TMHERR: Volume 6
The Monthly Health Equity Research Reader Volume 6 includes papers published from May 2025 to July 2025.
This edition of the TMHERR examines multifaceted aspects of health equity and disparities. Alberti (2025) argues for reframing health equity as equity of opportunity to benefit all communities, moving beyond outcome gaps to counter divisive narratives and emphasizing shared barriers like policy choices.
Kim and Backonja (2025) discuss a need for digital health equity frameworks before we get into research on disparities in specific health and healthcare-related outcomes. Yip et al. (2025) found later school start times mainly improved sleep for White adolescents, with weaker effects for Hispanic students and no effects for other groups. Higashi et al. (2025) noted lower patient portal and telehealth uptake among less educated and Spanish-speaking individuals in low-income communities. Norman et al. (2025) show how social determinants compound disadvantages for youth accessing digital mental health.
Further inequities are seen in healthcare settings and broader societal factors. Suh et al. (2025) reported perceived biases against incarcerated patients in emergency departments. Zare et al. (2025) linked income inequality to elevated allostatic load, particularly for women and non-White communities. Critically, Gemmill et al. (2025) examined the relationship between abortion bans and infant mortality. They found that abortion bans were associated with higher infant mortality rates, disproportionately impacting Non-Hispanic Black infants. This racial disparity in infant mortality resulted in an estimated 478 excess infant deaths among Non-Hispanic Black infants.
“Health Equity Benefits All Communities (Including White ones)” (Alberti in Milbank Quarterly)
Alberti argues that the focus of “first-generation health equity research surveillance” on measuring gaps in outcomes has created stumbling blocks. He argues that instead of focusing on equity of outcomes, that focusing on equity of opportunity for good health may remove some barriers. The focus on equity of opportunity, then, lends itself to the idea that health equity efforts must better convey that they benefit all populations—not just communities of color. He highlights how current messaging has unintentionally left room for opponents of equity to portray such efforts as exclusionary or harmful to White communities, framing health equity as a zero-sum game. Particularly in the current context, health equity of outcomes can be construed as exclusionary to white communities.
Alberti’s suggests embracing the CDC’s definition of health equity as: everyone has a fair and just opportunity to achieve their highest health. Framing equity through the “Vital Conditions for Health and Wellbeing” lens—such as access to clean air, housing, food, and education—helps make the case that all communities, including White ones, benefit from policies that support health equity. The article outlines four key actions to realign the health equity narrative.
First, advocates must clarify what health equity means and how it applies to all.
Second, they should highlight how policy decisions impact White communities too—for example, White Americans make up significant portions of populations affected by cuts to SNAP, Medicaid, and veterans’ services.
Third, measurement strategies should go beyond disparities to also assess opportunities and the systems—like classism and ableism—that hinder them. This could counter false narratives about meritocracy and reveal how many White people also experience inequity.
Finally, effective engagement requires enlisting expert communicators and community partners to reshape messaging and build broader coalitions.
Alberti concludes that inequity is a policy choice—not a biological inevitability—and achieving health equity demands cross-racial, non-ideological collaboration. He places special responsibility on White health equity advocates to lead engagement efforts with their communities, especially where misinformation and resentment have taken root. Only by acknowledging shared barriers and rejecting divisive rhetoric can society coalesce around a common goal: ensuring all communities can truly thrive.
Key Words: policy, health equity for all, equity of opportunity
“School start times and racial disparities in early adolescent sleep” (Yip et al in Sleep Health)
In response to the growing field of literature underscoring the importance of high quality, adequate sleep, communities have started to adopt later school start times. It is unclear whether benefits of delayed start times are distributed to students of all racial and ethnic groups. Using data from 3522 early adolescents in the Adolescent Brain Cognitive Development Study, Yip et al examined the associations between school start times and various sleep metrics across different racial groups. The authors found that later school start times were associated with longer sleep duration, later sleep onset and offset for White adolescents, but the effect was weaker for Latinx adolescents. No significant relationship was found between school start times and sleep duration for other racially minoritized early adolescents. This research emphasizes the importance of considering school start times in discussions about sleep health equity.
Key words: sleep, adolescent sleep, school start times
“Factors Associated with Portal and Telehealth Uptake and Use in a Minoritized, Low-Income Community: Mixed Methods Study” (Higashi et al in JMIR Formative Research)
Disparities persist in awareness and uptake of patient portals and telehealth, despite substantial evidence of their many health benefits. Higashi et al’s purpose in this paper is to understand the factors and strategies of underserved populations regarding healthcare and to determine uptake and barriers in the use of patient portals and telehealth. Surveys and interviews in a lower-resource area of Dallas, Texas, were used to assess experiences with patient portals and telehealth among residents from minoritized backgrounds. Surveys and interviews conducted with English- and Spanish-speaking adults, found that that a significant portion had engaged with these digital health tools. Higashi et al also found that those who did not use the portal or telehealth tended to have less education and increased likelihood of being Spanish speakers, highlighting disparities in digital health equity. Among participants, a majority expressed positive sentiments about using the Internet for health-related activities, indicating a desire for greater involvement in their health care. The authors identified seven factors reported by interview subjects as essential for increased engagement in portals and telehealth: (1) enhancing patient autonomy, (2) incorporating digital health technology into daily life, (3) receiving recommendations from trusted healthcare practitioners, (4) recognizing the significance of digital health technologies, (5) seeking help/support of care partners or peers, (6) managing chronic conditions, and (7) rapid access to test results.
