The difference between health disparities and health differences lies in inequity and injustice. We might see differences in mobility between elderly individuals and teenagers as a normal difference in age, not related to ageism, though certainly elderly individuals face issues of ageism. However, differences in mortality rates between people of different social classes can be directly related to social and economic inequity. Hence, a health disparity is a health difference that results from inequity and injustice.
Returning to my example of HIV, PrEP, and queer men, we know that queer men have been identified as a high risk group for HIV, which is why targeting PrEP and other interventions at queer men is so important for public health interventions and control of the epidemic. However, we also know that HIV/AIDS was originally considered to be a “gay disease” and limited action was taken at the original outbreak because of the social undesirable position of queer men. This social inequity based on sexuality was stronger at the outbreak of AIDS, but it still persists today. The combination of HIV stigma, poor sexual health education (for everyone, but also specifically for queer individuals), and lacking health care for queer individuals (health care providers are uncomfortable asking about sexual history, don’t ask about sexuality, don’t take necessary precautions, aren’t aware of health needs of queer individuals, etc) directly results in a health disparity resulting in higher rates of HIV among queer men, especially black queer men.
However, public health interventions that continue to target queer men for behavior change seem to push the blame of this health disparity and social inequity on those facing inequity, rather than targeting the providers who are unprepared and improperly educated to effectively care for queer men. We know that providers are less likely to prescribed PrEP to black queer men, compounding on social inequity based on sexuality to add race. This stems directly from racial and gender stereotypes that influence providers and limit their ability to appropriately care for black queer men (Calebrese et al, 2014; 2017). Nonetheless, public health interventions exacerbate the disparity by focusing on queer men adopting different health behaviors instead of educating health care providers and sexual health educators to provide better care for queer men. The root is structural, rather than individual, and ignoring the structural inequity continues to harm queer men, especially black queer men.