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achieve health equity, and attain health literacy to improve the health and well-being of all.” Low education and income levels are associated with health illiteracy, which has been identified as a critical factor contributing to health inequities (Paasche-Orlow & Wolf, 2010), and national data confirm that health inequities are exacerbated by the prevalence and severity of limited health literacy. Health literacy is generally referred to as the ability to apply literacy skills to health situations at home, work, and the community.

      Aging Process

      The pace of population aging is much faster than in the past. Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12 percent to 22 percent. Currently, the number of people aged 60 years and older is outnumbering children younger than five years. All countries face major challenges to ensure that their health and social systems are ready to make the most of this demographic shift. According to the World Health Organization, by 2050, the world’s population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015 (World Health Organization, 2018). Health generally deteriorates with age, but there is significant variation across people, regions, and countries.

      Life expectancy at birth compares the average number of years to be lived by a group of people born in the same year, if mortality at each age remains constant in the future. Life expectancy at birth is also a measure of overall quality of life in a country and summarizes the mortality at all ages. Increased life expectancy constitutes a considerable public health accomplishment, and for the first time in history, most people can expect today to live into their sixties and beyond. Living longer brings exciting opportunities not only for those who enjoy aging, but also for our society as a whole. Extended years of productive and active life mean additional contributions to family and community. However, these extended benefits greatly rely on two key factors: health and quality of life.

      Women’s and Men’s Health

      While the overall health of American women has improved over the past few decades, significant disparities still exist. Many minority women continue to lag behind White women in access to care and quality of care, which is affecting health outcomes. Certain policy decisions have a high impact on women’s health. For instance, while there is good evidence that comprehensive sex education programs are effective in reducing abortion and poverty, and empowering women, federal support for these programs has vanished. Meanwhile, the United Nations and international health agencies have declared that accurate STD, HIV/AIDS, and other related information should be regarded as a basic human right.

      Cultural, social, and structural factors also play a role in health differences between men and women. For instance, 1 in 3 women have experienced sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime. Similarly, women earn less than men: full-time female workers earn about one-fourth less than male counterparts in a given year. This contributes to higher rates of poverty among women compared to men, which in turn affects health and quality of life. There are also differences in the way women and men seek and receive healthcare services. These differences are in part due to how different people access the healthcare system and the provision of services. For example, women tend to use preventive and diagnostic services more frequently, whereas men make greater use of emergency service.

      Gender Identity and Sexual Orientation

According to a Gallup report, the percentage of American adults identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) increased to 4.5 percent in 2017, up from 4.1 percent in 2016 and 3.5 percent in 2012 (Newport, 2020). Research suggests that LGBTQ+ persons face health inequities linked to societal stigma, discrimination, and denial of their civil and human rights. Discrimination against LGBTQ+ persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide. Experiences of violence and victimization are frequent for LGBTQ+ persons, and have long-lasting effects on the individuals and the community. Personal, family, and social acceptance of gender identity affects the mental health and personal safety of LGBTQ+ individuals. There is evidence that:

       LGBTQ+ youth are 2 to 3 times more likely to attempt suicide.

       LGBTQ+ youth are more likely to be homeless.

       Lesbians are less likely to get preventive services for cancer.

       Gay men are at higher risk of HIV and other STDs, especially among communities of color.

       Lesbians and bisexual females are more likely to be overweight or obese.

       Transgender individuals have a high prevalence of HIV/STDs, victimization, mental health issues, and suicide and are less likely to have health insurance than heterosexual or LGBTQ+ individuals.

       Elderly LGBTQ+ individuals face additional barriers to health because of isolation and a lack of social services and culturally competent providers.

       LGBTQ+ populations have the highest rates of tobacco, alcohol, and other drug use.

      Disability

      One in four adults—61 million Americans—have a disability that impacts major life activities (Okoro et al., 2018). Disability is more common among women, non-Hispanic American Indians/Alaska Natives, adults with lower income and adults in rural areas. Mobility and cognition disability are the two most common disability types, followed by independent living, hearing, vision, and self-care; disability and income are directly associated.

In general, people with disabilities are more likely to report anxiety, pain, sleeplessness, and depression (Aro et al., 2019). Health professionals may need to make additional efforts to reach out to this population group, as people with disabilities are more likely to have behavioral health risks such as obesity, smoking, and being physically inactive, all of which can lead to poorer health and premature death. Adults with any disability were more likely to die of any cause compared to adults without any disability. Women with disabilities and those who are minorities experience additional social and environmental barriers that make them more vulnerable to certain health conditions. For instance, disabled women are more likely to suffer from pain, fatigue, osteoporosis, obesity, and depression. Disabled minorities are often said to be in double jeopardy because they have two characteristics: being disabled and being from a minority group that place them at greater risk for health disparities (Jones & Sinclair, 2008).

      Geographic Location

      In the United States, differences in one’s geographic location (i.e. neighborhood, town, community) are linked to variations in illness and death. In comparison with White children, Hispanic and African American children are more likely to live in communities near toxic waste sites. African Americans are more likely to live in communities that are less likely to have parks, green spaces, walking or biking trails, swimming pools, beaches, or commercial outlets for physical activity such as physical fitness facilities, sports clubs, dance facilities, and golf courses (Padilla et al., 2016). Further, those living in very poor neighborhoods often lack supermarkets with fresh produce.

      Access to Healthcare

      The United States is the richest country on the world and its healthcare system is the most complex of all; it is also the most expensive in relation to the percentage of the GDP and the expenditures per capita. Health expenditures in the United States duplicate the average expenses reported by other high-income countries. However, mortality related to healthcare access and quality is significantly higher in comparison to other high-income countries and some low and middle-income countries. The U.S. healthcare system is complex, with combined private and public funding, many different insurance structures, and mostly private service delivery (the latter excepting for the VA, the chronically underfunded Indian Health Service, and the insurance for the active military). It is also the most inequitable among similar countries (Geyman, 2018; Jones & Kantarjian, 2019).

      In the

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