HEALTH EQUITY

Health equity means that everyone has a fair and just opportunity to attain their full health potential and that no one is disadvantaged, excluded, or dismissed from achieving this potential. Many of the pertinent factors — education, poverty, housing, racism, and others — affect people way before they interact with the healthcare system, leaving many of us in healthcare unsure what lies within our sphere of influence. However, healthcare professionals can play a major role in improving health outcomes for disproportionately affected people.

DISPARITIES AND PAIN

For people who experience social inequities and structural violence, pain and related care are closely linked to experiences of injustice and stigma. Conditions that cause adversity, trauma and toxic stress include abuse and neglect, violence, living in poverty, incarceration, family separation, and exposure to racism and discrimination. These events are correlated with chronic health problems including persistent/chronic pain, mental illness, and substance use in adulthood. Our understanding of the links between pain, trauma and threat make health inequity not only an important social and public health issue, but a relevant one in establishing the trust of your individual patient with complex pain.

HEALTH INEQUITY AND PHYSIOLOGICAL ISSUES

There is evidence that social stressors alter neuroimmunological function, increasing the expression of pro-inflammatory genes. Pro-inflammatory cytokines play a role in widespread persistent pain, cancer, and even the cytokine storm seen in complicated COVID-19 illness. Thus, the grinding stressors of injustice actually take their toll on the body over time and can be expressed in a patient’s generalized pain.