Extreme disparities

Access to care, health literacy blamed for gaps

It won’t surprise many that poor health is linked to lower levels of income and education, but the magnitude of the disparities surprised the lead author of a federal report. “There are three- and four- and five-fold differences in some areas, and I don’t think I was expecting them to be that large,” said Amy Bernstein, a health services researcher at the Centers for Disease Control and Prevention’s National Center for Health Statistics, which recently released its 35th annual report on the nation’s health, a compilation of data from a number of sources. A summary of the key findings is highlighted in the chart below.

This year, the National Center for Health Statistics dedicated a section to the impact of socioeconomic status on health indicators including obesity, depression, and tobacco use.

For example, the rate of edentulism, or lack of natural teeth, was 23% for people living below poverty, five times the rate among the highest income group. Depression rates also were five times higher among those below poverty level.

The gaps arise from a confluence of factors, including lack of access to care and poor health literacy, said Marcie Wright, director of research support services at Virginia Commonwealth University’s Center on Health Disparities.

“It’s not just one thing,” Wright said. “It’s the relationship of all of these together—access to care, access to support, communication with physicians—that lead to disparities and make them hard to address.”