Introduction

The world including America benefits when every individual has equal opportunity to live a long, health as well as productive life, yet the issue of health disparities is a thorn in the flesh. A health disparity can be described as a variance in health outcomes across subsections of the population.  Health disparities are usually associated with economic, environmental or social disadvantages, for example, unsafe neighbourhoods, less access to jobs, and poor road networks. Health disparities negatively affect individuals who have systematically experienced bigger obstacles to accessing quality healthcare based on their ethnicity, race, gender status, sexual orientation, geographic location, physical disability, or other features historically associated with exclusion and discrimination.  Major health concerns such as obesity, HIV/AIDS, obesity, diabetes, asthma, heart disease, viral hepatitis B and C, violence, infant mortality disproportionately affect certain population group (Murphy et al., 2018). Reducing health disparities will provide an opportunity for every individual to live a healthy life as well as be able to access quality care hence increased living standards for not only American citizens but also the world at large.  Health disparity can also be defined as a given type of health difference that is directly associated with an environmental, economic, and social disadvantage (Murphy et al., 2018). Disparities is manifested in the high  prevalence of HIV in rural south; increased rate of suicide among lesbians, bi-sexual, transgender, and gay populations; higher incidence of obesity in lower-income groups; increase complications due to diabetes among Hispanic population; and shorter life expectancy among the  lower-income workers (Mokdad et al., 2018; CDC, 2018).  This paper will look at the health disparities challenge, the role that Medicare plays in reducing healthcare disparities, environmental factors contributing to healthcare disparities, and prevention as the primary tool to eliminating healthcare disparities.

While most of the recognized and widely discussed healthcare disparities are income groups,  racial, and ethnic, health outcomes can also be segregated along other factors such as sexual orientation, age, disability/ability, geographic location, gender, and ability to speak English. When the elements of poverty, environment and race meet, the convergence of these factors results in a bigger overall terrorization to health (Williams, 2007). Among people living in abject poverty, which influences nearly every health aspect, people of color are improperly represented. According to the study reports, people of color and individuals of low income within America have higher incidences of injury and poor health than white and higher incomes individuals do (Dankwa-Mullan et al., 2010).  Even though this article discusses healthcare disparities in general, it will particularly knuckle down to this array of concerns. Concentrating mainly on the actual causation of health disparities like racism and poverty is extremely broader approach and therefore less likely to lead to immediate improvement in health outcomes.

On the other hand, focusing on just individual care is a quite a narrower approach for alleviating health disparities (Apter & Casillas, 2011). Notwithstanding high-quality care, treating people lone will not do much in minimizing the higher ill health and diseases prevalence among particular groups.  A strategy mainly concentrating especially on altering the environmental conditions within communities can accomplish both long-term and short-term outcomes in alleviating health disparities. There is a forcible opportunity, consequently, to target prevention drives toward defined environmental condition contributing to ill health (Apter & Casillas, 2011).

Warranting that all people have access to quality medical care is part of a wider plan to eradicate health disparities. High-quality health care can easily identify conditions leading to poor health, promote healthy behaviours, as well as minimize the severity and persistent cases of diseases (Murphy et al., 2018). Nevertheless, the majority of low-income individuals and people of color still have limited access to quality medical care, broadening further the health outcomes gaps between them and higher income groups and the whites. Increasing healthcare access to this group of people is part of the long-term solution to enhancing health outcomes as well as alleviating health disparities. Improving access to high-quality health care alone cannot eliminate health disparities due to the following:

Medical care is not the primary health determinant: since the onset of the 20^th century there has been a significant improvement in life expectancy and of the 30-year improvement of the length of life, only five years of the improvement are credited to health care interventions. Even in nations that boast universal access to medical care, people in lower socioeconomic class have poorer health outcome (Apter & Casillas, 2011). According to Blum (1981), the most key health determinant is environmental conditions the lifestyle. Medical care is ranked third as a health determinant. Generally, medical care only deals with one individual at a time. By only concentrating on a single person and particular disease as they outbreak, medical care fails to decrease the severity or incidence of illness among the population.

Medical intervention usually comes as the last solution or late: Normally people seek medical care only when they become sick. Currently, the most chronic health conditions such as diabetes, HIV/AIDS, asthma, and diabetes are incurable (Mokdad et al., 2018). Therefore, it is imperative to prevent their occurrence on the word go. Besides, prevention is preferable for severe acute issues such as violence, contagious diseases, and traffic injuries.  While medical contributes to the recovery of certain conditions of people, they would certainly be at an advantage never suffering these conditions in first place.

Health disparities do not mean a given population is experiencing a more different set of diseases than the illness affecting the general populace. Rather, the general predisposition to illness is higher and rates of diseases are prevalent because of a wide range of environmental factors and conditions. The primary contributor to health disparities is cited to be economic and social inequality that is institutional racism and social bias, poverty, limited education and well as associated environmental factors that either promote unhealthy behavior or directly led to ill health. Other than water and air environment can be described as anything external to people shared by community members including behavioral norms of the community. In the investigation of the forces that affect health outcomes, environmental conditions are cites as a ubiquitous and powerful set of forces (Green, 2005).

Victims of health disparities often stay in settings with:

• Limited community access to a health-promoting environment such as affordable, nutritious food, playing and exercise space, relevant, accurate medical information, and effective systems of transport
• Toxic contamination as well as higher exposure to microbial and viral agents in the water, air, soils, parks, schools, and homes.
• Discrimination, poverty, institutional racism, joblessness as well as other life stressors
• The violence that renders the place insecure for any movement obstructs community development and surges psychological stress.
• Targeted marketing as well as disproportionate orifices of unhealthy products including fast foods, alcohol, cigarettes, and other illegal substances.
• Society norms that fail to promote protective health behaviors.

A number of these environmental factors directly lead to ill health. For instance, cancer can be due to toxins within the environment and chemical as well as other air pollutants can trigger asthma. In given instances, the environment directly influences health behaviors associated with ill health (Earl, 2015).  Progressively, health experts note that a special focus on personal responsibility in the causes of illness is limited. Thus, individual educational exertions will have greater effect if they are connected to efforts to alter environmental conditions. For instance, poor selection regarding physical activity and diet, which contributes to about one-third of premature deaths in the United States, are not merely based on information or personal preference regarding health risks (Earl, 2015). It is quite difficult for people to change their behavior if they have inadequate income to buy healthy food which in most cases are expensive hence will be diverted to purchasing unhealthy foods which are affordable and at their disposal. On a similar note, it is not possible for people to participate in physical activities such as games and exercises when there are few parks or gyms, and the street is insecure. Focusing on at least one of these environmental conditions could significantly reduce the prevalence of diseases and health disparities.

Primary prevention can be defined as the process of addressing the root causes of illness before the occurrence of poor health. It involves taking an early action before any diseases arise. Primary prevention is differentiated from secondary prevention that includes taking action when the real problem, for instance, high blood pressure is identified, and tertiary prevention that involves intervention to tackle the emergencies as well as prevent relapses following a traumatic event such as stroke or heart attack. It is thus obvious environment contributes largely to health disparities and elimination of health disparities needs strategies and approaches that change environmental conditions (CDC, 2019). The most effective strategy is primary prevention since it emphasizes on altering environmental conditions at the community level but not at the person level. While some people are often helped through services, treating one individual at a time may fail to change diseases occurrences within a given community. To minimize the incidences of health disparities rather than treating already high prevalence of illnesses, preventive action should take place at the system level.

The concept of focusing on environmental factors is an approach known to many and is rooted in the public health foundation. For instance, the recognition of the germ theory resulted in great improvement in health outcomes through the development of antibiotics as well as procedures and practice that contributed to the decrease in transmission of diseases such as securing clean water, safe foods, and appropriate disposal of liters or waste (Martinez, et al., 2017). Early practitioners of public health also acknowledged the effect of poverty in increasing diseases incidences prompting them to advocate for improvements such as better quality food and less crowded housing. In spite of the practice, the recent health promotion has tried to place, more focus on individual clinical screening and education (Sehgal, 2008). Many studies investigating the possible causes of poor health mainly concentrates on individual risk factors that by default results in interventions at a personal level. Nevertheless, some initiatives have successfully tackled environmental conditions and have contributed to multiple health benefits. These get through have molded the knowledge about effective primary prevention approaches that decrease health disparities. For example:

