The disparities in health and health care arecomplex, with different distributions, consequences, and experiences amongdifferent sociological groups. Disparities in health care refer to the (unjust)differences in the access, quality, and health care coverage received bydifferent groups. Meanwhile, disparities in health refer to the (unjust)difference in the likelihood of illness, the experience of illness andmortality of those different groups. Society needs to be concerned about the growing healthand health care disparities for many reasons.
The most obvious one is a socialequity and justice perspective. The U.S. is the only industrialized nation thatdoes not guarantee healthcare to its citizens.
Everyone should have a right toaccessible, non-discriminatory and quality care. