Final Term Paper Example

Introduction

Health inequality is a systemic problem in many countries. Inequalities occur when differences in health outcomes are observed among heterogeneous populations (CDC, 2013). Research shows that health inequality is related to a variety of factors that influence individual's or group's position on the socio-economic scale. Socio-economic status affects health and life expectancy in the United States. For instance, the status influences one’ residence, which has an implication on the access to social amenities and related services. Research reveals important variables and patterns of health inequality.

 

The inequalities are conspicuous with regard to ethnicity or race, gender and geographical location of a particular group of people. While health discrepancies across the population are largely a representation of injustice, some differences are biologically oriented; and hence are not unjust. The inequalities due to gender are apparent from the higher life expectancy of women as compared to men (Sreenivasan, 2008). This essay delves into the unjust health inequalities in the US particularly with respect to race or ethnicity. The underlying causes and patterns of the racial inequality are discussed. Finally, recommendations on how to address the problem are given.

World Health Organization states that social determinants of health (such as residence, work, and age) are predominantly responsible for health inequalities. Certain populations in the United States bear a heavier burden of illnesses, mortality and disabilities. Documented inequalities have been consistent for 80 percent with respect to the metrics of the 2010 healthy communities (CDC, 2013). Risk factor survey reports that residents of the minority groups continue to rank low on socioeconomic status, have limitation to healthcare access and are more exposed to diseases in comparison with the general population living in the same region (CDC, 2013).

Section I

One of the major health inequalities present in life expectancy between white and black Americans, both males and females. Among American black and white men, there is a difference of 14.4 years in life expectancy; black men are adversely affected by the disparity (Sreenivasan, 2008). Moreover, there is a life expectancy gap of 12.8 years between black and white women (Sreenivasan, 2008). Therefore, race is a major indicator of health disparities in the United States.

In the race-conscious United States, ethnicity is not only a matter of cultural differences. In fact, the term accurately captures the real picture of social classification of the American people (Jones, 2000). The racial features are most noted by police officers, judges, and sales clerks, etc. Moreover, the race has the biggest influence in the context of health discrepancies. Jones (2000) observed that race does not demonstrate sharp biological differences as outlined by existing inequalities. Rather, it is a social construct that accurately shows the consequences of racism. Moreover, Jones (2000) calls it institutionalized racism that is manifested in the access of materials and power.

A report by the CDC (2013) argues that race does not explain the health disparities, but rather discrepancies in educational levels among different populations. Also, race defines the effects of having or lacking education as the major factors that should be considered in a bid to understand the difference in access to healthcare. The higher the level of education an individual has, the more likely he or she will live a healthier and longer life (Braveman et al., 2011). The rationale is that higher education earns one a good job, with high income and security, which enables a person to provide finances for the medical needs. Contrary, the less education an individual has, the less are their earnings, the more stressful jobs they get, the less the security of the job, all these culminating to inability to provide for their families.

In addition, individuals with higher education are likely to adopt healthier lifestyles, for instance by having access to more healthy foods. The CDC (2013) found that the minority races including Black Americans and Hispanics had highest rates of non-completion of education. There is a positive correlation between poverty levels and non-completion of high school education (CDC, 2013). Thus, controlling education inequalities will contribute to reduction of health inequalities between white Americans and the minority groups of people. In effect, it is held that easier accessibility to education for all groups would play a role in reducing health inequalities.

Another variable for health discrepancy between American people of different racial or ethnic background is the geographical location and environment. The environment, in which a community lives, plays a major role in determining the kinds of health risks, to which they are exposed. In addition, the geographical location of an area defines the kind of health care available. For instance, people dwelling in rural areas may not have access to health facilities, or the needed medical practitioners to assist them in living healthy lifestyles (Morello & Lopez, 2006). Moreover, rural people may not have access to clean water, which exposes them to health hazards (Morello & Lopez, 2006). In addition, the kind of food individuals obtain in remote rural areas may lack quality compared to groceries in urban areas. Conclusively, Americans living in cities like New York are likely to be healthier than those living in rural areas.

Another way to examine health inequalities with respect to race is looking at the association of residential segregation with community environmental health. Segregation solidifies disparities in socio-economic status; and it influences the manner, in which resources are distributed at the individual and community level, fundamentally affecting community health (Geiger, 2004). Communities living in segregated neighborhoods are more exposed to environmental hazards due to emissions of contaminants from various sources including industrial plants (Morello & Lopez, 2006).

The exposure increases the chances of residents contracting health problems such as asthma. Moreover, the environmental pollution weakens individuals' resilience and ability to recover from illnesses. Incidentally, research shows that most of the segregated groups are communities of color that also face high levels of poverty (Morello & Lopez, 2006). Examining health inequalities from the dimension of discrimination provides an insight into a political economy characterized by social inequity, and degradation of environment and health. Policies should be enacted to address the forms of inequities that directly contribute to health inequity.

Sociological factors (conditions of residence, growth, work, life, and age) have also been identified as causes of health inequalities among populations of different races. Other important social attributes border on habits such as excess smoking, drinking and lack of physical exercise. However, the unhealthy lifestyle is associated with the education disparities discussed earlier. People may not be informed about the health risks of bad habits. Subsequently, health inequality is being observed among individuals with different personal characteristics (Geiger, 2004).

Section II

Policy 1: Reducing Residential Segregation

Racial residential segregation is a major factor attributed to the health disparity between African-Americans and the whites, as poor black neighborhoods are often situated near highways, industrial and toxic sites (Boustan, 2013). Housing quality is also poor (Williams & Collins, 2001). Subsequently, the federal government needs to adopt an infrastructural enhancement policy to eliminate or reduce residential segregation problem, which is the major cause of low socioeconomic status reflected in racial health disparity. The policy takes two dimensions based on the object of implementation, place-based dimension and, persons–based dimension (Bouston, 2013).

Place-based dimension aims at improving housing and amenities in black neighborhoods. The community improvement projects such as upgrading schools, health care facilities, and infrastructure should be introduced. Further, the government should aim at providing affordable housing options in the predominantly white environs in order to enable the low-income African–Americans to settle in the areas; hence reducing overcrowding in the black neighborhoods. The current zoning policies in the white suburbs are deterrent to black households (Bouston, 2013). Usually, suburbs have zoning laws that stipulate the least lot size requirements for building or preempt the development of multifamily housing units. The laws escalate the cost of entry into the white communities by demanding that residents purchase a particular amount of housing services. Therefore, a policy may intentionally or unintentionally ward off black households (Bouston, 2013).

People-based dimension seeks to enable individual renters or homebuyers to have access to existing neighborhoods. The strategy is exemplified by the Community Reinvestment Act of 1977, which was modified in 1995 to bolster lending to low-income borrowers irrespective of the features of the selected neighborhoods. In its modified form, the Act may eliminate the problem of racial residential segregation and the inherent health disparities by increasing credit to low-income African- Americans even if they relocate to middle or upper income white residential areas (Bouston, 2013).

Strengths. The policy solution is motivated by the findings of extensive studies on the relationship between racial and ethnic health disparity and residential segregation, particularly with reference to the African American neighborhoods. For instance, Mirtha and Gart (2011) cited residential segregation as a major determinant of the establishment and perpetuation of health inequalities in the US. Residential segregation has adverse effects on the black minority families that are intentionally or unintentionally excluded from the majority neighborhoods. Minority groups are likely to be poor and living in isolated areas. The factor of environment aggravates the poverty problem as it may bar minorities from interacting with the prosperous groups or accessing a variety of job opportunities (Acevedo-Garcia, Lochner, Osypuk, & Subramanian, 2003). Through the two dimensions, place-based and people-based, the policy aims to reduce the racial residential segregation. The strategy is comprehensive as it focuses on addressing the root causes of the residential segregation and its detrimental effects.

Weaknesses. In light of the complexity of urban housing markets, it is challenging to address the residential segregation problem through public policy. The initiative is complicated further by the legal barriers to directly formulate race-based housing rules. It is possible to theoretically design a program of racial quotas at the black neighborhood or other metropolitan impoverished areas. However, a direct approach to racial segregation would likely be unconstitutional and politically unsustainable given that a move would amount to discrimination (Boustan, 2013). However, the policy can be advanced as an affirmative action.

Policy improvement. In view of the legal constraints, any policy formulated to tackle residential segregation must be formally race nonaligned. The focus of the policy should be the neighborhoods and individuals based on income and opportunities instead of race (Acevedo-Garcia et al., 2003).

Policy 2: Transforming Health Care

Transforming health care is one of the five action plans formulated by the Department of Human and Health Services (US DHHS) that aims to create a society free of racial and ethnic disparities in health. Both the federal and state government should adopt a policy that will transform the current health care to create a value approach that will reduce health disparities with reference to the minority racial and ethnic groups (Department of Health and Human Services USA, 2011). The transformation policy can be implemented through several strategies.

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The first strategy aims at reducing inequality in health insurance coverage and access to medical care. US DHHS (2011) notes that racial minority groups have below national average rates of health insurance plans. Therefore, removing impediments to coverage will provide increased access to care for racial and ethnic minorities who have higher rates of chronic diseases. Actions include increasing the availability of health insurance and providing patient protections in Medicaid and other types of health insurance. The strategy is better implemented by the federal government (US DHHS, 2011).

The second strategy focuses on addressing disparities in access to primary health care services. Racial and ethnic minorities continue to face challenges of timely and needed basic health care services. In response to the problem, federal, state, and local governments should collaborate to expand primary care services and offer training to more health care providers. Actions include increasing the number of individuals with a primary health care provider and patient-concentrated health homes (US DHHS, 2011)

Strengths. The policy is in line with provisions of the 2010 Affordable Care Act (ACA). Requirements of ACA include supporting enhancements in primary health care, establishing linkages between traditional dimensions of health and social services and investments in health information technology, which are aimed at transforming health care and eliminating disparities (US DHHS, 2011). By being in conformity with the ACA, the policy and its underlying strategies are well positioned to succeed.

