Health cannot and should not be focused on some while ignoring others. Living in a country that plays lip service to equal rights for all often neglects the material needs to many. Nowadays with services being cut and wealth being appropriated by the upper classes health care for the poor has suffered greatly. Because of the history of racial discrimination the distribution of poverty weighs heavily on certain ethnic groups especially Blacks, Latinos, and Native Americans. It is clear that racism has been used as an excuse and has become institutionalized to justify consciously or not the inequitable distribution of wealth.
To disregard the health of some is unjust in a society and it is clear that the role of those who care about the health of others is that the greatest efforts must be taken to address the health of all no matter what obstacles stand in the way. This tradition is in fact an essential part of a mission of public health. Justice is viewed as so central to the mission of public health that it has been described as the field’s core value (Gostin, 2006).
Contributing Factors in Health Disparity
Traditional US society revolves around white male privilege. All social structure reflects European values. The white settlers eliminated any threat to their rule. The native people were largely exterminated, and the African were kidnapped and forced to work as slaves. It’s ironic that in the land of the free so many people have been denied their rights. Racism was intentionally integrated into the social structure and has subsequently become institutionalized.
The impact of racial discrimination is profound and in order for there to be improvement in health outcomes racism must be addressed. Strategies for measuring the depth of discrimination are readily available. For example for any one objective, progress toward the elimination of racial and ethnic disparities is measured in terms of changes in the relative difference between the best group rate and the rate for each of the other racial and ethnic groups…Disparities can also be viewed in terms of burden – that is, the number of people with limitations, risk factors, adverse health conditions, or health care access problems (Keppel, 2007).
Some make the claim that if one wants to they can pull themselves up by their bootstraps but when lacking even the most basic services this is most certainly impossible. Living in an impoverished neighborhood decreases ones survival odds. Inner city pollution and lack of fresh food as well as crime decrease survival odds. The negative impacts of these variables on individual people can be considered as the impact of one lacking in social capital. Nevertheless strategies to address a deficit of social capital are not sufficient as other unrecognized factors may exist.
The things many take for granted are not available to some in society. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to “blame the victim” at the community level while ignoring the health effects of macrolevel social and economic policies (Pearce, 2003).
In a society where wealth is not equitably distributed and where institutionalized racism exists certain minorities are going to suffer greatly. In the UK an example of the economic impacts are for instance that infant mortality rates for a social class V, that of unskilled manual workers, are twice that for a boy born into the professional and management classes, a social class I. In the USA, race and ethnicity are major factors (Anonymous, 2006).
In order to address inequitable health outcomes one must get to the root cause of these outcomes. A common opinion is that socio-economic considerations are central yet little investigation is done in the US regarding the impact of these socio-economic factors but focuses on racial inequalities almost exclusively. This is in contrast to Europe, where health statistics have routinely included socioeconomic data. The net effect has been to remove from view – and from policy discourse-the pervasive patterning of US health disparities by socioeconomic position within and across racial/ethnic groups, as well as to retard understanding of the contribution of racial discrimination to US racial/ethnic health disparities (Krieger, 2005).
Another error that commonly occurs since the criteria for analysis of health outcomes depends on ethnic factors only, often to address this inadequacy categories of racial identifiers are used inexactly to model socio-economic factors that result in unequal health outcomes. The easy availability of “racial” identifiers in public health databases has led researchers to sometimes use “race” as a crude proxy for economic inequality (Williams, 1997).
It is clear that socioeconomic factors are not the only reason that minorities suffer greatly in the USA. New immigrants not familiar with the language, customs and religion may suffer a well. Language is always a big barrier and this is particularly true for older newly arrived immigrants. Practitioners not familiar with the ancestral cultures of new immigrants may not be able to provide the services they need.
For example Mexican families are extended families and decisions are made by the group and not by any individual such as the patient themselves. Also the male patriarch in the clan must be consulted in any matter that must be decided. In non-native speakers it is important to have an independent interpreter rather than having the patient’s children or grandchildren doing the interpreting. One reason for this is that those translating may hide the severity of the issue at hand to protect the feelings of the patient. Also if a child is involved then this will give them a position of authority something that may be resented by the clans extended family. These and other oversights may have unforeseen consequences for care.
Achieving Positive Health Outcomes
There must be sensitivity to racist behavior in society and institutional racism. Steps must be taken to address racism in society and ensure that an economic distribution of wealth exists to adequately fund excellent health care for all. It is not enough to see that different ethic groups are treated the same. This will only result in poverty being equally distributed among ethnic groups. Rather efforts must be made to recognize those things that hold people down and rob them of their social capital, and we must empower the poor of all ethnic groups and involve them in their own care.
A thorough self examination must be instituted by the practitioner to understand ones own biases so that one can understand how these biases effect interaction with others, especially other ethnic groups. Also an effort must be made to be sure health care facilities in all areas are able to provide support services to any population regardless of the economic stature of the supported area. Only with this infrastructure can all segments of a population be served. Only when these resources are available including preventive care, acute and chronic care, including healthy lifestyle classes can people’s health outcomes be improved.
Observations For Health Science Research
The US medical system has fallen into disarray. There is no doubt the health care in the USA is unparalleled in sophistication and the superiority of treatment. The problem lies in the fact that so many are not insured and therefore lack access to health care. The poor who have no insurance have largely been thrown to the wind. Without preventative care death rates are much higher. With preventative care much chronic disease can be prevented. Avoiding poverty can enable people to eat healthier diets rather than being dependent on the local burger stand.
In 1988, the Director General of the WHO was already concerned that, “public health has lost its original link to social justice, social change and social reform” (Hancock, 1999). Twenty years later, the lack of accountability by public health practitioners remains the same. Health promotion must recover its original role and challenge social inequalities in health (Ridde, 2007).
The object of this endeavor is not to evoke an ideology of a redistribution of wealth but that this endeavor is really is a question of science. The task will be to demonstrate an evidence-based way to reduce socioeconomic disparities and to show that this improves health outcomes (Gostin, 2004). The evidence of racial and ethnic disparities in health outcomes is overwhelming. Excess deaths and excess morbidity and disability are clearly prevalent among racial and ethnic minority elders (Johnson, 2002).
The average health status of members within every society on earth increases in a stepwise fashion as one ascends from the bottom of the social ladder (defined, variously, by income, education or occupation) to the top (Hertzman, 2001). Ultimately to address this problem justly commensurate health services must be made available to all.
References:
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