Thesis Statement: An improved understanding of health care disparities and differing cultural beliefs and values will lead to stronger and more open communication between health care providers and their patients, further assisting United States policymakers in tearing down the walls of disparities and providing all individuals with more effective, efficient, and higher quality health care.
Questions/Issues Being Addressed:
I. What are health disparities?
II. What specific health disparities are among us today?
III. Why do they matter? How do they affect health care/health care system/providers?
IV. What initiative/avenues are being put into place to address such disparities?
I. One of the most unique qualities that the United States possesses is its immense diversity within the population. In many ways, a diverse population is beneficial to the nation as a whole; however, there are several challenges that arise when a population is as diverse as the one that exists within the United States today. The chief among these challenges is the existence of disparities in health care. To properly analyze the effects of health care disparities, it is essential to have a broad understanding of what defines health care disparities.
A. There is no single definition that encompasses all of what is included in health disparities. The past decade or so has been a time of repeated trial and error when it comes to defining health care disparities in their entirety.
1. In 2012, the Institute of Medicine published an Unequal Treatment Report which defined health care disparities as “all differences except those due to clinical need and preferences” (Cook, McGuire & Zaslavsky, 2012).
– This is effective in highlighting the component of disparities equating to differences, but it is quite vague and leaves much of the topic undefined.
2. The Healthy People 2010 initiative defined health disparities as including “differences that occur by gender, race or ethnicity, education or income, disability, living in rural localities, or sexual orientation (Braveman, et. al., 2011).
– This demonstrates a more expansive perspective regarding what health disparities include, however, it lacks an emphasis on how these disparities affect individuals in a negative manner.
3. In 2015, the United States Department of Health and Human Services defined a health disparity as “a type of difference in health that is closely linked with social or economic disadvantage” (Thomas & Smith, 2017).
– This is key in addressing both the broadness of concepts and the negative association in a concise manner.
B. It is important to distinguish disparities from inequities to better understand what disparities are and are not.
1. Inequities in health are “specifically impacted by social, economic, and environmental conditions or influences” (Johnson, 2015).
2. Health disparities are the consequences that appear because of inequities.
C. An improved understanding of health care disparities and differing cultural beliefs and values will lead to stronger and more open communication between health care providers and their patients, further assisting policymakers in tearing down the walls of disparities and providing all individuals with more effective, efficient, and higher quality health care.
II. In the United States today, there has been steady improvements in the quality of care and overall health for most of the population. However, not all Americans are benefiting equally.
A. “While individual choices and genetic factors are barriers to achieving the full health potential, the concept of health disparities focuses on the social and political factors that have historically disadvantaged certain groups” (Johnson, 2015, p. 574).
B. Some of the social and political factors that will be discussed include race and ethnicity, gender, disability status, geographic location, and income status.
a. These factors have produced some of the health and health care disparities among us today that put limitations on continued improvement in overall quality of care and population health which causes the United States unnecessary costs while widening the equity gap.
b. Health and health care disparities exist across multiple chronic, acute, and preventable disease processes including diabetes, cancer, cardiovascular disease, HIV/Aids, and obesity (Thomas, 2014, p. 7493).
– “The rise of chronic diseases worldwide has raised concerns not only about the quality of life and life expectancy, but also the overall cost of disease that has been estimated to be over $300 billion per year in the United States alone” (Schiavo, 2015).
C. To fully understand the context of disparities in the United States, it is important to understand the country’s general population.
1. In 2015, the U.S. population was estimated at a total of 321 million people (NCHS, 2017). This statistic can be further broken down to show the differences in population characteristics that better explain the status of health and health care disparities.
2. The United States rapidly growing population is becoming more and more diverse. It consists of 61.6% white, 12.4% black, 17.6% Hispanic, 5.4% Asian, and 3.0% all others (NCHS, 2017).
3. The population statistic can be separated by gender as well; with 158 million people being male and the other 163 million being female (NCHS, 2017).
4. Another factor, that tends to be overlooked, is the disability status of U.S. citizens, which was 18.7% of the population (Brault, 2012).
5. Also, the National Center for Health Statistics estimated that 46 million people lived in rural areas (14.4%) and roughly 275 million people lived in urban areas (85.6%) in 2015.
D. With the above statistics, researchers were able to recognize the status of some health and health care disparities in the United States that affect specific groups of the population.
1. Different minorities and people of color experience greater obstacles to health that is historically linked to discrimination or exclusion (Dubay, 2012, p. 608).
a. Obesity affects racial and ethnic minorities disproportionately. This disease is associated with other chronic conditions.
b. Heart disease and cancer are the leading causes of death across race/ethnicity as well as gender.
2. Gender specific disparities are present across all social determinants of health.
a. In 2015, the life expectancy at birth was 81 years for women and 76 years for men because chronic diseases such as heart disease, cancer, and diabetes are more prevalent in men (NCHS, 2016).
b. Also, men have a higher uninsured rate than women because men haven’t historically qualified for Medicaid (NASEM, 2016).
3. Most disabilities are acquired at birth or developed later in life. Living with a disability shapes one’s experiences of the social, economic, and environmental determinants of health.
– This can present barriers to accessing health care services and navigating the health care system (WHO, 2016).
4. Geographic location also matters because it’s been determined that rural areas haven’t made the same efforts as urban areas in improving population health
a. Compared to urban areas, rural communities have higher rates of preventable conditions (such as obesity, diabetes, cancer, and injury), and higher rates of related high-risk health behaviors (such as smoking, physical inactivity, poor diet, and limited use of seatbelts) (Crosby, 2012).
b. However, urban communities tend to influence health outcomes due to poor housing, unhealthy food choices, more pollution, and unclean water.
5. Low-income means lack of insurance which equal barriers to accessing care, poorer quality care, and worse health outcomes.
– In a study that examined health outcomes, it explained that “high-income adults were found to be in better health, to engage in healthier behaviors, to have greater use of general health and dental services, and to receive more timely screening for cancer and other health conditions, compared to low-income adults of the same race/ethnicity” (Dubay, 2012, p. 621).
III. Sir William Osler once said, “The good physician treats the disease, the great physician treats the patient with the disease.” As a nation and health system, the United States must be more focused on enhancing our knowledge of cultural diversity and the targeted populations, as well as gaining understanding of the specific social determinants of health that surround them, so that it can be free of such health disparities among its diverse population.
A. The encounters between individuals and health care providers and the cultural distance that can increase adverse health outcomes due to misunderstandings from cultural differences and beliefs, thus causing “less patient participation and providers viewing those encounters more negatively” (Franks ; Fiscella, p. 674).
1. Studies suggest that effective communication may play a critical role in reducing inequity among the different ethnicities.
2. Warner and Washington explain that policies that allow for better understanding of health care and stronger patient-provider communication will provide minorities with more effective, efficient, and higher quality care (2011).
3. Also, healthcare providers must educate themselves on the beliefs of the patients that they serve as well as how those cultures could possibly affect their health care and health outcomes.
a. The United States is quite culturally diverse thus requiring the medical education community to revamp their teaching methods to teach how patients with differing cultural backgrounds and how those individuals may require modification in regards to approaching and managing their health concerns (Vaughn et al., 2009).
b. Exposing medical students to the societal implications of health disparities has proven to be successful in altering knowledge.
B. Along with enhanced communication among health care providers and their patients, the need for higher quality and quantity of health care, primarily preventative care, must come into play.
1. Primary care physicians have been considered the gatekeepers, or the coordinator of an individual’s health care.
2. Because of the decrease in availability of primary care physicians, minorities have been at an even greater disadvantage with trying to receive basic health care.
3. The need for an increase in primary care physicians is higher as it was estimated that 32 million individuals, who were previously uninsured, will have health insurance coverage and therefore, be in need of preventative care (Bentancourt et al., 2014).
4. Because of the need for improvement in the delivery of preventative care, the Affordable Care Act stepped in and supported several different programs (Hamel et al., 2015).
– Most of the “projects emphasize care coordination, improved chronic disease management, greater access to primary care, and administrative simplification” (Hamel, 2014).
IV. Even though there are already health reforms and legislation that try to identify and reduce disparities, it has been proposed that “future efforts should focus on identifying gaps where existing measures and program efforts are insufficient, enhancing implementation of existing measures, and addressing barriers to their development or implementation” (Ng et al., 2017).
A. In order to truly abolish health and health care disparities, there is a necessity for health care policy makers to have a deep understanding of the causes of social inequalities and health disparities.
1. Despite ongoing clinical research, there is continued growth of disparities in the United States health care system, thus a combination of ideas will need to be pooled in order to minimize these health disparities.
2. Although evidence is mixed, it has been studied that managed care organizations are more responsible for defined populations; therefore, they are superior for concentrating on disparities, which requires a population approach to health care (Franks & Fiscella, 2008).
3. To truly make successful utilization of all the available resources, it is essential to consider social circumstances and inequalities among individuals.
4. The aim is “to reverse the systemic and personal factors which contribute to the failure of the U.S. health care system to meet the needs of diverse patient groups,” resulting in the drastic reduction or, ideally, the elimination of health care disparities (Butler & Freedy, p. 207).
5. By understanding certain relationships, the United States can develop the proper policies to reduce disparities in health care.
a. There is the idea that by improving the knowledge of cultural differences and then communicating and addressing these socioeconomic disparities between the providers and patients, the United States health care system has a greater ability to provide higher quality of care to each and every individual.
b. Betancourt determined that a new health care system was justly needed and within reach, describing the ideal system as one that was “culturally competent, equitable, ethical, and high quality” (2014, p. 147).
B. By “improving educational levels, income redistribution, and universal health insurance coverage”, health disparities in the U.S. health system can be reduced (Franks & Fiscella, p. 672).
C. Efforts to reduce health care disparities and mold such a system have been brought on by the Department of Health and Human Services (HHS) Disparities Action Plan, which desired to provide equal access to each and every American, and the Affordable Care Act (ACA), which aimed to improve access to health insurance (Gostin et al., p. 19).
1. Although it is a very controversial health care reform and there are many kinks in relation to the ACA, it can also be seen as a step in the process of development versus an end goal to solving the United States health care system (Colander, 2017).
2. The basic issue with the United States health care system is that health care costs an astronomical amount and is inaccessible to many, even though it should not.
3. Although escalating health care costs and the need to reduce such is what drove the U.S. to a health care reform, a major flaw with “the ACA is that it tries to deal with the U.S. health care problem as an insurance problem, when in fact the fundamental problem with the U.S. health care system is a cost and accessibility problem” (Colander, p. 173).
a. Currently, the U.S. health system is a jumbled mess of the following systems that do not mix effectively: “If government pays, experts appointed by government decide what health care will be available to individuals, and how much government will pay for it. If individuals pay, then individuals decide. If insurance companies pay, then insurance companies decide” (Colander, p. 174).
b. The hope for this new health care reform was also to strengthen the quality of health care being distributed among the population, specifically those in need.
c. As stated before, there have been many flaws in the Affordable Care Act but it has also expanding health care coverage to those who did not have access previously.
D. The goal for redesigning the health system is to not only reduce the previously discussed disparities but to mainly improve the quality of care and aptly distribute care based upon need.
V. As the United States continues to become more diverse, it needs to be understood that each culture brings its own beliefs and values which may differ from our traditional or set ways.
A. It is essential then that the U.S. health care system concentrate and invest in the social and environmental factors that contribute to inequality, specifically income inequality, and its impact on the health of the underprivileged in order to drastically improve the United States health system and have the ability to resolve any gaps in care.
B. Times are changing and our country is now more diverse than ever. The effects of cultural beliefs and social changes have definitely been responsible for molding the U.S. health care system.
C. The differences in the beliefs about health care that are at play have had a direct effect on the health care delivery system, and providing care to the different socioeconomic groups is a necessary plan for reducing health inequalities. Therefore, it is indispensable to create a health system that has the ability to provide high quality care to every patient, regardless of any of the reasons discussed.
D. By improving the understanding of health care disparities and differing cultural beliefs and values, the United States health care system will lead health care providers a their patients to have stronger and more open communication, thus assisting policymakers in obliterating disparities and providing each and every individual with more effective, efficient, and higher quality health care.