Weaknesses. The strategy cannot provide a long-term solution to ethnic and racial health disparities as it addresses the effects rather than causes of health disparities. Further, the implementation of the policy is resource-intensive, since it is mainly based on expanding health insurance coverage to the poor groups. The plan may be realized at the expense of the well-off groups. Most Americans accept that health disparity, particularly based on race or ethnicity, is undesirable and should be eliminated. However, increased taxes for the Americans may result in the rejection of a policy that aims at reducing disparities by improving the lower economic status at the expense of those in higher social positions.

Policy improvement. The policy focuses solely on mitigating the effects of health disparities, for example by increasing insurance coverage to the poor minority populations. The policy can be modified to encompass solutions to the root causes of health disparity, such as unemployment, low educational attainment, food insecurity, poor housing and transportation, among other factors. The aforementioned economic and social problems contribute to lowering the socioeconomic status of the race and ethnic minority groups. Addressing health disparity from the national perspective could offer a long-term solution.

Strategy 3: Reinforcing the Country’s Health and Human Services Structure and Workforce

The policy is contained in the 2011 National Stakeholders Strategy report that offers recommendations to achieving health equity in the United States. Moreover, US DHH task force recommends a similar policy solution. The strategy entails providing solutions to the critical shortfall of primary health care specialists, nurses, community health workers, behavioral health providers among other key players in health care. Further, the increasing national diversity caused a rise in the disparity between racial and ethnic composition of healthcare personnel in the country’s population (Mirtha & Gart, 2011). The policy aims at reducing the gaps in the workforce diversity and shortfalls in health care providers through a number of strategies.

The federal and state governments’ healthcare agencies should devise ways to increase the capacity of all health care systems and health care specialists to identify and address the problems of racial and ethnic health inequalities. Racial and ethnic minorities groups, particularly individuals whose first language is not English, are more likely to complain about poor quality of patient-provider relations than English speakers (Mirtha & Gart, 2011). Specific actions to address the language disparity and bolster patient-provider relations include supporting the translation services as an integral part of health care workforce. The application of translation will enhance access to and quality of health care for individuals with limited English competency. Moreover, the cooperation with health care professional and communities will make improvements to the present national standards that guide appropriateness of culture and linguistics-based services in health care (Mirtha & Gart, 2011).

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Furthermore, most racial and ethnic minority professionals are more likely to work in medically underserved areas, where they serve large populations. Actions to the diversity problem, which also translates to a shortage of healthcare workforce in the underserved localities, include increasing health care and public health personnel in the areas like African American neighborhoods (US DHHS, 2011).

Strength. The policy recognizes the shortage of healthcare workforce and the increasing diversity in the workforce. Moreover, it offers strategies to address problems inherent in the two situations. In particular, it recognizes than in a heterogeneous country like the United States, cultural and linguistic competence is important to combat health disparities that arise from poor interactions between patients and health care providers. Finally, it provides action plans for the policy.

Weakness. The policy does not focus on the root causes of health disparities in minority race and ethnic groups.

Policy improvement. Rather than largely attributing the health disparity problem to patient-provider communication barriers, the policy can be more comprehensive by addressing heath disparities from the perspective of important factors that have been identified in broad literature. Most importantly, unequal treatment of the minority people of color due to actions and attitudes of healthcare providers and managers and system’s bias should be included in the plan (Cooper, 2015). Inequality is seen in the distribution variation of infrastructural facilities, such as location of hospitals and deployment of health personnel.

Conclusion

Health is a fundamental factor to the well-being of a person as it determines their capacity to effectively take part in the workforce and other domains in the society. Poor health exposes people to suffering, incapacitation and premature deaths, which jeopardize an individual’s ability to lead a quality life. Every individual should be able to attain good health irrespective of ethnicity or race, gender, sexual orientation, skin color, geographical location, political association and other factors that are linked to segregation of socio-economic opportunities. It is evident that the minority groups of the United States, mostly the blacks, are poorly positioned with respect to health.

The International Human Rights agreement places obligations on governments of all participant countries to safeguard and promote rights of people. The obligation includes the right to access the maximum health standard, and right to sufficient living conditions for an individual’s health and well-being (Braveman et al., 2011). Subsequently, governments must show goodwill in removing barriers to uphold individuals’ health rights.

As a principle, equity refers to fairness. In the case of access to health care, the term advances the requirement to extend care based on the needs of people. Equal inputs must be committed to the same needs. Viewed in simple terms, each person must be presented with the opportunity to access the same quality of health services. In the current case, it is anticipated that the proposed policies would create the necessary conditions for equity in health service access. Equity can only be possible if policies that eliminate variances are adopted. In other words, no system can embrace equity and inequality at the same time.

The policy infrastructural development would play a leading role in reducing inequality because it encourages the building of medical facilities in poor neighbors to ensure that each person has access to reasonable care. The policy of transforming healthcare would help by ensuring the provision of support services to health care providers. The policy is also expected to strengthen the adoption of technology to ease healthcare extension, leading to an increase in the number of person accessing care. The reinforcement of health and human services structure and workforce would also assist in solving the disparity problem. In particular, the strategy will address the personnel shortages affecting the sector.

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