Policy Selection and Background

2

Health Inequities Among Low-Income Communities and People of Color in the United States

Taliegha Carter

Capella University

Social Welfare Hist Plcy Pract

Prof. Katti Carlson

7/26/26

Health Inequities Among Low-Income Communities and People of Color in the United States

Social justice problems may affect different populations in unique ways. Social workers need to know the issues that may come up in relation to these populations when trying to provide assistance and support to them. One of the social justice issues that exists in the United States is that of the health disparity between poor communities and racial minorities. These people tend to face problems accessing affordable health care, preventative measures, and quality care. Inequality results in adverse health consequences, more chronic illnesses, and unnecessary deaths (Ndugga et al., 2024). The issue of health inequality is affected by such factors as social, economic, and structural factors instead of just individual decisions. Social workers need to participate in the fight for equal access to care through advocacy and policymaking. Analysis of oppression, ethics, public policy, and advocacy gives insights into how to address health disparities.

Forms and Mechanisms of Oppression and Discrimination

Health inequities arise due to the system of oppression and discrimination that is prevalent since time immemorial. Structural inequities such as racism, poverty, unemployment, and disparity in health care services put at risk the well-being of economically underprivileged populations and minority groups. Minorities usually lack health care facilities like hospitals, primary care physicians, specialists, pharmacies, and mental health services in comparison with richer neighborhoods. Constraints to timely health care include limited health care access, difficulties in transportation, lack of health insurance, and poverty.

Discrimination occurs in the healthcare sector as well. Studies have shown that implicit bias impacts the impression of diagnosis, decision-making regarding treatment and pain management, and interaction with healthcare professionals for ethnic minorities (Job et al., 2024). Cultural diversity and communication barriers can also cause delays in treatment and low patient satisfaction.

The implications of these effects are many. According to the estimates by the U.S. Census Bureau in 2023, there are some 25.7 million people in the United States who lack health insurance (Tolbert et al., 2024). The rate of lack of insurance in Hispanic, Black, and lower socio-economic groups is much higher than among those in higher socioeconomic status and the white population. As per the Centers for Disease Control and Prevention (CDC), blacks have higher incidences of high blood pressure, diabetes, heart disease, and stroke (Sells et al., 2023). Black women have three times the risk of death during pregnancy than white women. The consequences are dire for the family economics, disabilities, and mortality rate of the population groups. The impact on communities of health inequities on communities' productivity, education, and lives can be damaging.

Ethical Problems Associated With Health Inequities

The issue of inequities in health has important ethical implications for social work. Among the values promoted in the NASW Code of Ethics are social justice, dignity and worth of the person, service, integrity, and the value of human relationships. Social workers are ethically responsible for opposing discrimination, claiming equal access to services, and ensuring health policy proactively disseminates services to marginalized groups.

An ethical issue may include unequal healthcare provision depending on income level, race, or employment. Everybody has to receive good medical care irrespective of their socio-economic background. Furthermore, there is an ethical problem associated with existing obstacles in the system that keep disadvantaged groups from accessing preventive care, medicines, and other special services. These inequalities are contrary to the principles of fairness and respect for human rights. Another problem relates to the need for social workers to develop their skills in cultural competency and implicit bias. Social workers should know about different factors that influence the way they perform their work (National Association of Social Workers, 2025). Ethical practice calls for culturally responsive communication, respect for clients’ autonomy, and working with the individual and the community to create care plans.

The implications for practice are significant. Social workers can improve client outcomes by connecting individuals with community resources, assisting with insurance enrollment, advocating for culturally appropriate services, and addressing social determinants of health such as housing, food security, employment, and transportation. Ethical Advocacy boosts trust, improves health care access, and contributes to healthier communities.

Current Enacted Policies

Various federal policies have been enacted to minimize health disparities in the United States. One of the significant laws enacted to improve health service accessibility is the Affordable Care Act (ACA), enacted in 2010. Some of the changes made by the Affordable Care Act include expansion of Medicaid to cover more people in states opting for the change, a ban on insurance discrimination based on existing medical conditions, promotion of preventive care, and Health Insurance Marketplaces (U.S. Department of Health and Human Services, 2022).

