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INTRODUCTION

As noted in Chapter 1, healthcare received by people with disability, regardless of type of disability, is inferior to care received by those without disability. This lack of quality healthcare results in health inequities. These differences in the quality of healthcare, and in the health status of those with disability, are largely preventable. This chapter discusses the social determinants of health that play a role in these health inequities. It also highlights models of disability, explains the difference between disability and disabling conditions, addresses disability etiquette, and offers a brief history of disability and disability rights.

HEALTH INEQUITIES AND SOCIAL DETERMINANTS OF HEALTH

The term health inequity, or health inequality, refers to the inequitable and preventable burden of disease, disability, injury, or violence experienced by socially disadvantaged populations, and to the lack of opportunities for these populations to achieve optimal health (Braverman, 2014; World Health Organization [WHO], 2018).

The causes of these inequities are usually a lack of opportunities and unequal treatment, or discrimination, within the healthcare system (Krahn, Walker, & Correa-De-Araujo, 2015). This unequal treatment or discrimination is often a result of social and other determinants of health, such as the following:

  • The physical and social environment

  • The availability of health services

  • Economic resources

  • Social and political power

All these factors affect people’s ability to obtain quality healthcare and achieve an optimal level of health (Krahn et al., 2015; National Academies of Sciences, Engineering, and Medicine, 2017; US Department of Health and Human Services [USDHHS], 2010, 2011).

Health inequity is often used to describe differences in health status or access to healthcare by members of different racial or ethnic groups or by people of different ages, genders, sexual orientations, immigration statuses, socioeconomic classes, and education levels. However, there are also serious health inequities due to disability status. These have a major impact on the well-being of people with disability. Further, people who face discrimination for other reasons (race, ethnicity, age, gender, sexual orientation, immigrant status, socioeconomic class, or education level) are at additional risk if they have a disability.

These social determinants—which are often influenced by policy decisions—are responsible for most health inequities.

Although disability status is a significant cause of health inequity, people with disability are often overlooked in discussions of social determinants of health.

Health Inequities Versus Health Disparities

The term health disparities is often used interchangeably with health inequities or health inequalities to describe differences in health status due to social injustice. This is incorrect, however. Health disparities are differences in health status that may or may not be a result of social injustice. For example, male infants generally weigh more than female infants at birth. This is considered a health disparity, not a health inequity.

Per the Healthy People 2020 initiative, ...

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