This essay reviews a selection of the literature on healthcare-related inequalities, with the aim of illuminating how we can differentiate between fair and unfair, and between avoidable and unavoidable, inequalities in health. This essay also reviews some of the more common methods used to measure healthcare inequalities and discusses their limitations. Some policy considerations are provided at the end.
In a society, inequalities in health outcomes, healthcare access and healthcare utilisation are caused by a myriad of factors. In order to appreciate whether an inequality is fair or unfair, and avoidable or unavoidable, we should avail ourselves to the approach proposed by Fleurbaey and Schokkaert (2009). The authors suggest that we start with a “structural model” that describes the whole social context in which a utility-maximising individual makes decisions, subject to a budget constraint. This budget constraint is determined by a range of market, insurance and economic factors: the general price level, tax levels, out-of-pocket payments, insurance coverage and insurance premiums. Individuals have a health production function that depends on factors like medical care, lifestyle choices (for instance nutrition and exercise regimes), genetic endowments, information access, socioeconomic status, and random shocks.
In the Fleurbaey-Schokkaert framework, utility-maximisation depends on factors that depend on the individual’s own choice (such as lifestyle factors), as well as factors beyond the individual’s control (random shocks and genetic endowments). Inequalities arising from factors within an individual’s control are deemed “fair”. Conversely, other factors like genetic endowments and socioeconomic status are typically thought...
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...ogeneity is addressed by the measurement technique. For instance Dias (2009, 2010) and Trannoy et. al. (2010) aim to model the error term in their econometric techniques to account for unobserved individual efforts and childhood experiences. Thirdly, the characteristics of the health variables used in the measurement technique matters as well. For instance Erreygers and van Ourti (2010) show how the logical consistency of the CI can be influenced by the nature of the health variable (bounded/ unbounded and scale of the variable). In conclusion, measurement of health inequalities is definitely possible, however achieving good quality estimates requires good knowledge of the technique and behavior of the health variables. Furthermore the degree to which we have accurately measured unfair health inequalities depends on the quality of our moral and ethical judgments.
O Grady, M. A. (2005, May 21). In Canadian Health Care: Some Are More Equal Than Others Are. Charter health. Retrieved from http://www.charterhealth.ca/news/2005may21.html
Health disparity is one of the burdens that contributes to our healthcare system in providing equal healthcare to everyone regarding of race, age, race, sexual orientation, and socioeconomic status to achieve good health. Research reveals that racial and ethnic minorities are likely to receive lower quality of healthcare services than white Americans.
Healthcare disparities are when there are inequalities or differences of the conditions of health and the quality of care that is received among specific groups of people such as African Americans, Caucasians, Asians, or Hispanics. Not only does it occur between racial and ethnic groups, health disparities can happen between males and females as well. Minorities have the worst healthcare outcomes, higher death rates, and are more prone to terminal diseases. For African American men and women, some of the most common health disparities are diabetes, cancer, hypertension, cardiovascular disease, and HIV infections. Some factors that can contribute to disparities are healthcare access, transportation, specialist referrals, and non-effective communication with patients. There is also much racism that still occurs today, which can be another reason African Americans may be mistreated with their healthcare. “Although both black and white patients tended not to endorse the existence of racism in the medical system, African Americans patients were more likely to perceive racism” (Laveist, Nickerson, Bowie, 2000). Over the years, the health care system has made improvements but some Americans, such as African Americans, are still being treating unequally when wanting the same care they desire as everyone else.
The goal within the United States government is to treat each individual as an equal citizen. Unfortunately, through the inadequate practice of public policies people have been treated unequal because of natural conditions and the countries social environment. In health policy, the two concepts that cause unequal treatment are health disparities and health differences. Health disparities are resulted from social factors that are avoidable and unjust. For example, saying ovarian cancer death rates are higher because men have better research on prostate cancer (Smith, 2016). “The extent and nature of health disparities changes over the life course” (Adler, 2008, p. 241). Health differences are inherently biological being completely natural and
Townsend, P., Whitehead, M. and Davidson, N. (eds) (1992) Inequalities in Health: the Black Report and the health divide, Harmondsworth, Penguin.
