Addressing Health Disparities in Diverse Populations

"Healthcare professionals really want to provide the best care possible to every single patient.The problem is they have not always been properly equipped to do that," Jason Zibart, BSPH '18 said in a recent interview.

Since the 19th century, healthcare and public health practitioners and policymakers have become increasingly aware of the many nonmedical factors that contribute to health disparities for diverse populations and the negative consequences those disparities have for individuals and the larger society.¹

Zibart is the Community Connected Health Manager for Benson Hospital, which is part of the Tucson Medical Center system in Arizona. He has personal insights into the disparities that Benson community members face and his work centers around resolving them. "A lot of disparities are tied directly to inequalities and inequities of one sort or another," he said. "One of the biggest impacts I see is on the quality of life. It is one thing to know that health disparities can reduce life expectancy. It’s another thing entirely to see people struggling day to day because of those disparities."

Read more about addressing health disparities in diverse populations, including more of Jason Zibart's experiences.

The Office of Disease Prevention and Health Promotion (ODPHP) in the U.S. Department of Health and Human Services developed the Healthy People framework in 1980, a year after U.S. Surgeon General Julius Richmond issued the landmark “Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention." The 1980 framework set national 10-year goals for improving health and well-being. The framework's public health objectives have been evaluated and updated every decade since then, revised based largely on progress measured against the previous goals.²

The current framework, Healthy People 2030, envisions creating "a society in which all people can achieve their full potential for health and well-being across the lifespan." The ODPHP plans to reduce health disparities and advance health equity through research, information sharing and program support to "promote, strengthen, and evaluate the nation’s efforts to improve the health and well-being of all people."³

Healthy People 2030 defines health equity as "the attainment of the highest level of health for all people." The framework defines a health disparity as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage."⁴ A definition posted by the Center for Disease Control, one of ODPHP's sister agencies in the Department of Health and Human Services, provides some additional context. It reads, "Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment."⁵

A wide range of social and economic factors contribute to ongoing health and healthcare disparities. Healthy People 2030 says, "Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion."⁴

In a 2023 issue brief on health and health care disparities, the Kaiser Family Foundation identified six social and economic inequities that drive health disparities, with racism and discrimination causing racial and ethnic health disparities across dimensions. The brief noted that "disparities occur across the life course, from birth, through mid-life, and among older adults;" the groups suffering from the effects of health disparities "are not mutually exclusive and often intersect in meaningful ways;" and that those groups have generally poorer health outcomes.⁶

Similarly, the Healthy People 2030 framework conceptualizes the factors affecting health outcomes for diverse populations into five domains called the social determinants of health (SDOH). The framework recognizes that SDOH contribute to wide-scale health disparities and inequities negatively affecting people's mental and physical health, well-being and quality of life. That's why addressing SDOH is one of the five overarching goals in the ODPHP's efforts to eliminate health disparities.

The five social determinants of health are:⁷

• Economic stability
• Education access and quality
• Healthcare access and quality
• Neighborhood and built environment
• Social and community context

Each of the five domains encompasses many objectives that advance health equity through initiatives such as improving access to healthcare resources, diversifying the healthcare workforce, and raising health literacy. Other initiatives that don't at first glance appear directly related to advancing health equity are also included. One example is helping people find work that provides them with economic security and health insurance coverage. Another is improving access to healthy foods. Learn more about the importance of access to healthy food in achieving health equity.

Benson Hospital in Arizona serves "a rural population that tends to be a bit on the older side." As the hospital's Community Connected Health Manager, Jason Zibart manages several initiatives aligned with the Healthy People 2030 framework. "In that role, I oversee telehealth, community health needs assessments, outreach and our partnerships with community-based organizations such as food banks."

Zibart also manages an innovative specialist physician clinic that helps improve access to medical care for the rural population. It's a turnkey medical facility that Tucson health care providers can rent by the day. "This makes it financially viable for specialists to provide care in town a few days a month and lets people access the same level of care locally that they would otherwise have to travel 50 miles to access. I am always looking for more specialists to provide care in the community a few days a month," he said.

Zibart recently secured a grant from the Health Resources and Services Administration to address rural health care disparities, "particularly in patients discharged from metropolitan hospitals," he said. "For example, a post-cardiac event patient discharging back into their rural community has a completely different experience than one in a metro area in terms of access to specialist care, cardiac rehab and other resources.

"We want to connect those patients with the needed follow-up care and community-based organization support (such as ride services and food pantries) so they can recover close to home while reducing their chances of needing readmission. This program will also work together with our health equity initiative to make sure we are connecting with people in a way that works."

Zibart's goal of connecting people with care in a way that works hints at the importance of cultural competence in effectively supporting minority health. A 2014 Public Health Reports article by C.S. Jackson and J.N. Gracia, posted on the National Library of Medicine website, said, "Cultural competency, defined as the ability of health care providers to function effectively in the context of cultural differences, has been shown to improve the quality of health care received by racial/ethnic minority groups."⁸

The National Institute of Health (NIH) describes culture as "the combination of a body of knowledge, a body of belief, and a body of behavior. It involves several elements that are often specific to ethnic, racial, religious, geographic, or social groups. This includes personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions."⁹

The NIH publication discuss the importance of cultural respect, which is foundational to developing cultural competence, in improving healthcare disparities: "The concept of cultural respect has a positive effect on patient care delivery by enabling providers to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients."⁹

Zibart agrees. "You improve your programs and care delivery by being in a constant learning, adapting, and evaluating mode," he said. "You need to learn that not everyone sees and interacts with the world the way you do, while also building trust with the population you serve. This sounds easy, but it's something people really struggle with."

Zibart believes "you can’t effectively serve a community you don’t understand. Understanding a person’s lived experience can often be the key to understanding their health issues. Patients who feel truly cared for and understood by their healthcare providers have better health outcomes."

Recollecting his early days on the job in Benson, he said, "I needed to get to know essential stakeholders, official and unofficial community leaders (the same for inside the organization). But networking must come from a genuine place. No one likes to feel like they are just being “networked” as just an end goal itself. For me, this meant it was important to show up to community-based organization and hospital meetings and actively listen to people."

Building trust and credibility with your client population is foundational for success, and it takes time. "My advice is to balance your passion and eagerness to create change with your own stockpile of social capital," Zibart said. "No one likes to work with an outsider who shows up and thinks they have all the answers. Listen to the community you are serving. Learn about their challenges and help with their ongoing projects where you can. Build your trust and social capital, and it will make your programs more likely to succeed. Most of the time, this approach has worked for me."

Kent State College of Public Health (COPH) is focused on helping you improve public health and designed the CEPH-accredited online programs to help you develop the skills and experiences you need within the context of your other responsibilities. Those are some of the reasons Jason Zibart chose to earn his BSPH with a specialization in Health Services Administration at Kent State.

"When I went back to school I had a family and a job as a patient care technician. I really needed a program with the flexibility to fit into my hectic life," he said. I also knew that I did not want to be part of a program that was just an online-only school." Opportunities to observe and participate in the public health activities of a health organization that you will choose collaboratively with COPH faculty are built right into the Kent State College of Public Health online degree programs.

"I reviewed a lot of programs," Zibart said. "Many of them seemed unorganized, and that wasn’t going to work for me. The program at Kent really stood out as organized, well-planned, and manageable. It was also really well-reviewed online. It just seemed like a great fit for me." To learn more about how Kent State University's online Bachelor of Science in Public Health or Master of Public Health can fit in with your career goals and your life, schedule a call with an admissions outreach advisor.