Pursuing health equity: zoning codes and public health.

journal of law, medicine & ethics Health equity can be defined as the absence of disadvantage to individuals and communities in health outcomes, access to health care, and quality of health care regardless of one’s race, gender, nationality, age, ethnicity, religion, and socioeconomic status.1 Health equity concerns those disparities in public health that can be traced to unequal, systemic economic, and social conditions.2 Despite significant improvements in the health of the overall population, health inequities in America persist. Racial and ethnic minorities continue to experience higher rates of morbidity and mortality than non-minorities across a range of health issues.3 For example, African-American children with asthma have a seven times greater mortality rate than Non-Hispanic white children with the illness.4 While cancer is the second leading cause of death among all populations in the U.S., ethnic minorities are especially burdened with the disease. African-American men, for example, are more than twice as likely as their white counterparts to die of prostate cancer. In addition, 36% of adults with a disability are obese compared to 23% of adults without a disability, and smoking prevalence for people with disabilities is approximately 50% higher than for people without disabilities.5 Among the 10 leading causes of mortality in the U.S., minority populations experience the highest rate of death.6 The reported reasons for these disparities vary, including individual factors such as limited access to health care and differences in cultural beliefs, social norms, and socioeconomic status.7 Any analysis of how these health disparities arise and how they are perpetuated must include the interplay between individual factors and broader environmental conditions. Research on the connections between health and the environment, specifically the built environment, has shown that the burden of illness is greater on minority and vulnerable populations, and on those of low socioeconomic status.8 The high prevalence of noxious land uses and ready availability of tobacco products and inexpensive, unhealthy foods in communities where low-income families and people of color are more likely to live, work, and play provide salient examples of how the built environment can impact health and exacerbate health disparities.