Access to Social Determinants of Health and Determinant Inequity for the Black Population in US States in the Early Twenty-First Century

Abstract

This analysis develops indices of (1) modifiable social determinants of health and (2) social determinant inequity and applies the indices to the black population in US states. It uses state data available between 2013 and 2018 stratified by black and white race on six social determinants covering a range of topics (high school non-completion, incarceration, non-home ownership, poverty, unemployment, and voter non-registration). Determinants are ranked by state on (1) limited determinant access by blacks and (2) on black-white determinant differences, i.e., inequity. For each state, ranks are summed for each determinant and determinant differences. Greater determinant access and greater equity are found in southern states. More limited access is found in northeastern and western states; lowest ranked of access is found in some midwestern states. Greatest equity is found in southern states; greatest inequity is found in midwestern states. Indices are associated with state rates of black self-reported health. Indices of social determinant access and inequity can be developed and applied to states for US minority populations. The indices promote attention to the differential distribution of social determinants, suggest the consequences of structural racism, and indicate targets for the redress of inequity.