Equalizing the Playing Field: Common Elements of Equity and Disparity Among Marginalized U.S. Families

Background. Health disparities occur when a subgroup experiences a higher rate of disease incidence, prevalence, morbidity, mortality, or survival as compared to the general population or majority group. To reduce common and co-occuring disparities in individual health due to poverty and inequality, system level efforts are needed to remove the burden on individuals and improve the healthfulness of community environments in which people live, work, and play. Intersections of race/ethnicity and low socioeconomic status have resulted in discrimination and oppressive practices, consequently challenging parenting and child health outcomes. However, a paucity of research has examined practical strategies from the perspectives of parents and key community stakeholders to address health and wellbeing disparities. The overarching aim of this qualitative study was to identify both common and unique underlying narratives from parents and service providers in low-income communities to gain an in-depth understanding of the major barriers and facilitators to health and mental health equity among families with limited economic resources, particularly during early childhood.

Method. An ecosystems framework and narrative approach was used to guide qualitative in-depth interviews with 20 service providers and 21 African American and Hispanic parents with young children and low-economic status in Philadelphia. Purposive sampling was used to recruit from behavioral health, food assistance, maternal and child health, and child welfare programs. A semi-structured interview guide was used to elicit narratives related to major strengths, challenges, and supports experienced by children and families. Interviews were transcribed and analyzed using MaxQDA v.20.

Results. Two major themes emerged with similarities and differences between parents and providers: 1) social and emotional support; 2) practical support. Parents defined social and emotional supports as consistent support from longstanding relationships; feeling secure in meeting kids’ basic needs; having positive role models; and receiving positive feedback on parenting skills. Lacking trusting, close relationships, fearing for safety, and feeling isolated were major social and emotional challenges for parents. Providers similarly described the importance empowerment and encouragement from peers Providers also described forms of support different from parents that included fostering a sense of shared responsibility and support and access to community events/resources. However, like parents, providers felt stigma and lack of trust in community-based resources and institutions; bureaucratic hurdles and system fragmentation; supporting short-term stability over long-term wellbeing; and food, housing, income insecurity; in addition to oppressive practices based on race, ethnicity, and social class were major barriers to equity in health and wellbeing. Parents also emphasized access to short-term, trustworthy childcare and access to community supports that are practical, fun, and free or low cost. Providers described practical supports related to essential items that parents did not describe, including food, toiletries, school supplies, and clothing accessible within in walking distance.

Conclusion. To facilitate health-promoting resources, family-reported practical supports (i.e., trusted childcare, transportation, housing) and provider-identified supports (food, clothing), should be addressed while removing administrative barriers to streamline community resources. Improving access to reliable social and emotional supports could help improve mental health, reduce parenting stress, and increase access to practical supports for isolated parents.