Content area
Full Text
Introduction
Education, housing, employment, law and justice, civic participation, public health, and health care are included among the powerful determinants of long-term morbidity and mortality referred to as “social determinants of health”—the upstream aspects of a society’s organization and processes that cause downstream health effects [1, 2]. Education shapes the capacities of the young for society and affects the long-term course of their lives, including their health (Hahn and Truman). Housing provides shelter and is a source of wealth—also with health consequences; by its location, housing also affects access to other resources that have health consequences [3]. Deprivation of social determinant resources produces social disadvantage, with harmful health consequences. In addition, in the USA, the black population (and others) have been subject to multiple, pervasive, and often deliberate forms of structural racism and discrimination in access to social determinants. Reskin [4] refers to a “race discrimination system” in which an ideology of racism underlies a system of racist institutions which pervade our society and reproduce themselves. Population access to social determinants is in part determined by federal and state laws, policies, and programs [5]. Thus, it is reasonable and useful to examine the distribution among states of black access to social determinants and of black-white inequity in access to social determinants.
This analysis examines the distribution and distributional inequity of selected social determinants of health for the black population in US states (and Washington, D.C.). Indices of limited access to social determinants of health (LASDI) for blacks and black-white social determinant inequity (SDII) are formulated. Determinants are selected to cover diverse domains of social life from data available by race at the state level: high school non-completion, incarceration, non-homeownership, poverty, unemployment, poverty, and voter non-registration. For each determinant, states are ranked in terms of access and inequity, and ranks for determinants are summed for each state. Five basic hypotheses are assessed:
Because of the history and legacies of the South, black access to social determinants of health is lowest in southern states and highest in northern states, including the midwestern and northeastern states, and in western states.
Similarly, among the US states, black-white inequity in social determinants is highest in southern states and lowest in northern states, including the midwestern and northeastern states, and in...