Community and Environmental Factors and Arthritis Outcomes

Abstract

NC Med J November/December 2007, Volume 68, Number 6 reat strides have been made in the past century in preventing disease and reducing early mortality, but disparities in health between and within countries are still pervasive. The National Institutes of Health defines disparities broadly as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.” The national health care research agenda places high priority on reducing disparities in health outcomes among persons of different socioeconomic and racial/ethnic groups through examining the mechanisms for disparities and proposing prevention strategies. There is now an increasing interest in more explicit investigations of the complex issues regarding disparities and health outcomes. The urgency of understanding the effects of external forces at multiple levels including individuals and their behaviors, communities and environments, and social policies was made vividly apparent in the wake of Hurricane Katrina. The same could be illustrated in how we reacted to the fall 2007 California wildfires. We cannot deny that place can have a significant impact on outcomes regardless of an individual’s resources. We also cannot deny that there are racial and ethnic differences in communities in the US. The association between lower levels of individual socioeconomic status and poorer health outcomes has been documented for centuries in various parts of the developed world. Associations between lower socioeconomic status and increased prevalence of disease, morbidity, and mortality in persons with arthritis and rheumatic conditions have been demonstrated in a number of population-based and clinical studies. The role of individual socioeconomic status has been studied examining variables such as formal education level, income, occupation, and home ownership. Health outcomes have been shown to be associated with the socioeconomic environment of an individual’s neighborhood, independent of the individual’s socioeconomic status. Although there is a long tradition of public health research relating community factors to patterns of health and disease, this has traditionally been in the context of hygiene, clean water, and the presence/ eradication of infectious disease-bearing vectors. Increasingly, research findings are beginning to focus on the upstream determinants related to the community in the context of chronic diseases. These include place of residence, work environment, or wider social and economic policies. These community variables often are described as “social context,” a catch-all phrase referring to the spectrum of societal factors that may not be directly