The American Rescue Plan Act of 2021 makes health coverage more affordable for low-income Americans and their families by increasing premium subsidies for ACA coverage (U.S. Department of Health and Human Services, 2022). Additional subsidies and reduced Medicare prescription drug costs were further extended in the Inflation Reduction Act (IRA) of 2022. Medicaid, another key federal-state program, is health coverage for low-income individuals, children, pregnant women, older adults, and people with disabilities, and is also important. States that increased Medicaid eligibility have generally seen more gains in insurance rates than have states that failed to expand eligibility. Such policies remain in place, and their impact continues to improve health care access to the poor and disadvantaged and to reduce cost barriers to health care services.

Effectiveness of Current Policies

Improvements in current policies provide greater access to insurance coverage and better access to preventive services, but there are significant gaps. Medicaid expansion has been associated with decreased uninsured status, increased preventive services use, better chronic disease management, and fewer unnecessary hospitalizations among low-income adults (Tolbert et al., 2026). Additional insurance expansion has also included increased availability of medications through the system and regular medical attention.

Nevertheless, the success of policies is inconsistent from state to state, as Medicaid extension is an optional policy. People living in non-expanding states may experience coverage gaps which restrict healthcare access. Coverage alone also cannot address disparities stemming from provider shortages, transportation, language barriers, or provider discrimination within the health care system. According to Hayre et al. (2026), policies on broader social determinants of health, in addition to policies on health financing, are required to reduce health inequities. Investments in education, the community, housing, employment, and health infrastructure are tied to long-term health outcomes. As a result, health inequalities that disproportionately affect low-income communities and people of color continue to be present and part of current policy.

Policy Impact and Constraints

Currently, policies have enhanced health insurance coverage and increased access to preventive services for many among these vulnerable populations. Within recent changes, more people receive routine, chronic disease management, maternal and behavioral health services than before reform (Osmani, 2025). These enhancements have helped with early detection and control of many chronic diseases.

However, policy limitations exist as well. The eligibility rules for the Medicaid program differ depending on the state and, consequently, depending on geographic location. Provider shortages affect many individuals, particularly those living in rural and underdeveloped urban areas. Lower payments reduce the willingness of some medical institutions to treat Medicaid recipients. Another factor that affects healthcare eligibility is immigration status. Furthermore, factors such as administration issues, lack of transport options, lack of access to the Internet, and language barriers prevent eligible people from accessing healthcare services. These barriers make the policies ineffective as a whole and exacerbate inequities.

Comparison of Advocacy Methods

Various types of advocacy can be used to deal with health inequalities. Advocacy through policies involves urging legislators to introduce new legislation aimed at ensuring insurance coverage, increased funding in healthcare, and protection from discrimination. Community organizing provides community members the opportunity to identify issues that impact them and to demand better health care services (Jimenez & Heller, 2025). The goal of health education is to increase awareness of health disparities and preventive strategies. Evidence-based policy development, research, and legislative engagement are supported through advocacy by social workers and health professionals.

These two approaches come with their pros and cons. Policy advocacy can lead to systemic, long-term change, and may require the cooperation of policymakers, as well as time to implement. Community organizing is useful because it helps to build trust and empower communities that could be affected but may lack the funds to act independently. Public education can make a difference for awareness but cannot address structural problems alone.

Further advancements require better collaboration between healthcare professionals, social workers, policymakers, and the community. Expanding culturally competent care, growing workforce diversity, better transport facilities, and better investment in disadvantaged areas will build on current efforts. These methods help to foster health equity by addressing the root cause of healthcare inequities.