A health disparity is a term used to show that there are inequalities that occur in the healthcare system. Race, sex, age, disability, and socioeconomic status can all attribute to a person 's health outcome. According to Healthy People 2020, health disparity is defined as “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 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.” In the United States, many ethnic minorities experience the effects of health disparities. African American, Asian American, Latinos, and Native Americans have a higher occurrence of poor health outcomes compared to the white population. Some examples of health disparities include: African American men, for instance, are more likely to die from cancer than white men. White women are more likely to develop breast cancer than African-American women. African-American men are more likely than white men to develop prostate
The disparities in the healthcare system contribute to the overall health status disparities that affect ethnic and racial minorities. The sources of ethnic and racial healthcare disparities include cultural barriers, geography differences, or healthcare provider stereotyping. In addition, difficulties in communication between health care providers and patients, lack of access to healthcare providers, and lack of access to adequate health care coverage
Ungen, M. M., Siegel, M. M., & Lauterbach, K. W. (2011). Could inequality in health be cured
“There is no social justice without equity in health and no equity in health without social justice”. (Pauly, 2009, pp. 118). “Social injustice is a matter of life and death. It affects people’s way of living and their chances of being ill and their risk of premature death.” (WHO, 2008, pp. 1)’ “The social determinants of health (SDOH) are associated with structural differences such as income, employment and working conditions, housing education, food security, social inclusion, and the environmental conditions.” (CNA, 2016, pp 1).
Positive rights are rights that everyone is entitled to including: the right to a public education, access to public roads, and the right to health care. There are no guarantees when it comes to life, but having health insurance makes a huge difference with preventing, diagnosing, and treating diseases. Of course having insurance itself is a great resource to ensure medical care and containing costs, but not all insurance programs are created equal. Insurance programs have caveats, exclusions, varying co-payments, and access to certain doctors and hospitals, which creates an ethical dilemma. Receiving the best care is subjective in most cases, but with money you can buy almost anything, including the best care. Although those living in poverty are given access to healthcare, that does not mean they receive the best or equal care as those who are wealthy.
Public health as it is implicated in the lives of the community – it is important to conceptualise what this might mean. Moreover, public health has seen as a multidiscipline perspective in which it can be defined on many levels, and I find that it could be elusive to understand its meaning. By simple understanding of public health, I refer to an approach derived by Winslow (1920) and Baggott (2000).
Health care inequality has long been customary in the United States. Those in lower classes have higher morbidity, higher mortality, higher infant mortality, and higher disability. Millions of low-income families and individuals have gone with out the care they need simply because they cannot afford it. Denial of benefits due to pre-existing conditions, outrageous deductibles, and unreasonable prescription prices are in large part why the low-income class suffers. In addition, not receiving preventative health care, lack of access to exercise equipment and lack of availability to fresh foods all create health problems that become to expensive to fix. Low-income families need to have better, more affordable access to health care, specifically preventative health care, and be more educated about the benefits of health care in order to narrow the gap of inequality. The new Affordable Care Act under the Obama administration expands heath care coverage to many low income families and individuals by lowering the eligibility requirements for Medicaid, although it is not mandatory for individual states to make this expansion for Medicaid coverage.(CITE) It also requires that preventative health care be included in coverage by insurance companies. So with all the benefits the expansion of Medicaid could offer, why would some states choose not to offer it?
In the United States is Health Care Equally Distributed? The Health Care Industry is one of the largest Social Institutions, made to ensure a communities wellbeing. The issue at hand, Health Care distribution is directly correlated to one’s income. In most cases Health care is often not distributed to those who need it but cannot afford it, and is to those who can afford it and may not need it. Health Care equality can be related to both Conflict and Functionalist Theories.
Levy and Sidel (2006) defines social injustice in medical terms as the actions and/or policies implemented that adversely affect the social conditions of the population’s health. More often, this injustice is seen in the poor, minority/indigenous groups on a community, national and global level. This form of injustice can be seen in the difference in high and low socioeconomic position. Phelan, link and Tehranifar (2010) founded the fundamental cause theory which was developed to give reasons for the continuous link overtime between SES and health status and mortality rates. The fundamental cause theory details how SES impacts upon multiple health issues and risk factors particularly affecting citizens in low SES. To illustrate, many deaths are linked to a low SES in regards to mortality from chronic diseases, communicable diseases and injuries. Additionally, the theory proposed that SES represents an array of resources, for instance; money, education, power, and social capital. The more people have of these resources the more likely to be health protected. More importantly, people with low SES lack man of those resources and in turn the people’s health is less protected. With this in mind, the link between SES and health related benefits must be broken in order to achieve greater equality in aspects of health, life and death. In summary, the inequalities within SES, for example;
Despite this, there is still a need for the Canadian government to raise public awareness of income-related health inequalities in order to make policy changes to reduce the wealth gap and create a more equitable health care