Key words: telehealth, patient portals, digital equity
“Physician Perceptions of the Evaluation and Management of Incarcerated Patients in the Emergency Department” (Suh et al in The Journal of Emergency Medicine)
Incarcerated patients often present in emergency departments, yet it is not clear whether there is differential care in the evaluation and management by emergency medicine physicians. Suh et al examined the perceptions and attitudes of evaluation and management of incarcerated patients care in a survey conducted during the period May-June 2023. The conducted a survey among EM residents and attending physicians at three academic safety-net EDs to understand their perceptions of care for incarcerated patients. The 80 surveys the authors analyzed comprised a 27% response rate of full-time staff across the three institutions. Suh et al uncovered three key themes: perceived bias against incarcerated patients, mixed opinions on the extent of care differences, and uncertainty about interactions with law enforcement and coordination with correctional facilities. Despite the low response rate, the authors identified mixed attitudes on the existence of bias and confusion regarding best practices in the care of incarcerated patients. Further research is necessary to address these biases and to define optimal care practices for this population.
Key Words: incarcerated populations, vulnerable populations, emergency departments
“‘Multi-stressed’: A Qualitative Study Exploring the Impact of the Social Determinants of Health on Access to Digital Mental Health for Youth and Young Adults in Alberta” (Norman et al in Digital Health)
Mental illness among youth aged 15-24 is a significant global public health challenge influenced by various social determinants of health. Norman and colleagues explored how these determinants affect access to digital mental health services among young people in Alberta, Canada. Using qualitative methods (23 focus groups with 168 participants), they identified three key themes impacting access: social influences, socio-economic circumstances, and community contextual factors. These themes underscore the interconnectedness of social determinants of health, such that disadvantages are compounded for some youth. Addressing these determinants is essential to ensure equitable access to digital mental health solutions for all youth.
Key words: digital health, digital mental health services, young people, social determinants of health
“Digital Health Equity Frameworks and Key Concepts: A Scoping Review” (Kim and Backonja in Journal of the American Medical Informatics Association)
Digital health equity is a growing priority globally, necessitating a comprehensive understanding of digital health, equity, and health outcomes. Kim and Backonja conducted a scoping review to find and describe frameworks relevant to digital health equity interventions by searching through CINAHL (nursing), Engineering Village (computer science and engineering), PsycINFO (psychology), PubMed (biomedical), and Web of Science (social health sciences) databases. They identified 910 publications, which was narrowed down to 44 after exclusions. Among these 44 publications, 42 described frameworks, although none were fully comprehensive. From these 44 articles, Kim and Backonja identified 243 concepts categorized into 43 groups, which included individual, community, and organizational characteristics, societal context, and access to digital health services. The insights from this study aim to support stakeholders in achieving digital inclusion and health equity.
Key words: digital health equity, frameworks, scoping review, PRISMA
“Income Inequality, Gender Disparities, and Ethnic Differences: Investigating Allostatic Load in American Adults” (Zare et al in Journal of Racial and Ethnic Health Disparities)
Zare et al examines the association between income inequality and allostatic load scores in adults aged 20+, focusing on the impacts across racial and gender groups. Using data from NHANES, the authors assessed allostatic load with 8 biomarkers (systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), pulse rate (beats/min), body mass index (kg/m2), glycohemoglobin (%), direct HDL cholesterol (mg/dL), total cholesterol (mg/dL), and serum albumin (g/dL). They utilized negative binomial regression to evaluate a sample of over 15,000 adults from the 1999-2016 NHANES cohorts. Zare et al found that while men had a higher poverty-to-income ratio, women experienced elevated allostatic load and were more negatively affected by income inequality. High poverty-to-income ratios seemed to be protective for White non-Hispanic individuals, and engaging in physical activity was linked to lower allostatic load. These results underscore the necessity of targeted policies for low-income populations, particularly among Black non-Hispanic and Hispanic communities, to address health disparities stemming from income inequality.
Keywords: income inequality, allostatic load, NHANES
“US Abortion Bans and Infant Mortality” (Gemmill, et al in the Journal of the American Medical Association)
The impact of recent abortion bans on infant mortality rates is concerning and not fully understood, particularly regarding racial and ethnic disparities. Gemmill and colleagues conducted a population-based study analyzing infant mortality rates in 14 states with abortion bans from 2012 to 2023, using data from all 50 states and the District of Columbia. They find higher than expected infant mortality rates after the bans, with an estimated 478 excess infant deaths in the states implementing these restrictions. Non-Hispanic Black infants experienced the highest relative increase in mortality rates. Overall, the findings suggest that abortion bans are associated with higher infant mortality, especially among vulnerable populations and in southern states.
Keywords: abortion bans, infant mortality,