References

Hayre, J., Canning, E., Pearce, H., Khera, R., & Ford, J. (2026). Public health policies and interventions to address health inequities in high-income countries: An umbrella review. BMC Public Health, 26(1). https://doi.org/10.1186/s12889-025-25876-2

Jimenez, C., & Heller, J. C. (2025). Community organizing and public health: A rapid review. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-21303-8

Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R. (2024). Health professionals' implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: A scoping review. BMJ Open, 14(7), e081723. https://doi.org/10.1136/bmjopen-2023-081723

National Association of Social Workers. (2025). Standards and indicators for cultural competence in social work practice. In National Association of Social Workers. https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/Standards-and-Indicators-for-Cultural-Competence-in-Social-Work-Practice

Ndugga, N., Pillai, D., & Artiga, S. (2024). Disparities in health and health care: 5 key questions and answers. In KFF. https://www.kff.org/racial-equity-and-health-policy/disparities-in-health-and-health-care-5-key-question-and-answers/

Osmani, A. R. (2025). Unequal gains? A literature review on the Affordable Care Act’s effects on healthcare utilization across racial and ethnic groups. International Journal of Environmental Research and Public Health, 22(7), 1059. https://doi.org/10.3390/ijerph22071059

Sells, M., Blum, E., Perry, G. S., Eke, P. I., & Presley-Cantrell, L. (2023). Excess burden of Poverty and hypertension, by Race and ethnicity, on the prevalence of Cardiovascular disease. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230065

Tolbert, J., Bell, C., Cervantes, S., & Singh, R. (2024). The uninsured population and health coverage | KFF. In KFF. https://www.kff.org/uninsured/health-policy-101-the-uninsured-population-and-health-coverage/

Tolbert, J., Cervantes, S., Bell, C., & Damico, A. (2026, June 16). Key facts about the uninsured population. KFF. https://www.kff.org/uninsured/key-facts-about-the-uninsured-population/?entry=financial-implications-of-being-uninsured-financial-insecurity

U.S. Department of Health and Human Services. (2022). About the Affordable Care Act. In U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-aca/index.html

2

Health Inequities Among Low-Income Communities and People of Color in the United States

Taliegha Carter

Capella University

Social Welfare Hist Plcy Pract

Prof. Katti Carlson

7/26/26

Health Inequities Among Low-Income Communities and People of Color in the United States

Social justice problems may affect different populations in unique ways. Social workers need to know the issues that may come up in relation to these populations when trying to provide assistance and support to them. One of the social justice issues that exists in the United States is that of the health disparity between poor communities and racial minorities. These people tend to face problems accessing affordable health care, preventative measures, and quality care. Inequality results in adverse health consequences, more chronic illnesses, and unnecessary deaths (Ndugga et al., 2024). The issue of health inequality is affected by such factors as social, economic, and structural factors instead of just individual decisions. Social workers need to participate in the fight for equal access to care through advocacy and policymaking. Analysis of oppression, ethics, public policy, and advocacy gives insights into how to address health disparities.

Forms and Mechanisms of Oppression and Discrimination

Health inequities arise due to the system of oppression and discrimination that is prevalent since time immemorial. Structural inequities such as racism, poverty, unemployment, and disparity in health care services put at risk the well-being of economically underprivileged populations and minority groups. Minorities usually lack health care facilities like hospitals, primary care physicians, specialists, pharmacies, and mental health services in comparison with richer neighborhoods. Constraints to timely health care include limited health care access, difficulties in transportation, lack of health insurance, and poverty.

Discrimination occurs in the healthcare sector as well. Studies have shown that implicit bias impacts the impression of diagnosis, decision-making regarding treatment and pain management, and interaction with healthcare professionals for ethnic minorities (Job et al., 2024). Cultural diversity and communication barriers can also cause delays in treatment and low patient satisfaction.

The implications of these effects are many. According to the estimates by the U.S. Census Bureau in 2023, there are some 25.7 million people in the United States who lack health insurance (Tolbert et al., 2024). The rate of lack of insurance in Hispanic, Black, and lower socio-economic groups is much higher than among those in higher socioeconomic status and the white population. As per the Centers for Disease Control and Prevention (CDC), blacks have higher incidences of high blood pressure, diabetes, heart disease, and stroke (Sells et al., 2023). Black women have three times the risk of death during pregnancy than white women. The consequences are dire for the family economics, disabilities, and mortality rate of the population groups. The impact on communities of health inequities on communities' productivity, education, and lives can be damaging.

