by: Daniel Pearce, D.O., FACOI, AAHIVMS
Photo by: Li Sun from Pexels

I attended the major HIV meeting of the year recently and one of the main thrusts of each meeting is disparity: Why is one group winning and another group is losing—money, attention, priority. You’ve heard of systemic racisim (the system is set up to discriminate against some), that there is no conscious racism, it is automatic. “That’s just the way it is, we’re not racist.” Here is a deeper, more detailed explanation of why things are this way. I hope you and I can do many things to counteract this and correct it.

The five SDOH are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes. If you have it easy in the 5 areas below then they and their children and grandchildren have it much easier in life, there is more money, less mental illness; they don’t understand why someone else can’t be successful. Some of these conditions are as disabling as having a major illness, such as diabetes or a major car accident.

1. Healthcare Access and Quality
Do you live far from clinics, have insurance problems, or speak a different language than the clinic? Is the healthcare the clinic delivers low quality where they rush you through and don’t seem to be helpful? For minor things they don’t have an appointment available and suggest you go to the Emergency Department where there are a crowd of people waiting 6 hours for care? The Emergency Department is set up to take care of life-threatening problems, not so much the other long list of problems, so they refer you back to your clinic which is not that helpful. You feel caught up in a cycle where no one cares and you ignore your problems till they become life-threatening. The system seems set up to fail. Do you understand the complexities of the health care system and keep running into dead ends? Is there access to good mental health care? There are delays in getting insurance, e.g., when you move to a different county.

2. Education Access and Quality
People with higher education usually live longer and have higher paying jobs.Were you (or your children) sent to schools and preschools that were poorly maintained with very large classes and overworked teachers, with a poor library, poor supervision of recess times so that violence happened at times? Were your schools far away. Were there few after-school sports and programs available so your learning was not cultivated? Did you master English and your studies so that you graduated and got into college if you desired? What barriers were against you to reach your full potential? Did your relatives read to you and encourage you in your studies?

3. Social and Community Context
Is your family or community full of friction and suspicion? Is there racial discrimination or violence in your neighborhood. Are many of those from your neighborhood in prison or recently released. Are single-parent familes, teen pregnancy, and latch-key kids the norm?

4. Economic Stablitiy
Did your parents buy a house and save for retirement? Did your relatives pass some of the wealth to you after they died? Did employers respect you and hire or promote you for your skills? Is job loss an issue? Do you have to prioritize the bills and buy food over rent? Do you borrow money to make ends meet. Do you get evicted due to non-payment. If you are moving from job to job with big gaps, then it is hard to get ahead. Are you injured or do you have a disability that makes it hard to find and keep a job?

5. Neighborhood and Built Environment
Is there more crime, traffic, and pollution in your neighborhood. Is good housing affordable? Is there healthy food available at markets near you for a good price? Do people ride bikes in bike lanes and others stroll on the sidewalk. Are there problems playing in the park? Is the park too far away? Is there childcare available? Are prices higher in your neighborhood.The business people typically locate the harmful companies in neighborhoods they don’t live in The stress of a bad neighborhood can cause poor school performance..

There was an experiment where some people were given 50% more play money in monopoly and, with this advantage, they won the games. When asked how they won, they said it was skill, not the extra money/advantage at the beginning.

I’m not saying money is the source of happiness, but a basic amount helps level the field—eliminates the disadvantage.

Keep those questions coming and be safe!

Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine HIV, Hepatitis B,C, Transgender, Suboxone Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto) Member, Coachella Valley Clinical Research Initiative