• In California, there is a steady and higher decline in the bronchus and lung cancer prevalence than any other parts in America. This is attributed to a sharp decline in the rates of smoking in the area (Levin, 2019). This was achieved by a multi-prolonged approach such as increasing taxes and cigarettes and related products, decrees for smoke-free bars, public places, restaurants, places of works as well as a highly discernible anti-tobacco marketing campaign.
• The creation of national minimum drinking age laws has saved over 19,000 lives since 1975 (Voas, 2013).
• Regulations and laws that direct the use of non-inflammable materials in sleepwear of children have resulted in the reduced death incidences due to burns.
• Reduced level of lead and other toxic metals in the environment especially because of the new improved standards of paint and gasoline led to about 80-percent reduction high blood pressure level in kids aged between 1 and 5 in America from 1976 to 1991 (Burns & Gerstenberger 2014).

The success of each of the above-stated prevention, knowledge regarding risks was inadequate to alter industry practices or individual behavior. A combination of policy change, advocacy, and education were required. Particularly increasing the level of awareness about the problem among individuals and communities followed by data of community collaboration to advocate and push for changes in organizational policies and practices led to the creation of laws and regulations that contributed to the extensive improvements in health (Green, 2005).

Choosing the right and effective environmental intervention demands an analysis of the fundamental factors affecting health.  Mokdad et al (2018) in trying to examine the major contributor of mortality incidence in the United States, identified sets of factors strongly connected to key causes of mortality (Martinez, et al., 2017). They designated these factors as the real causes of the death and this includes alcohol, toxic agents, motor vehicles, illicit drug use, sexual behavior, firearms, microbial agents, tobacco, and diet and activity patterns. The above factors contributed to about 50-percent of premature deaths (CDC, 2019). Most programs and strategies put in place to address the issue of poor health just center on certain diseases alone. For instance, the American health department, as well as other health departments in various countries of the world, are divided into programs targeting specific diseases as well as separate funding streams for HIV, TB, Cancer, and diabetes among many other carelessly promote an illness-specific approach.  Addressing the actual causes experienced in various medical conditions is critical (Williams, 2007).

Up to now, the majority of efforts to enhance health outcomes tends to center on education, whether at the community, professional/practitioner, or individual level (Cohen et al., 2007). By increasing public awareness about certain health problems among the general population, education plays a key role in facilitating change among politician, healthcare providers, and planners.  However, prevention can only be effective in alleviating health disparities if a detailed approach going beyond education is employed. It comprises changing organizational and institutional practices as well as influencing legislation and policy (Williams, 2007).

By combining diverse players, networks and coalitions are usually powerful that any organization working in solo. In addition to assuring coordination and decreasing duplication, coalitions have increased political influence by combining various regions to work on common interests (Martinez, et al., 2017). The multidimensional approaches needed to eliminate health disparities would be difficult without the full participation by the business representatives, government, and community (Green, 2005). Since disparities in health are mainly caused by environmental factors, which affects many communities at one, go, the national government can play a key role especially in coordinating the efforts of various agencies working towards improving community health.

Altering the practices of key institutions such as government, management of healthcare, and business, can significantly impact issues associated with marketing, community design, product development as well as marketing, and service delivery, all which have a great impact on health. The policy and legislative platforms normally present opportunities for the widest improvement of health outcomes (Martinez, et al., 2017).  Policies linked to the industry are created in response especially to abuses. The enacted policies can prevent deaths and injuries. Both legal and institutional policies affects larger percentage of the population and social norms.  Primary prevention can be strengthened by continuous assessment of stakeholders’ efforts. Evaluation processes play a key role in developing the field of primary prevention by giving the community and practitioners real proof that prevention is effective. In addition, evaluation ensures that best practices are employed in solving issues (Martinez, et al., 2017).

In conclusion, there is a great opportunity to include primary prevention in the general effort to alleviate health disparities.  Only about 5-percent of the total yearly cost of healthcare is spent on disease prevention and health promotion, and a much less figure is allotted to prevention initiatives which effectively address key influences and causal factors that adversely affect health. With a focus on these casual factors multidisciplinary collaboration, changes to organizational policy, and community orientation, primary prevention can greatly improve the health of communities, families, and people most affected by premature death and poor health. It is not all about health but fairness. The disparity of mortality, morbidity, cost as well as the quality of life loss not only directly affects a group of people but also damages society as a whole.

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