Ethical Problems Associated With Health Inequities

The issue of inequities in health has important ethical implications for social work. Among the values promoted in the NASW Code of Ethics are social justice, dignity and worth of the person, service, integrity, and the value of human relationships. Social workers are ethically responsible for opposing discrimination, claiming equal access to services, and ensuring health policy proactively disseminates services to marginalized groups.

An ethical issue may include unequal healthcare provision depending on income level, race, or employment. Everybody has to receive good medical care irrespective of their socio-economic background. Furthermore, there is an ethical problem associated with existing obstacles in the system that keep disadvantaged groups from accessing preventive care, medicines, and other special services. These inequalities are contrary to the principles of fairness and respect for human rights. Another problem relates to the need for social workers to develop their skills in cultural competency and implicit bias. Social workers should know about different factors that influence the way they perform their work (National Association of Social Workers, 2025). Ethical practice calls for culturally responsive communication, respect for clients’ autonomy, and working with the individual and the community to create care plans.

The implications for practice are significant. Social workers can improve client outcomes by connecting individuals with community resources, assisting with insurance enrollment, advocating for culturally appropriate services, and addressing social determinants of health such as housing, food security, employment, and transportation. Ethical Advocacy boosts trust, improves health care access, and contributes to healthier communities.

Current Enacted Policies

Various federal policies have been enacted to minimize health disparities in the United States. One of the significant laws enacted to improve health service accessibility is the Affordable Care Act (ACA), enacted in 2010. Some of the changes made by the Affordable Care Act include expansion of Medicaid to cover more people in states opting for the change, a ban on insurance discrimination based on existing medical conditions, promotion of preventive care, and Health Insurance Marketplaces (U.S. Department of Health and Human Services, 2022).

The American Rescue Plan Act of 2021 makes health coverage more affordable for low-income Americans and their families by increasing premium subsidies for ACA coverage (U.S. Department of Health and Human Services, 2022). Additional subsidies and reduced Medicare prescription drug costs were further extended in the Inflation Reduction Act (IRA) of 2022. Medicaid, another key federal-state program, is health coverage for low-income individuals, children, pregnant women, older adults, and people with disabilities, and is also important. States that increased Medicaid eligibility have generally seen more gains in insurance rates than have states that failed to expand eligibility. Such policies remain in place, and their impact continues to improve health care access to the poor and disadvantaged and to reduce cost barriers to health care services.

Effectiveness of Current Policies

Improvements in current policies provide greater access to insurance coverage and better access to preventive services, but there are significant gaps. Medicaid expansion has been associated with decreased uninsured status, increased preventive services use, better chronic disease management, and fewer unnecessary hospitalizations among low-income adults (Tolbert et al., 2026). Additional insurance expansion has also included increased availability of medications through the system and regular medical attention.

Nevertheless, the success of policies is inconsistent from state to state, as Medicaid extension is an optional policy. People living in non-expanding states may experience coverage gaps which restrict healthcare access. Coverage alone also cannot address disparities stemming from provider shortages, transportation, language barriers, or provider discrimination within the health care system. According to Hayre et al. (2026), policies on broader social determinants of health, in addition to policies on health financing, are required to reduce health inequities. Investments in education, the community, housing, employment, and health infrastructure are tied to long-term health outcomes. As a result, health inequalities that disproportionately affect low-income communities and people of color continue to be present and part of current policy.

Policy Impact and Constraints

Currently, policies have enhanced health insurance coverage and increased access to preventive services for many among these vulnerable populations. Within recent changes, more people receive routine, chronic disease management, maternal and behavioral health services than before reform (Osmani, 2025). These enhancements have helped with early detection and control of many chronic diseases.

