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“Health disparities” and “health equity” have become increasingly familiar terms in public health, but rarely are they defined explicitly. Ambiguity in the definitions of these terms could lead to misdirection of resources . This article discusses the need for greater clarity about the concepts of health disparities and health equity, proposes definitions, and explains the rationale based on principles from the fields of ethics and human rights.

During the past two decades, the public health community's attention has been drawn increasingly to the social determinants of health (SDH)—the factors apart from medical care that can be influenced by social policies and shape health in powerful ways. We use “medical care” rather than “health care” to refer to clinical services, to avoid potential confusion between “health” and “health care.” The World Health Organization's Commission on the Social Determinants of Health has defined SDH as “the conditions in which people are born, grow, live, work and age” and “the fundamental drivers of these conditions.” The term “social determinants” often evokes factors such as health-related features of neighborhoods (e g., walkability, recreational areas, and accessibility of healthful foods), which can influence health-related behaviors. Evidence has accumulated, however, pointing to socioeconomic factors such as income, wealth, and education as the fundamental causes of a wide range of health outcomes This article broadly reviews some of the knowledge accumulated to date that highlights the importance of social—and particularly socioeconomic—factors in shaping health, and plausible pathways and biological mechanisms that may explain their effects. We also discuss challenges to advancing this knowledge and how they might be overcome.

Objectives. We examined the prevalence of dental care during pregnancy and reasons for lack of care.Methods. Using a population-based survey of 21,732 postpartum women in California during 2002–2007, we calculated prevalence of dental problems, receipt of care, and reasons for non-receipt of care. We used logistic regression to estimate odds of non-receipt of care by maternal characteristics.Results. Overall, 65% of women had no dental visit during pregnancy; 52% reported a dental problem prenatally, with 62% of those women not receiving care. After adjustment, factors associated with non-receipt of care included non-European American race/ethnicity, lack of a college degree, lack of private prenatal insurance, no first-trimester prenatal insurance coverage, lower income, language other than English spoken at home, and no usual source of pre-pregnancy medical care. The primary reason stated for non-receipt of dental care was lack of perceived need, followed by financial barriers.Conclusions. Most pregnant women in this study received insufficient dental care. Odds were elevated not only among the poorest, least educated mothers, but also among those with moderate incomes or some college education. The need for dental care during pregnancy must be promoted widely among both the public and providers, and financial barriers to dental care should be addressed.

Objectives. Income data are often missing for substantial proportions of survey participants and these records are often dropped from analyses. To explore the implications of excluding records with missing income, we examined characteristics of survey participants with and without income information.Methods. Using statewide population-based postpartum survey data from the California Maternal and Infant Health Assessment, we compared the age, education, parity, marital status, timely prenatal care initiation, and neighborhood poverty characteristics of women with and without reported income data, overall, and by race/ethnicity/nativity.Results. Overall, compared with respondents who reported income, respondents with missing income information generally appeared younger, less educated, and of lower parity. They were more likely to be unmarried, to have received delayed or no prenatal care, and to reside in poor neighborhoods; and they generally appeared more similar to lower- than higher-income women. However, the patterns appeared to vary by racial/ethnic/nativity group. For example, among U.S.-born African American women, the characteristics of the missing-income group were generally similar to those of low-income women, while European American women with missing income information more closely resembled their moderate-income counterparts.Conclusions. Respondents with missing income information may not be a random subset of population-based survey participants and may differ on other relevant sociodemographic characteristics. Before deciding how to deal analytically with missing income information, researchers should examine relevant characteristics and consider how different approaches could affect study findings. Particularly for ethnically diverse populations, we recommend including a missing income category or employing multiple-imputation techniques rather than excluding those records.

Objectives. To examine multiple dimensions of socioeconomic status and breastfeeding among a large, random sample of ethnically diverse women.Methods. This study used logistic regression analysis to examine the influence of a range of socioeconomic factors on the chances of ever breastfeeding among a stratified random sample of 10,519 women delivering live births in California for 1999 through 2001. Measures of socioeconomic status included family income as a percentage of the federal poverty level, maternal education, paternal education, maternal occupation, and paternal occupation.Results. Consistent with previous research, there was a marked socioeconomic gradient in breastfeeding. Women with higher family incomes, those who had or whose partners had higher education levels, and women who had or whose partners had professional or executive occupations were more likely than their counterparts to breastfeed. After adjustment for many potential confounders, maternal and paternal education remained positively associated with breastfeeding, while income and occupation were no longer significant. Compared with other racial or ethnic groups, foreign-born Latina women were the most likely to breastfeed.Conclusions. The significant association of maternal and paternal education with breastfeeding, even after adjustment for income, occupation, and many other factors, suggests that social policies affecting educational attainment may be important factors in breastfeeding. Breastfeeding rates may be influenced by health education specifically or by more general levels of schooling among mothers and their partners. The continuing importance of racial/ethnic differences after adjustment for socioeconomic factors could reflect unmeasured socioeconomic effects, cultural differences, and/or policies in Latin American countries.