Disparities in Healthcare



Disparities in HealthcareApril YearwoodUnion UniversityDisparities in HealthcareThe National Institute on Minority Health and Health Disparities (NIMHD) defines health disparities as, “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups” (Williams, 2010, p. 1). As the United States is becoming a melting pot for different types of populations, Marshall (2012) notes that, “by the year 2050, minority populations will represent nearly half the country’s population” and that this is “one of the nation’s greatest assets; one of its greatest challenges is reducing the profound disparity in health status of American’s racial and ethnic minorities” (p. 128). Americans either choose to not see or are oblivious to the fact that overall healthcare “is inferior for racial and ethnic minority groups compared with nonminorities” (Marshall, 2011, p. 128). “Differences persist not only in the prevalence of diseases but also in access to care, actual experiences in healthcare systems, and outcomes of care” (Marshall, 2011, p. 128). Marshall goes on to explain, States with the greatest racial diversity, also show greatest disparities in cancer deaths, immunization rates, infant mortality, income disparity, and insurance coverage…Even when insurance coverage is available, minorities often receive lower quality of care. Such disparities affect quality and length of life and diminish all of us as a society. Eliminating health disparities is one of the greatest current challenges for leaders in health care. (Marshall, 2011, p. 128)This paper will delve into healthcare disparities and address related issues pertaining to socioeconomic, racial, and ethnic issues. It will also address causes of disparity and interventions for equalizing care. Health Issues for Multiple GroupsSocioeconomicBerkman (2009) notes that “recent studies indicate that socioeconomic inequalities in health have been widening in the past decades” (Berkman, 2009, p. 27). This is definitely one of the many disparities in our country, not only for the classes of persons seeking care but for the socioeconomic classes who want to be a provider of care. The United States, one of the richest countries in the world, spends more than any other on health care, but does not provide the best nor does it provide healthcare equally. Much of this inequity stems from vast socioeconomic inequalities (Apter & Casillas, 2009, p. 1237)The National Conference of State Legislatures posted a file on their website stating: In 2008, African Americans and Latinos accounted for 14 percent of medical school graduates, a number that does not currently reflect the Nation’s population. The ACA has multiple sections within the law that are aimed at increasing the diversity within the primary care, dental, mental health, and long-term care workforce. In addition, it requires the collection of workforce diversity data. Workforce diversity grants are expanded to include nurses. Studies from the Commonwealth Fund and the Office of Minority Health show that providers who have participated in culturally competent training and education can improve the quality of care given to diverse populations. The ACA invests in the development and evaluation of culturally competent curricula in educational training over the next five years. Other support is also given for cultural competence training to primary care providers. In addition, loan repayment preference will be given to individuals who have cultural competency experience. ("Workforce and cultural competence," 2008, p. 1) RacialRacial-ethnic minorities receive lower quality and intensity of health care compared with whites across a wide range of preventive, diagnostic, and therapeutic services and disease entities. These disparities in health care contribute to continuing racial-ethnic disparities in the burden of illness and death. (Washington et al., 2008, p. 685)The Institute of Medicine and many other organizations have published multiple articles/studies to speak to eliminating health care disparities; however, health care providers cannot always put those interventions/recommendations into practice. The article cited above gives some examples of consistently documented disparities of racial and ethnic origin including cancer care, hospital services, surgical procedures, and pain treatment. “Most research has found that racial-ethnic disparities persist even after adjustment for these factors” (Washington et al., 2008, p. 685) of socioeconomic and access to care. EthnicityThe United States is among the most diverse countries in the world. Alexander reminded that 25% of the American population is African American, Hispanic, Native American, or Asian/pacific Islander. By 2050, minority populations will represent nearly half the country’s population. (Marshall, 2011, p. 128)The differing population groups have multiple disparities including language issues, health issues such as hypertension, diabetes and cancer deaths at higher percentages, and issues of insurance coverage to name a few. As Americans become more accustomed to being around all types of nationalities, we will see just how much inequality exists. And as we begin to open our eyes, hopefully we will start to learn how to help these underserved populations.CausesSocioeconomicNot much has to be said about the cause of socioeconomic disparities today. In the crazy economy that we live in, there is much diversity in persons’ income. The Center for Disease Control and Prevention (CDC) published a health disparities and inequalities report in 2001 which states that, Lower income residents report fewer average healthy days. Residents of states with larger inequalities in reported number of healthy days also report fewer healthy days on average. The correlation between poor health and health inequality at the state level holds at all levels of income. (U.S. Department of Health and Human Services [CDC], 2011, p. 3)It also states, “Rates of preventable hospitalizations increase as incomes decrease. Data from the Agency for Healthcare Research and Quality indicate that eliminating these disparities would prevent approximately 1 million hospitalizations and save $6.7 billion in health-care costs each year”.