Looking to Community Experts for Guidance: Defining Health Disparity
At OMNI, when faced with a question, we rely heavily on our core value of Inquiry. Inquiry for us doesn't only mean hitting the books and academic journals but searching for answers and learning from our clients and partners, especially when discussing equity and a community's historical context. We recently developed a resource for the Virginia State Epidemiological Outcomes Workgroup (SEOW) that highlighted the concept of health disparities and how data can be used to recognize, understand, and reduce health disparities in Virginia. As we began our work, what seemed like a straightforward question, how to define and visualize health disparity, turned out to be much more complicated, and so we turned to the SEOW members for guidance. Deriving the appropriate definition for this resource taught us a great deal about both the concept of health disparities itself and a powerful lesson about our roles as evaluators and researchers.
We began with the simple process of reviewing the public health literature and the personal reflections of our team of experts to define “health disparity” and we quickly learned there is no consensus definition for the term. Quite often you will find as many definitions for the term as sources you consult and experts you talk to, and while different definitions have broad similarities and overlaps, their meanings vary substantively given a particular context. These variations can be influenced by a number of factors such as the intended audience, differing values and beliefs of the definer, similar or interchangeable terms such as “health inequity,” and the sheer complexity of the concept -- are health disparities merely the difference in health outcomes between groups or do they also encompass the underlying causes of these differences?
It was essential for our team to let the experiences of the SEOW members guide our work. The SEOW members are embedded in behavioral health work across Virginia and hold an abundance of community-based knowledge essential to understand unique community needs, histories, and circumstances. SEOW members’ on-the-ground perspectives of health disparities in local Virginia communities allowed our report to reflect the local stories and important nuances from the perspective of the communities more impacted by the disparities. And, we understood through this work that these disparities are best told through examples that allow for the complexity and nuance of each community experience to be brought to life.
Health disparities often reflect the unique history and circumstances of the marginalized groups living within a specific community. Examples of health disparities include barriers to health due to race or ethnicity, religion, socioeconomic status, gender, age, mental health status, disability status, sexual orientation or gender identity, or geographic location. The reason these characteristics result in barriers to health is largely due to years of systemic discrimination and exclusion based on these characteristics. This discrimination has existed for centuries and has led to greater rates of poverty, lack of access to jobs with fair pay, poor education, unsafe housing, and lack of health care among marginalized groups. All those factors contribute to poorer physical, emotional, and mental health, resulting in health disparities.
For our project, our team developed the following contextually-relevant definition that we believe reflects the term's unique complexities and can be used in a variety of behavioral health contexts:
A health disparity is a systematic and potentially avoidable difference in health between groups of people who have relatively different positions in society.1 Health disparities adversely affect the health of people linked to social, economic, and environmental disadvantages.2
The iterative development of creating this health disparities resource reinforced an essential lesson for our OMNI team as evaluators. The knowledge we seek as evaluators and researchers is only valuable when the communities we serve are integrated into the evaluation and research process so that the stories of those most impacted can be truly understood and brought to life. When studying and understanding health disparities, community voices from affected populations must be deeply heard to ensure a fuller, more holistic understanding of the community, their challenges, and possible solutions. Our role as evaluators is in asking the right questions to leverage our skills to amplifying their voices.
References:
1. Braveman P. Health Disparities and Health Equity: Concepts and Measurement. Annual Review of Public Health. 2006 Apr 13;27(1):167–94.
2. The Secretary's Advisory Committee. Phase I Report - Recommendations for the Framework and Format of Healthy People 2020. 2008. [cited 2020 May 4]; Available from: https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf