What is health equity?

Our belief is straightforward. Everyone in North Carolina deserves the opportunity to be as healthy as possible. This opportunity is what is also known as health equity.

Achieving health equity requires removing obstacles to good health for everyone - the barriers, sometimes referred to as root causes, that are the result of policies, rules, institutional practices, and social norms that impact an individual’s or even communities’ potential to achieve good health. Racism and discrimination, public infrastructure priorities, school investments, and zoning regulations are just a few examples. And so too are decisions on where to locate everything from hospitals and manufacturing facilities to grocery stores and sidewalks. Addressing these root causes is where the greatest opportunity lies to improve the health of everyone in North Carolina.

Unfortunately, both here in our home state and across the country there are significant disparities in health tied to these factors. This is especially true where they intersect and therefore where their impacts are multiplied. The result is that some bear more of the burden of poor health when examined by race and ethnicity, where they live, their economic situation, and more. And the effects of these systemic factors are demonstrated in disparities in health outcomes.

Lack of health equity by Race and Ethnicity:

Life expectancy is significantly lower for American Indian (74.5 years) and Black (74.7 years) populations in North Carolina, as compared to white (78.1 years) and Latino (87.3 years). ¹
The infant mortality rate for American Indian and Black residents in North Carolina is more than two and a half times that of white and Latino residents and the maternal mortality rate is more than three times higher for Black residents as opposed to their white counterparts. ^{2, 3}
Black residents in North Carolina die of heart disease at a rate higher than any other group and succumb to cancer at a rate that is 47 percent higher than that of white residents. ⁴
Nationwide, Latinos experience diabetes at a rate that is more than 45 percent higher than non-Hispanic whites and Asian American/Pacific Islanders have the highest rates of liver and stomach cancer, with incidence rates two to two and a half times that of white residents. ⁵

Lack of health equity by Geography:

The life expectancy for someone living in Swain County (71 years) is nearly a dozen years less than someone living in Orange County (82 years). ⁶
Rural residents are more likely to die from heart disease, cancer, and stroke than their urban counterparts, and unintentional deaths are 50 percent higher in rural areas. ⁷
Nationwide, 80 percent of high food insecurity counties are in the South and 90 percent of high food insecurity counties are rural. Food insecurity contributes significantly to a number of health challenges, both physical and mental. ^⁸

Lack of health equity by Economic Stability:

Adults living in poverty have higher rates of diabetes, heart disease, stroke, and other chronic conditions, and people living below 200% of the Federal Poverty Level are more likely to rate themselves in fair or poor health. ⁹
Children born to mothers with low income have a greater risk of low birth weight and higher rates of heart conditions, hearing problems, and intestinal disorders. ⁹
Lower-cost housing is often farther removed from essential services and can have greater exposure to hazardous toxins such as mold and lead which can lead to acute and chronic health conditions. ⁹

Lack of health equity by Education:

Individuals with less education are more likely to experience a number of health risks, such as obesity, smoking, less opportunity for physical activity, and intentional and unintentional injury. ¹⁰
Higher education has been shown to help individuals secure higher paying work with fewer safety risks. ¹¹
Data from 2019 show that North Carolinians with less than a high school education were nearly three times more likely to report fair or poor health as compared to those with a college degree and nearly five times less likely to have health insurance coverage. ¹²

Lack of health equity by Veteran Status

Veterans as a whole have experienced an increase in mental health challenges over the past decade at a rate twice that of civilians. ¹³
Veterans are nearly four times more likely to have severe hearing impairments, as compared to civilians, and experience chronic pain at more than two and a half times the rate. ¹³
Civilians are significantly more likely to be able-bodied than their veteran counterparts – 85 percent vs. 72 percent. ¹³

Because we aspire for everyone in North Carolina to have the opportunity to be as healthy as possible, we know that it is essential that we seek to understand and address the many systemic factors that inhibit an individual’s pursuit of a healthy life.

Sources:

¹ North Carolina State Center for Health Statistics

² March of Dimes

³ America’s Health Rankings

⁴ North Carolina Health Equity Report

⁵ U.S. Department of Health and Human Services

⁶ North Carolina State Center for Health Statistics

⁷ Centers for Disease Control

⁸ Feeding America

⁹ North Carolina Institute of Medicine

¹⁰ Centers for Disease Control

¹¹ Tulane University School of Public Health