(CDC, 2011, p. 3).As well as, The socioeconomic circumstances of persons and the places where they live and work strongly influence their health. In the United States, as elsewhere, the risk for mortality, morbidity, unhealthy behaviors, reduced access to health care and poor quality of care increases with decreasing socioeconomic circumstances. (CDC, 2011, p. 13) Income status can greatly affect whether a family can afford insurance or not as well as whether they seek health care advice from a provider or not. Berkman (2009) notes that, Epidemiologists and economists have explicitly noted the rising health inequalities in the United States related to socioeconomic conditions and among racial/ethnic groups. Meara reports that life expectancy hardly changed for people with low levels of education over the 20-year period from 1981 to 2000, and among women with low levels of education, it actually declined during that period. For men and women with higher levels of education, life expectancy at age 25 improved 1.8 years for white men, 1.0 years for white women, 3.3 years for black men, and 1.6 years for black women. (p. 28) RacialAgain, in the CDC report from 2011, the narrative lists disparity causes pertaining to racial issues as:? Men of all race/ethnicities are two to three times more likely to die in motor vehicle crashes than are women, and death rates are twice as high among American Indians/Alaska Natives.? Men of all ages and race/ethnicities are approximately four times more likely to die by suicide than females. Though American Indians/Alaska Natives, who have a particularly high rate of suicide in adolescence and early adulthood, account for only about 1% of the total suicides, they share the highest rates with Non-Hispanic whites who in contrast account for nearly 5 of 6 suicides. The suicide rate among AI/ANs and non-Hispanic whites is more than twice that of blacks, Asian Pacific Islanders and Hispanics.? Rates of drug-induced deaths increased between 2003 and 2007 among men and women of all race/ethnicities, with the exception of Hispanics, and rates are highest among non-Hispanic whites. Prescription drug abuse now kills more persons than illicit drugs, a reversal of the situation 15–20 years ago.? Racial/ethnic minorities, with the exception of Asians/Pacific Islanders, experience disproportionately higher rates of new human immunodeficiency virus diagnoses than whites, as do men who have sex with men (MSM). Disparities continue to widen as rates increase among black and American Indian/Alaska Native males, as well as MSM, even as rates hold steady or are decreasing in other groups. (CDC, 2011, p. 3)EthnicityThere are multiple causes of disparities of ethnic groups. One population group hit hard are the Hispanics. “Hispanics are more likely than any other racial or ethnic group in the United States to lack health insurance” (Maxwell, Cortes, Schneider, Graves, & Rosman, 2011, p. 1451). In Massachusetts, Hispanics are the fastest-growing ethnic minority group (9.6%, a 46% increase from 2000). Not only in that state, but in every state, Hispanics face an uphill battle with barriers on every side. A few of the causes are language barriers as well as structural barriers such as an interpreter being available within a health care facility, a racial-ethnic person being on staff, and the availability of patient education material in their language are just a few of the issues. They on average make less money so “insurance premiums put a strain on low-income Hispanic households” (Maxwell et al., 2011, p. 1454). InterventionsSocioeconomicMany studies have been performed that identify social, environmental, and behavioral conditions that could lower health disparities; however, we must “design effective interventions and make specific policy changes to modify them” (Berkman, 2009, p. 1). One hopeful way that this disparity could be helped is from the American Recovery and Reinvestment Act of 2009, the Stimulus package, which “designates health disparities research as among those areas with high priority for funding. Most important, legislation for health care reform is being proposed; inequities in insurance coverage are at the heart of health care inequities” (Apter & Casillas, 2009, p. 4). Now that the “Obamacare” has been passed, this funding might actually exist and come into being for the research that is needed.Racial/Ethnicity combinedAt the expense of Washington et al. (2008), I will post a table from their article that summarizes detailed interventions for racial as well as ethnicity inequalities combined with others:(p. 686) And lastly, I would like to post the Institute of Medicines report brief of the six national priorities that were developed for a set of areas for quality improvement and disparities elimination:(Institute of Medicine [IOM], 2010, p. 2).ReferencesApter, A. J., & Casillas, A. M. (2009). Eliminating health disparities: what have we done and what do we do next? Journal of Allergy Clinical Immunology, 123, 1237-1239. Doi:10.1016/j.jaci.2009.04.028Berkman, L. F. (2009, January 19). Social epidemiology: social determinants of health in the United States: are we losing ground? Annual Review of Public Health, 30(), 27-41. Doi: 10.1146/annurev.publhealth.031308.100310Health reform. (2008). Retrieved from documents/health/HDandACA.pdfInstitute of Medicine. (2010). Future directions for the national healthcare quality and disparities reports (Report brief). Retrieved from Institute of Medicine website: iom.edu/ahrqhealthcarereportsMarshall, E. S. (2011). Transformational leadership in nursing. New York, NY: Springer Publishing Company.Maxwell, J., Cortes, D. E., Schneider, K. L., Graves, A., & Rosman, B. (2011). Massachusetts’ health care reform increased access to care for hispanics, but disparities remain. Health Affairs, 30, 1451-1460. Doi: 10.1377/hlthaff.2011.0347U.S. Department of Health and Human Services. (2011). CDC health disparities and inequalities report — United States, 2011 (Morbidity and Mortality Weekly Report Supplement/Vol 60). Retrieved from : , D. L., Bowles, J., Saha, S., Moody-Ayers, S., Brown, A. F., Stone, V. E., & Cooper, L. A. (2008, January 15). Transforming clinical practice to eliminate racial-ethnic disparities in healthcare. Journal of General Intern Medicine, 23, 685-691. Doi: 10.1007/s11606-007-0481-0Williams, K. (2010). NIH announces institute on minority health and health disparities. Retrieved from ................
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