As you get into this post you'll notice that my right-brain is coming to the surface. Forgive me if this is a bit dry and analytical. However, I think it is important to not only discern where we should go, but the why and the how as well.
Since my last post I've had the opportunity to do more reading, attend a few webinars and generally increase my understanding of health disparities and their impact on individuals of lower socioeconomic status (SES). As a consequence I now view poverty as a convenient way of collectively referring to social ills that contribute to adverse health outcomes, but also understand that subgroups, e.g. Blacks and Brown Americans, have been disproportionately impacted. For example, at every level of education and income, African Americans have shorter life expectancy (overall health measure) at age 25 than whites and Latinx, with blacks with a college degree or more education, having the same life expectancy as whites and Latinx with a high school education. It is also noteworthy that declining health has been associated with middle-aged, U.S.-born Mexican Americans and Mexican immigrants resident 20 years or more in the U.S. having a health profile that did not differ from African Americans.
If there is something more than the social determinants of health (SDH - presented in Part 2) in play here, what is it? Based on accumulating research data, the most likely explanation is chronic stress that results in real and lasting physiological and psychological changes that can cause dysfunction and disease in those so effected. Chronic stress, especially beginning early in life, can cause a spectrum of disorders, including reduced immunity, hypertension and cardiac disease, and premature aging; premature aging can be measured and defined in biological terms at the cellular level. It is not my intention to turn this post into a scientific treatise. What I do want to point out though is that subtle and overt discrimination, and violence, and or the threat of violence, experienced by Blacks and Mexican residents and immigrants long-resident in the U.S., has real and measurable adverse consequences for health and longevity. In other words, chronic stress experienced as a result of discrimination based on race and or ethnicity is a compounding factor that exacerbates an already difficult set of conditions one experiences as a consequence of living in long-term poverty.
Returning to the questions posed in the prior post:
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?
High-level answers to the first two questions have been presented in this, and my prior post. The last question is much more difficult to answer. Nevertheless, I believe we, the Body of Christ, must begin to creatively engage with those in our community living with health disparities to determine how best to partner in changing undesirable outcomes.
Where to Begin?
It is helpful to examine a weighted listing of factors contributing to health disparities to better understand where to focus attention and resources. Consider the following model:
For those of you who may have wondered about the contribution of health care to the problem of health disparities, you can see from the data above that lack of access or the quality of clinical care is a relatively small (20%) contributor when compared to the combination of health behaviors, and social and economic factors (70%). (Data and methodology) Social and economic factors breakdown into three related issues: education, employment and income, the latter two, though related, are not synonymous, and of the three, education is the foundational issue determining outcomes for employment and an income that will ensure economic stability over time.
Assuming we begin by looking at how we can positively impact education and employment (income is not an outcome we can effect directly), then the question arises as to how do we as a church engage and invest, and just as importantly, over what period of time are we willing to wait to see a measurable return on investment? There are a number of related questions that need to be considered, but at this point I am interested in your feedback. You can leave questions and comments here that will allow us to start a dialog.
GOing into the world in name of Christ is a life-long mission. Finding direction and taking action is an existential challenge that requires prayer, perseverance and a heart fixed on loving and pleasing God through love of neighbor. Let's get about being the Gospel!
Blessings,
Greg