Health inequities in aging, part one

August 4, 2021 / By Melissa Clarke, MD

Everyone deserves the opportunity to live a long, healthy and rewarding life. However, we know that older adults of color disproportionally experience inequities in the health care system.

Disrupt Disparities, an initiative aimed at bringing about change for older adults of color, is a collaboration between AARP Illinois, Asian Americans Advancing Justice—Chicago, The Chicago Urban League and The Resurrection Project. Disrupt Disparities recently published a report on health disparities among America’s seniors and hosted a two-day virtual Disrupt Disparities Summit with the Illinois Department on Aging and the RRF Foundation for Aging. During the conference, Disrupt Disparities announced the launch of a multi-year initiative to create systemic policy changes on behalf of older adults of color in Illinois.

I was interviewed as a featured speaker at the summit to articulate the barriers to health that older Americans of color face and steps to take to create an equitable health care system. In part one of this two-part blog series I will recap the interview.

“As people age, health issues can become paramount. How do you see health inequities manifest in older adults of color?”

As we age, chronic diseases become more prominent because of years of accumulated insults to our bodies. Recognizing early signs and getting them treated can help prevent the progression of chronic illnesses, but those early signs are often unrecognized and therefore go untreated. Delay in diagnosis is seen more often in older adults of color. The reasons are multi-factorial, but are closely linked to social determinants of health:

  • Early signs often go unheeded because the economic hardships that adults of color disproportionately face, force health issues to be prioritized below survival issues like food and housing.
  • Racism, and the additional life stressors it brings, is a determining factor in overall health. Multiple studies have documented that populations experiencing racism have higher rates of chronic inflammation and cellular damage which leads to premature aging and chronic disease.
  • Access barriers to health care are more common in communities of color for a variety of reasons. Individuals aged 50-64 years in communities of color are less likely than their white counterparts to have health insurance. Medicare and Medicaid eligible individuals have geographic barriers that limit access to quality health care providers in their neighborhoods. Access is also limited by poor provider-patient communication. Patients of color more often have less time with their doctor, are less likely to get their questions answered, sometimes face language barriers, and are referred less often for life saving treatments within the health care system.
  • Finally, access to resources that promote health like nutritious food and safe exercise spaces are also linked to economics and neighborhood. Higher rates of economic disadvantage for individuals of color, especially those on a fixed income like many older adults, may force them to rely on cheaper, less nutritious food sources like fast food or canned goods. This worsens nutrition-related illnesses like high blood pressure, diabetes, and kidney disease. Food dessert communities may have a dearth of grocery stores with fresh produce, forcing residents to more convenient, but more unhealthy food options.

These social determinants of health account for at least half of health outcomes and explain many of the health disparities among older adults of color. In this population, the resultant health conditions manifest at earlier ages, progress faster and are sometimes less aggressively treated by the medical system.

The second installment of this two-part series will address steps to create a more equitable system of health care to support older adults of color.

Melissa E. Clarke, MD, CMQ, is senior medical director, health care transformation and health equity, at 3M Health Information Systems.


References

  1. Disrupt Disparities: Challenges and Solutions for 50+ Illinoisans of Color. AARP Illinois, Asian Americans Advancing Justice Chicago, Chicago Urban League, The Resurrection Project. Accessed July 11, 2021 a AARP-Disrupt-Disparities-Report.pdf (disruptdisparitiesil.com)
  2. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003. 
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