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MLK’s Legacy: Health Equity & the Social Determinants of Health

Each year on the third Monday in January, the nation celebrates Martin Luther King, Jr. Day–an opportunity to reflect on the individual, ideas, and impact of this civil rights icon. Throughout his life, Dr. King championed important social causes such as poverty, discrimination, education, and housing–factors that many experts today refer to as the Social Determinants of Health.

Dr. King was well ahead of his time in understanding that the conditions and environments where people are born, live, learn, work, play, worship, and age greatly impact their quality of life and a wide range of public health outcomes.

At a Convention of the Medical Committee for Human Rights held in Chicago in March 1966, Dr. King declared:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”

In what ways do health disparities continue to exist?

Many decades later, health disparities and inequities among various communities are prevalent here in Colorado and across the nation.

For example, consider these statistics:

Coloradans who speak a language other than English at home (more than 937,000 people) are less likely than English speakers to have accessed health care in the past 12 months.
Coloradans who skipped mental health care due to fear of unfair treatment were three times as likely to report poor mental health compared with those who didn’t skip care (46.6% compared with 15.6%).
Black or African American Coloradans were more than twice as likely than non-Hispanic/Latino white Coloradans (5.4% compared to 2.3%) to report skipping care due to concerns about unfair treatment or consequences. Hispanic/Latino Coloradans (4.4%) were also nearly twice as likely as white Coloradans (2.3%) to report this challenge.
In 2021, 1 in 14 (6.9%) Coloradans reported needing health care that was responsive to a particular need or part of their identity, most often due to their disability, language, sexual orientation, or experience with violence or abuse.
According to the CDC, while the reported prevalence of mental disorders, substance use, or substance use disorders are not generally higher among racial and ethnic minority groups, persons in these groups are often less likely to receive treatment services due to systemic social inequities and discrimination.
Although rates of depression are lower in blacks (24.6%) and Hispanics (19.6%) than in whites (34.7%), depression in blacks and Hispanics is likely to be more persistent.
People who identify as being two or more races (24.9%) are most likely to report any mental illness within the past year than any other race/ethnic group, followed by American Indian/Alaska Natives (22.7%), white (19%), and black (16.8%).
American Indians/Alaskan Natives report higher rates of post-traumatic stress disorder (PTSD) and alcohol dependence than any other ethnic/racial group.
Racial/ethnic minority youth with behavioral health issues are more readily referred to the juvenile justice system than to specialty primary care, compared with white youth.
People from racial/ethnic minority groups are less likely to receive mental health care. In 2015, among adults with any mental illness, 48% of whites received mental health services, compared with 31% of blacks and Hispanics, and 22% of Asians.
Nearly 1 in 5 transgender and nonbinary youth attempted suicide and LGBTQ youth of color reported higher rates than their white peers.

What are the barriers to care?

The reasons why these gaps in care persist are complex, systemic, and varied. As the data above illustrates, some of the most common factors affecting access to treatment by members of diverse groups may include:

Lack of insurance or underinsurance
Mental illness stigma, which is often greater among minoritized populations
Lack of diversity among mental health care providers
Lack of culturally competent providers and responsive care
Language barriers
Distrust in the health care system rooted in historic trauma
Inadequate support for mental health services in safety net settings (uninsured, Medicaid)

What can we do to break down barriers to care?

At MHP, we believe that we have a social responsibility to address inequities in the behavioral health system and–in the words of Dr. King - “raise the conscience of the nation.”

According to Sara D. Anderson, our VP of Justice, Equity, Diversity, and Inclusion:

“We accomplish this by not only speaking out about such disparities, but also by taking actionable steps to expand access to expert, culturally-responsive care for those we serve, as well as investing in community engagement and empowerment.”

In the last year, MHP has committed to this mission through action in several important ways. For example, we implemented internal policy changes regarding pronoun usage and dress code. We also instituted foundational JEDI Values as a guide to applying an equity lens on every facet of decision-making within the organization. Most recently, we hired a JEDI Facilitator & Curriculum Development Specialist to help develop trainings for our clinicians and staff in how to provide culturally responsive care.

While profound systemic and societal change does not happen overnight, we are committed to continuing our ongoing work with community partners and state leaders to deliver long-term health equity and justice for our clients, community, and colleagues.

In the words of Dr. King: