A capabilities approach to understanding health disparities

Health disparities are pervasive in the U.S., and three of the greatest risk factors for poor health outcomes are race, rural residence, and disability. Individuals in these groups frequently experience poor health outcomes and social disadvantages. Such disadvantages contradict ethical principles such as respect for equal moral worth of all and social values such as non-discrimination. The purpose of this dissertation was to explore race, disability, rural culture, and disparities experienced by these groups using a social justice lens. Specifically, this dissertation relies upon a social constructionist perspective situated within Sen’s capabilities approach to examine the cultural and social systems that influence the meaning and experience of health, well-being, and disability. The dissertation is comprised of three separate manuscripts; each presents findings from a distinct investigation. The first is an issue brief that answers the research question: how does the capabilities approach compare with the WHO’s International Classification of Functioning, Disability, and Health (ICF) in terms of these models’ ability to accommodate the diverse experiences and needs of people with disabilities? The second presents results from a critical analysis of literature related to racial disparities in healthcare utilization and outcomes among veterans in the Veterans’ Healthcare Administration (VHA). This investigation answers the research question: what are the structural determinants that influence disparities in health between African-American veterans and their non-Hispanic white counterparts with osteoarthritis? The third presents findings from a grounded theory study investigating well-being among working-age adults with disabilities living in rural counties in Texas. This investigation of 12 rural-dwelling adults with disabilities answers the research questions: how do working-age adults with disabilities who live in rural Texas define and pursue well-being, and how does the rural environment influence both their definition of and their ability to pursue well-being? The findings from this dissertation underscore the critical notion that individuals are inextricable from their social worlds. It is argued that without a holistic assessment of an individual’s sociocultural and economic circumstances, healthcare providers may inadvertently perpetuate disparities by providing culturally inappropriate care and/or prescribing physically or economically unattainable interventions. Implications for nursing practice, policy, and the delivery of long-term services and supports in rural areas are discussed.