However, policy limitations exist as well. The eligibility rules for the Medicaid program differ depending on the state and, consequently, depending on geographic location. Provider shortages affect many individuals, particularly those living in rural and underdeveloped urban areas. Lower payments reduce the willingness of some medical institutions to treat Medicaid recipients. Another factor that affects healthcare eligibility is immigration status. Furthermore, factors such as administration issues, lack of transport options, lack of access to the Internet, and language barriers prevent eligible people from accessing healthcare services. These barriers make the policies ineffective as a whole and exacerbate inequities.

Comparison of Advocacy Methods

Various types of advocacy can be used to deal with health inequalities. Advocacy through policies involves urging legislators to introduce new legislation aimed at ensuring insurance coverage, increased funding in healthcare, and protection from discrimination. Community organizing provides community members the opportunity to identify issues that impact them and to demand better health care services (Jimenez & Heller, 2025). The goal of health education is to increase awareness of health disparities and preventive strategies. Evidence-based policy development, research, and legislative engagement are supported through advocacy by social workers and health professionals.

These two approaches come with their pros and cons. Policy advocacy can lead to systemic, long-term change, and may require the cooperation of policymakers, as well as time to implement. Community organizing is useful because it helps to build trust and empower communities that could be affected but may lack the funds to act independently. Public education can make a difference for awareness but cannot address structural problems alone.

Further advancements require better collaboration between healthcare professionals, social workers, policymakers, and the community. Expanding culturally competent care, growing workforce diversity, better transport facilities, and better investment in disadvantaged areas will build on current efforts. These methods help to foster health equity by addressing the root cause of healthcare inequities.

References

Hayre, J., Canning, E., Pearce, H., Khera, R., & Ford, J. (2026). Public health policies and interventions to address health inequities in high-income countries: An umbrella review. BMC Public Health, 26(1). https://doi.org/10.1186/s12889-025-25876-2

Jimenez, C., & Heller, J. C. (2025). Community organizing and public health: A rapid review. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-21303-8

Job, C., Adenipekun, B., Cleves, A., Gill, P., & Samuriwo, R. (2024). Health professionals' implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: A scoping review. BMJ Open, 14(7), e081723. https://doi.org/10.1136/bmjopen-2023-081723

National Association of Social Workers. (2025). Standards and indicators for cultural competence in social work practice. In National Association of Social Workers. https://www.socialworkers.org/Practice/NASW-Practice-Standards-Guidelines/Standards-and-Indicators-for-Cultural-Competence-in-Social-Work-Practice

Ndugga, N., Pillai, D., & Artiga, S. (2024). Disparities in health and health care: 5 key questions and answers. In KFF. https://www.kff.org/racial-equity-and-health-policy/disparities-in-health-and-health-care-5-key-question-and-answers/

Osmani, A. R. (2025). Unequal gains? A literature review on the Affordable Care Act’s effects on healthcare utilization across racial and ethnic groups. International Journal of Environmental Research and Public Health, 22(7), 1059. https://doi.org/10.3390/ijerph22071059

Sells, M., Blum, E., Perry, G. S., Eke, P. I., & Presley-Cantrell, L. (2023). Excess burden of Poverty and hypertension, by Race and ethnicity, on the prevalence of Cardiovascular disease. Preventing Chronic Disease, 20(20). https://doi.org/10.5888/pcd20.230065

Tolbert, J., Bell, C., Cervantes, S., & Singh, R. (2024). The uninsured population and health coverage | KFF. In KFF. https://www.kff.org/uninsured/health-policy-101-the-uninsured-population-and-health-coverage/

Tolbert, J., Cervantes, S., Bell, C., & Damico, A. (2026, June 16). Key facts about the uninsured population. KFF. https://www.kff.org/uninsured/key-facts-about-the-uninsured-population/?entry=financial-implications-of-being-uninsured-financial-insecurity

U.S. Department of Health and Human Services. (2022). About the Affordable Care Act. In U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-aca/index.html