reviews the factors included in the four major SDH categories you realize that these same factors contribute to the risk of becoming homeless, the likelihood of completing high school or higher levels of education, the risk of incarceration and other adverse social outcomes. In other words, these factors can all be mapped to the higher-level category of: POVERTY.
FULL CIRCLE
The existence of and the impact of long-term poverty on our neighbors brings us back to the issue of God's concern for the poor. If God is concerned for the poor, then surely we, his people, should be also. Disparities exist, have existed and will exist. Nevertheless, I submit as Christians we must struggle with a number of questions including:
Why do health disparities exist in our community?
What are the consequences of health disparities on individuals and families?
Can we, the Church, mitigate the adverse outcomes associated with health disparities?
Coming: Part 3. GOing Into the World - Being the Gospel