Health equity
Encyclopedia
Health equity refers to the study of differences in the quality of health
and health care
across different populations.. This may include differences in the "presence of disease, health outcomes, or access to health care" across racial, ethnic, sexual orientation
and socioeconomic groups.
Differences among populations in the presence of disease and health outcomes is well documented in many areas. In the United States
, disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos, with these groups having higher incidence of chronic diseases, higher mortality, and poorer overall health outcomes. For example, the cancer incidence rate among African Americans is 10% higher than among whites, and adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes. Similarly, disparities in the overall level of health in individuals also exist between differing socioeconomic groups, with lower-status socioeconomic groups generally having poorer health and higher rates of chronic illness including obesity, diabetes, and hypertension.
Health equity also includes differences in access to health care
between populations. For example, those in lower-status socioeconomic groups receive less consistent primary care, which is positively correlated to overall level of health in the recipient.. Similarly, in England
, "people living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements."
A lack of health equity is also evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals
.
.
The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these racially-centered disparities continue to exist and are a significant social health issue. The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race.
The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.
There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory
care..
There is debate about what causes health disparities between ethnic and racial groups. However, it is generally accepted that disparities can result from three main areas:
Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive. Additionally, attention on health care disparities is largely focused on race and ethnicity; data on racial and ethnic disparities are relatively widely available. In contrast, data on socioeconomic health care disparities are collected less often, often using education as the indicator of socioeconomic status.
The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data.
The Institute of Medicine report, Race, Ethnicity, and Language Datahttp://www.nap.edu/catalog.php?record_id=12696 identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement.
A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast, prostate and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.
Transplantation rates differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list. For example, different groups express definite interest and complete the pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.
The National Partnership for Action to End Health Disparities (NPA) was established to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. http://minorityhealth.hhs.gov/npa/
The National Stakeholder Strategy (NSS)for Achieving Health Equity is a product of the NPA. This document provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential. The strategy incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. Local groups can use the National Stakeholder Strategy to identify which goals are most important for their communities and adopt the most effective strategies and action steps to help reach them. http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
The NSS defines health equity as the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. According to the NSS, a health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion
.
Often under emphasized are the minority groups that are heavily affected by health disparities in America, UK and all the same worldwide. Health disparities are not just based on race, ethnic, and cultural differences. Such disparities are seen as affecting the sexuality minority groups and observations and surveys show that one’s sexual minority
status may limit access to health care, with especially bad impact on lesbian
s, which are being discriminated both as females and as homosexual.
“Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism
.” This known interference with health care access is a prime example of heterosexual privilege and homosexual prejudice prevalence in Western societies. Just as this lack of health care affects minority races, ethnic groups, and less represented cultural beliefs; lesbian and bisexual women are deteriorating their health by either not seeing (being feared of) or not be attended to by health care professionals.
It is important that health care professionals consider the nine cultural competency techniques suggested by the Agency for Healthcare Research and Quality and make an effort to break the barriers put into place through society’s homophobia
and heterosexism
.
In the United States, women have better access to healthcare, in part, because they have higher rates of health insurance. In one study of a population group in Harlem, 86% of women reported having health insurance (privatized or publicly assisted), while only 74% of men reported having any health insurance. This trend in women reporting higher rates of insurance coverage is not unique to this population and is representative of the general population of the US.
Gender-based perceptions of health and healthcare may help explain some of the lag of men behind women in levels of insurance coverage. Women report higher rates of illness than men, which barring the idea that women are sicker than men, indicates women are more likely to seek medical care out and are therefore more likely to possess medical insurance.
Gender-related disparities in access to healthcare are also related to socioeconomic factors including geographic job-market differences and differing levels of government assistance available to men and women. There are fewer job opportunities with insurance coverage available to men and women living in poorer communities, and of these opportunities, women tend to occupy more of the jobs with these benefits. Government assistance available to these individuals without job-related coverage varies between men and women, with women, especially women with children, receiving a higher percentage of available public assistance than men. Ultimately, for both men and women discrepancies in access to adequate healthcare is largely based on socioeconomic issues including income and full-time work status, with both groups of men and women with higher levels of income and full-time work receiving greater access to adequate healthcare.
It is also important to note the almost caste-like conditions created by the U.S. healthcare system. The permanent effect that delayed, patchy, and second-rate health care has on an individuals body affects their chances of being healthy enough to rejoin the stratum of the labor market that provides health benefits.
A study conducted in 2010 characterized the association between neighborhood poverty, racial composition and deceased kidney donor waitlist. Blacks in poor, predominantly Black neighborhoods were less likely to appear on transplant waitlist than those in wealthy, predominantly Black neighborhoods and poor, predominantly White neighborhoods. All were all less likely to be waitlisted than their Black counterparts in wealthy, predominantly White or mixed neighborhoods. These findings, using national data from the USRDS, support work indicating that neighborhood poverty and racial admixture affect the likelihood of being listed on the deceased donor kidney waitlist.
Additionally, the Office of Minority Health has released the NPA Toolkit for Community Action. Community members can use the toolkit to engage fellow citizens and local media as they spread the word about health disparities and educate others about the impact disparities have in the lives of individuals and the greater impact on society.
The Commonwealth Fund
, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:
Other methods for ending health disparities or reducing health disparities have been suggested based on research that observes cultural differences within health care systems. According to the Agency for Healthcare Research and Quality
and the assisting authors Cindy Brach and Irene Fraserirector, in an effort to reduce disparities between racial and ethnic groups, the health care system should consider the following nine cultural competency techniques:
for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada
, the issue was brought to public attention by the LaLonde report
.
In UK, the Black Report
report was produced in 1980 to highlight inequalities. On 11 February 2010 Sir Michael Marmot
, an epidemiologist at University College London, published the Fair Society, Healthy Lives report on the relationship between health and poverty. Marmot described his findings as illustrating a "social gradient in health": the life expectancy of the poorest is seven years shorter than the most wealthy, and the poor are more likely to have a disability. In its report on the study, The Economist argued that the causes of this health inequality include lifestyles - smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain.
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
across different populations.. This may include differences in the "presence of disease, health outcomes, or access to health care" across racial, ethnic, sexual orientation
Sexual orientation
Sexual orientation describes a pattern of emotional, romantic, or sexual attractions to the opposite sex, the same sex, both, or neither, and the genders that accompany them. By the convention of organized researchers, these attractions are subsumed under heterosexuality, homosexuality,...
and socioeconomic groups.
Differences among populations in the presence of disease and health outcomes is well documented in many areas. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos, with these groups having higher incidence of chronic diseases, higher mortality, and poorer overall health outcomes. For example, the cancer incidence rate among African Americans is 10% higher than among whites, and adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes. Similarly, disparities in the overall level of health in individuals also exist between differing socioeconomic groups, with lower-status socioeconomic groups generally having poorer health and higher rates of chronic illness including obesity, diabetes, and hypertension.
Health equity also includes differences in access to health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
between populations. For example, those in lower-status socioeconomic groups receive less consistent primary care, which is positively correlated to overall level of health in the recipient.. Similarly, in England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
, "people living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements."
A lack of health equity is also evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals
Millennium Development Goals
The Millennium Development Goals are eight international development goals that all 193 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015...
.
Ethnic and racial disparities
See Ethnicity and health and Race and healthRace and health
Race and health research, often done in the United States, has found both current and historical racial differences in the frequency, treatments, and availability of treatments for several diseases. This can add up to significant group differences in variables such as life expectancy...
.
The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these racially-centered disparities continue to exist and are a significant social health issue. The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race.
The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.
There are also considerable racial disparities in access to insurance coverage, with ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory
Ambulatory
The ambulatory is the covered passage around a cloister. The term is sometimes applied to the procession way around the east end of a cathedral or large church and behind the high altar....
care..
There is debate about what causes health disparities between ethnic and racial groups. However, it is generally accepted that disparities can result from three main areas:
- From the personal, socioeconomic, and environmentalNatural environmentThe natural environment encompasses all living and non-living things occurring naturally on Earth or some region thereof. It is an environment that encompasses the interaction of all living species....
characteristics of different ethnic and racial groups (such as how certain racial groups, on average, live in poorer areas with high incidence of lead-based paint, which can harm children). A great deal of research on social determinants of health and the socio-ecological model have also surfaced, which connect economic and social conditions in determining a community's or a population's health. - From the barriers certain racial and ethnic groups encounter when trying to enter into the health care delivery system; and
- From the quality of health care different ethnic and racial groups receive.
Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive. Additionally, attention on health care disparities is largely focused on race and ethnicity; data on racial and ethnic disparities are relatively widely available. In contrast, data on socioeconomic health care disparities are collected less often, often using education as the indicator of socioeconomic status.
The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data.
The Institute of Medicine report, Race, Ethnicity, and Language Datahttp://www.nap.edu/catalog.php?record_id=12696 identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement.
A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast, prostate and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.
Transplantation rates differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list. For example, different groups express definite interest and complete the pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.
The National Partnership for Action to End Health Disparities (NPA) was established to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities and to move the nation toward achieving health equity. The mission of the NPA is to increase the effectiveness of programs that target the elimination of health disparities through the coordination of partners, leaders, and stakeholders committed to action. http://minorityhealth.hhs.gov/npa/
The National Stakeholder Strategy (NSS)for Achieving Health Equity is a product of the NPA. This document provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential. The strategy incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. Local groups can use the National Stakeholder Strategy to identify which goals are most important for their communities and adopt the most effective strategies and action steps to help reach them. http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286
The NSS defines health equity as the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. According to the NSS, a health disparity is a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial and/or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion
LGBT minority group health disparities
See also LGBT issues in medicineLGBT issues in medicine
LGBT topics in medicine are those that relate to lesbian, gay, bisexual and transgender people's health issues and access to health services. According to the US Gay and Lesbian Medical Association , besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis,...
.
Often under emphasized are the minority groups that are heavily affected by health disparities in America, UK and all the same worldwide. Health disparities are not just based on race, ethnic, and cultural differences. Such disparities are seen as affecting the sexuality minority groups and observations and surveys show that one’s sexual minority
Sexual minority
A sexual minority is a group whose sexual identity, orientation or practices differ from the majority of the surrounding society. The term was coined most likely in the late 1960s under the influence of Lars Ullerstam's ground breaking book "The Erotic Minorities: A Swedish View" which came...
status may limit access to health care, with especially bad impact on lesbian
Lesbian
Lesbian is a term most widely used in the English language to describe sexual and romantic desire between females. The word may be used as a noun, to refer to women who identify themselves or who are characterized by others as having the primary attribute of female homosexuality, or as an...
s, which are being discriminated both as females and as homosexual.
“Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism
Heterosexism
Heterosexism is a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships. It can include the presumption that everyone is heterosexual or that opposite-sex attractions and relationships are the only norm and therefore superior...
.” This known interference with health care access is a prime example of heterosexual privilege and homosexual prejudice prevalence in Western societies. Just as this lack of health care affects minority races, ethnic groups, and less represented cultural beliefs; lesbian and bisexual women are deteriorating their health by either not seeing (being feared of) or not be attended to by health care professionals.
It is important that health care professionals consider the nine cultural competency techniques suggested by the Agency for Healthcare Research and Quality and make an effort to break the barriers put into place through society’s homophobia
Homophobia
Homophobia is a term used to refer to a range of negative attitudes and feelings towards lesbian, gay and in some cases bisexual, transgender people and behavior, although these are usually covered under other terms such as biphobia and transphobia. Definitions refer to irrational fear, with the...
and heterosexism
Heterosexism
Heterosexism is a system of attitudes, bias, and discrimination in favor of opposite-sex sexuality and relationships. It can include the presumption that everyone is heterosexual or that opposite-sex attractions and relationships are the only norm and therefore superior...
.
Healthcare equity and sex
The results in comparing inequities in access to adequate healthcare and gender are somewhat surprising, with women in the United States generally having higher levels of access to care. These disparities can be explained in part by looking at rates of overall insurance coverage (privatized and publicly assisted) between men and women, the effects of certain socioeconomic factors on levels of coverage between men and women, and overall gender-based differences in perceptions of health and health care.In the United States, women have better access to healthcare, in part, because they have higher rates of health insurance. In one study of a population group in Harlem, 86% of women reported having health insurance (privatized or publicly assisted), while only 74% of men reported having any health insurance. This trend in women reporting higher rates of insurance coverage is not unique to this population and is representative of the general population of the US.
Gender-based perceptions of health and healthcare may help explain some of the lag of men behind women in levels of insurance coverage. Women report higher rates of illness than men, which barring the idea that women are sicker than men, indicates women are more likely to seek medical care out and are therefore more likely to possess medical insurance.
Gender-related disparities in access to healthcare are also related to socioeconomic factors including geographic job-market differences and differing levels of government assistance available to men and women. There are fewer job opportunities with insurance coverage available to men and women living in poorer communities, and of these opportunities, women tend to occupy more of the jobs with these benefits. Government assistance available to these individuals without job-related coverage varies between men and women, with women, especially women with children, receiving a higher percentage of available public assistance than men. Ultimately, for both men and women discrepancies in access to adequate healthcare is largely based on socioeconomic issues including income and full-time work status, with both groups of men and women with higher levels of income and full-time work receiving greater access to adequate healthcare.
Healthcare Inequality and Socioeconomic Status
While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual's level of access to healthcare. Not surprisingly, individuals of lower socioeconomic status in the United States have lower levels of overall health, insurance coverage, and less access to adequate healthcare. Furthermore, individuals of lower socioeconomic status have less education and often perform jobs without significant health and benefits plans, whereas individuals of higher standing are more likely to have jobs that provide medical insurance.It is also important to note the almost caste-like conditions created by the U.S. healthcare system. The permanent effect that delayed, patchy, and second-rate health care has on an individuals body affects their chances of being healthy enough to rejoin the stratum of the labor market that provides health benefits.
A study conducted in 2010 characterized the association between neighborhood poverty, racial composition and deceased kidney donor waitlist. Blacks in poor, predominantly Black neighborhoods were less likely to appear on transplant waitlist than those in wealthy, predominantly Black neighborhoods and poor, predominantly White neighborhoods. All were all less likely to be waitlisted than their Black counterparts in wealthy, predominantly White or mixed neighborhoods. These findings, using national data from the USRDS, support work indicating that neighborhood poverty and racial admixture affect the likelihood of being listed on the deceased donor kidney waitlist.
Disparities in access to health care
Reasons for disparities in access to health care are many, but can include the following:- Lack of insuranceInsuranceIn law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the...
coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites. - Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.
- Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.
- Legal barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing MedicaidMedicaidMedicaid is the United States health program for certain people and families with low incomes and resources. It is a means-tested program that is jointly funded by the state and federal governments, and is managed by the states. People served by Medicaid are U.S. citizens or legal permanent...
coverage to immigrants who have been in the country fewer than five years. - Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.
- The health care financing system. The Institute of MedicineInstitute of MedicineThe Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers. - Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.
- Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not EnglishEnglish languageEnglish is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...
-proficient. - Health literacyLiteracyLiteracy has traditionally been described as the ability to read for knowledge, write coherently and think critically about printed material.Literacy represents the lifelong, intellectual process of gaining meaning from print...
. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors. - Lack of diversityMulticulturalismMulticulturalism is the appreciation, acceptance or promotion of multiple cultures, applied to the demographic make-up of a specific place, usually at the organizational level, e.g...
in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population. - Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet. This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it.
Disparities in quality of health care
Health disparities in the quality of care different ethnic and racial groups receive can include:- Problems with patient-provider communication. This communication is critical for the delivery of appropriate and effective treatment and care and, regardless of a patient’s race, miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. Among non-EnglishEnglish languageEnglish is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...
-speaking populations in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during health care visits report having one. Additional communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. For example, patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with. Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.
- Provider discriminationDiscriminationDiscrimination is the prejudicial treatment of an individual based on their membership in a certain group or category. It involves the actual behaviors towards groups such as excluding or restricting members of one group from opportunities that are available to another group. The term began to be...
. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than other patients. Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.
- Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care. For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people.
Ending health disparities
The National Stakeholder Strategy for Achieving Health Equity (NSS) provides a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities -- and other underserved groups -- reach their full health potential.Additionally, the Office of Minority Health has released the NPA Toolkit for Community Action. Community members can use the toolkit to engage fellow citizens and local media as they spread the word about health disparities and educate others about the impact disparities have in the lives of individuals and the greater impact on society.
The Commonwealth Fund
Commonwealth Fund
The Commonwealth Fund is a private U.S. foundation whose stated purpose is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, especially for society's most vulnerable.-History:...
, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:
- Consistent racial and ethnic data collection by health care providers.
- Effective evaluation of disparities-reduction programs.
- Minimum standards for culturally and linguistically competent health services.
- Greater minority representation within the health care workforce.
- Establishment or enhancement of government offices of minority health.
- Expanded access to services for all ethnic and racial groups.
- Involvement of all health system representatives in minority health improvement efforts.
Other methods for ending health disparities or reducing health disparities have been suggested based on research that observes cultural differences within health care systems. According to the Agency for Healthcare Research and Quality
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...
and the assisting authors Cindy Brach and Irene Fraserirector, in an effort to reduce disparities between racial and ethnic groups, the health care system should consider the following nine cultural competency techniques:
- Interpreter services. If agencies take an active approach in hiring professional interpreters, for both foreign languages and for the speaking and hearing impaired, communication barriers will begin to decrease.
- Recruitment and Retention. Healthcare systems need to become more conscious of the staff within their facilities. It is essential to the reduction of disparities that most minority groups be represented within the various health care offices and clinics.
- Training. The Agency for Healthcare Research and Quality and its assisting authors emphasized the importance of health care professionals being trained to work with interpreters and minority groups.
- Coordinating with traditional healers. Health care workers should be supportive and able to adjust health care plans according to the patient’s cultural beliefs and traditional health practices.
- Use of Community Health Workers. These individuals could be responsible for bringing in the population of people who rarely seek out health care.
- Culturally competent health promotion. This information can be available through community health workshops, or simply by health care workers taking the necessary measures to promote early detection and treatment and outlining the good and risky health behaviors to all patients.
- Including family and/or community members. The Agency for Healthcare Research and Quality states that this particular cultural competency may be vital to obtaining consent and adherence to treatments.
- Immersion into another culture. Allowing yourself to step outside of your comfort zone will increase your tolerance for another culture as well as raise your awareness to new ideals and beliefs.
- Administrative and Organizational accommodations. These are some aspects of the health care offices that should be considered; they include the location of the healthcare offices, public transportation availability, clinic hours, the physical environment of the clinic, and the rapport built with the patients.
Health inequalities
Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services. Such examples include higher rates of morbidity and mortalityDeath
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, the issue was brought to public attention by the LaLonde report
LaLonde report
The Lalonde Report is a 1974 report produced in Canada formally titled A new perspective on the health of Canadians. It proposed the concept of the "health field", identifying two main health-related objectives: the health care system; and prevention of health problems and promotion of good health...
.
In UK, the Black Report
Black Report
The Black report was a 1980 document published by the Department of Health and Social Security in the United Kingdom, which was the report of the expert committee into health inequality chaired by Sir Douglas Black...
report was produced in 1980 to highlight inequalities. On 11 February 2010 Sir Michael Marmot
Michael Marmot
Sir Michael Gideon Marmot is professor of Epidemiology and Public Health at University College London.- Career :Michael Marmot was born in London, England. He moved to Australia as a young child and graduated in Medicine from the University of Sydney, Australia, in 1968. He earned a MPH in 1972...
, an epidemiologist at University College London, published the Fair Society, Healthy Lives report on the relationship between health and poverty. Marmot described his findings as illustrating a "social gradient in health": the life expectancy of the poorest is seven years shorter than the most wealthy, and the poor are more likely to have a disability. In its report on the study, The Economist argued that the causes of this health inequality include lifestyles - smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain.
See also
- Center for Minority HealthCenter for Minority HealthThe Center for Minority Health , part of The University of Pittsburgh Graduate School of Public Health, was established in 1994 through a grant from the Richard King Mellon Foundation...
- Global Task Force on Expanded Access to Cancer Care and Control in Developing CountriesGlobal Task Force on Expanded Access to Cancer Care and Control in Developing CountriesThe Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries is a research and advisory initiative promoted by the Dana Farber Cancer Institute, the , the Harvard Medical School and the Harvard School of Public Health to address the global burden of cancer in...
- Hopkins Center for Health Disparities SolutionsHopkins Center for Health Disparities SolutionsThe Hopkins Center for Health Disparities Solutions , a research center within the Johns Hopkins Bloomberg School of Public Health, was established in October 2002 with a 5-year grant from the National Center for Minority Health and Health Disparities , of the National Institutes of Health under...
- Inequality in diseaseInequality in diseaseThis article discusses social inequality in the United States and its effects on individual health, and more specifically likelihood of developing diseases....
- Population healthPopulation healthPopulation health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” It is an approach to health that aims to improve the health of an entire population. One major step in achieving this aim is to reduce health...
- Public healthPublic healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
- Social determinants of healthSocial determinants of healthSocial determinants of health are the economic and social conditions under which people live which determine their health. They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease, for example for cardiovascular disease and...
- Unnatural Causes: Is Inequality Making Us Sick?Unnatural Causes: Is Inequality Making Us Sick?Unnatural Causes: Is Inequality Making Us Sick? is a four-hour documentary series, broadcast nationally on PBS in spring 2008, that examines the role of social determinants of health in creating health inequalities/health disparities in the United States...
- Health Disparities CenterHealth Disparities CenterHealth Disparities Centers refer to institutions that cover a broad range of needs and focus areas to decrease currently disproportionate illness and disease rates that lead to health disparities, as well as promote the engagement, empowerment and recruitment of underrepresented populations in...
- The Cultural Competency Organizational Assessment-360 (COA360)The Cultural Competency Organizational Assessment-360 (COA360)The Cultural Competency Organizational Assessment-360 is a multi-dimensional, web-based tool used to assess the cultural competency of health care organizations...
- Drift HypothesisDrift HypothesisDrift hypothesis, concerning the relationship between mental illness and social class, is the argument that illness causes one to have a downward shift in social class. The circumstances of one's social class do not cause the onset of a mental disorder, but rather, an individual's deteriorating...
Further Notes
- Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Health Policy Institute of Ohio (November 2004).
- McDonough, J., Gibbs, B., Scott-Harris, J., Kronebusch, K., Navarro, A., and Taylor, K. A. "State Policy Agenda to Eliminate Racial and Ethnic Health Disparities," Commonwealth Fund (June 2004).
- Smedley, B., Stith, A., and Nelson, A. "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care." Institute of MedicineInstitute of MedicineThe Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
(2002).
External links
- Progress in Community Health Partnerships: Research, Education, and Action (PCHP)Progress in Community Health PartnershipsProgress in Community Health Partnerships: Research, Education, and Action is a peer-reviewed medical journal published quarterly by the Johns Hopkins University Press. In each issue, one article is selected for a “Beyond the Manuscript” podcast....
- Institute of Medicine Roundtable on Health Disparities was created to enable diaologue and discussion of issues related to the visibility of racial and ethnic disparities in health and health care as a national problem, the development of programs and strategies to reduce disparities and the emergence of new leadership.
- Center for Managing Chronic Disease
- Cultural Diversity in Health Care Speaker Series videos presentations from expert lecturers, University of Wisconsin School of Medicine and Public Health
- Cultural Diversity in Health Care Research Symposium video presentations from expert lecturers, University of Wisconsin School of Medicine and Public Health
- National Center on Minority Health and Health Disparities
- Journal of Health Care for the Poor and UnderservedJournal of Health Care for the Poor and UnderservedThe Journal of Health Care for the Poor and Underserved is an academic journal founded in 1990 by David Satcher, then President of Meharry Medical College who later became the 16th Surgeon General of the United States...
- Understanding Health Disparities
- Initiative to Eliminate Racial and Ethnic Disparities in Health United States government minority health initiative
- Health Disparities Collaborative
- Massachusetts General Hospital seeks to bridge healthcare's racial gap
- Diversity Health Institute Clearinghouse
- Case Center for Reducing Health Disparities
- FIU Health Disparity Research Group
- "Kaiser Health Disparities Report: A Weekly Look at Race, Ethnicity and Health", News summary report from kaisernetwork.org
- Health inequality in New Zealand
- BBC News article regarding health inequalities
- EXPORT Project webpage atTuskegee University
- VIDEO: Health Status Disparities in the US, April 4, 2007, featuring Paula Braveman, Gregg Bloche, George Kaplan, Thomas Ricketts, Mary Lou deLeon Siantz, and David Williams
- UK National Health Service Specialist Library for Ethnicity & Health http://www.library.nhs.uk/ethnicity
- National Rural Health Association
- The National Partnership for Action to End Health Disparities
- The National Partnership for Action Toolkit for Community Action