Barriers to Health Care Among Adults With Minoritized Identities in the United States, 2013–2017

Stephanie M. Hernandez, MS; P. Johnelle Sparks, PhD

Disclosures

Am J Public Health. 2020;110(6):857-862. 

In This Article

Abstract and Introduction

Abstract

Objectives: To examine the relationship between minoritized identity and barriers to health care in the United States.

Methods: Nationally representative data collected from the 2013 to 2017 waves of the National Health Interview Survey were used to conduct descriptive and logistic regression analyses. Men and women were placed in 1 of 4 categories: no minoritized identities, minoritized identities of race/ethnicity (MIoRE), minoritized identities of sexuality (MIoS), or minoritized identities of both race/ethnicity and sexuality (MIoRES). Five barriers to health care were considered.

Results: Relative to heterosexual White adults and after controlling for socioeconomic status, adults with MIoRE were less likely to report barriers, adults with MIoS were more likely to report barriers, and adults with MIoRES were more likely to report barriers across 2 of the study measures.

Conclusions: Barriers to care varied according to gender, minoritized identity, and the measure of access to health care itself.

Public Health Implications: Approaching health disparities research using an intersectional lens moves the discussion from examining individual differences to examining the role of social structures such as the health care system in maintaining and reproducing inequality.

Introduction

A significant body of health disparities literature suggests pervasive differences in the health of adults in the United States. In general, adults with minoritized racial, ethnic, and sexual identities are more likely to report poor health outcomes than are heterosexual non-Hispanic White adults.[1] Also, an extensive body of literature suggests that adults with minoritized identities are more likely to report barriers to health care than are their nonminoritized counterparts.[2,3] However, the reproduction of social hierarchies and structural policies and practices exacerbates disparities in access as a result of the norms of care developed around and delivered to traditional dominant groups (e.g., men, non-Hispanic Whites, and individuals of high socioeconomic status [SES]). Taking this historical and normative perspective into account in assessing disparities in health care access changes the focus from one of differences to one of inequalities, which are best addressed via an intersectional perspective.

Social identity is multifaceted, situated in historical and contemporary sociopolitical contexts and composed of several relational dimensions including but not limited to race, ethnicity, sexuality, ability, religious affiliation, nativity, gender, gender expression, and class.[4] According to Zinn and Dill, these dimensions are "components of both social structure and social interaction."[5] (p327) Although race/ethnicity and sexuality are not the only dimensions of identity that influence an individual's experience with the health care system, no study to our knowledge has quantitatively examined barriers to health care among both racial/ethnic and sexual minorities (multiple marginalization[6]).

To address this gap, we examined barriers to health care among adults with varying self-reported minoritized racial/ethnic and sexual social identities using an intersectionality perspective. The research question guiding the analysis was as follows: are adults with minoritized racial/ethnic and sexual identities more likely to report barriers to health care than are adults with nonminoritized racial/ethnic and sexual identities? On the basis of the literature just discussed, we hypothesized that net of controls, adults with minoritized identities would be more likely to report barriers to health care than would heterosexual White adults because of the ways in which structural racism and homophobia reinforce a social structure that limits and excludes some adults with minoritized identities from the health care system.

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