Social, Economic, and Environmental Interactions in Reducing Asthma Disparities Through Improved Family and Social Function and Modified Health Behaviors
Disparities are most apparent among populations with varying levels of socioeconomic status (SES). Significant evidence has demonstrated that a gradient exists between SES and health status, with individuals of high SES having better overall health that those of low SES. Many hypothesize that the health disparities seen across SES levels are due to health-care access. Yet in industrialized nations with universal health-care systems, an SES gradient exists in all causes of morbidity and mortality, across middle and upper income brackets, suggesting that health-care access alone is not the sole cause. Others propose that low SES may result in poor physical and/or mental health by operating through various psychosocial mechanisms such as discrimination, social exclusion, prolonged and/or heightened stress, loss of sense of control, and low self-esteem. In turn, these psychosocial mechanisms can lead to physiologic changes such as raised cortisol, altered BP response, and decreased immunity that place individuals at risk for adverse health and functioning outcomes. A third possibility is that SES is a general measure of educational, financial, and social resources that enable individuals to both live healthier lives and to obtain better health services, even when basic access for all is ensured. This is evidenced by the fact that even societies with universal health coverage also have private medical services that are accessed by those with the money to pay for them.
Equally important is the notion that individual behavior and lifestyle choices contribute to disparate health outcomes in lower SES strata. There have been recent data that indicate when individual behavior and lifestyle choices such as smoking, alcohol consumption, diet, and exercise are corrected for, disparate health outcomes are still obseived in lower SES groups. Such findings suggest that access to health care and individual behavior and lifestyle choices are not the major determinants of SES-related disparate health outcomes. Indeed, these results shift research emphasis toward an examination of mechanisms by which social and physical environments may interact with SES to produce health disparities.
In the United States, race is closely linked with SES, making the effects of the two factors difficult to separate. Race and ethnicity have often been used as surrogate variables for poverty and material deprivation. However, this is not always valid and adds to the difficulties in examining underlying causes for disparities. Additionally, while racial groups share certain genetic attributes, it is important to note that there are limitations to using “race” as more than a social construct. The definitions of racial groups vaiy across time and location. Also, how a person might classify their race often differs from how others may classify that person. Instead, the social and cultural attributes of race appear more likely to significantly affect health status. Improve your health status with remedies of Canadian Pharmacy Mall.
Moreover, research indicates that race does not appear to affect illness behavior once other social and behavioral factors are taken into account. This suggests that race affects health outcomes and disparities through its relation to other behavioral and social factors. For instance, culture affects health through its influence on risk and protective behaviors, the nature of the family and social relations, and the meanings and expectations associated with group memberships (eg, shared beliefs that disease symptoms are part of normal life and should be “toughed out,” causing delays in accessing medical services and increase risk of harm in some minority populations). Collectively, this evidence provides the basis for the belief that there are multiple social forces that shape and support behavior in different groups of people. In addition, social and physical environments vary for different social groups. Within these environments, certain racial, ethnic, and socioeconomic groups are more severely affected by asthma than others. These same groups encounter multiple barriers (eg, financial constraints, logistical and cultural barriers, and environmental stressors) when attempting to follow health and treatment recommendations. The relationships and mechanisms by which family, social, and behavioral factors contribute to disparities and affect health-related quality of life either directly or indirectly are complex,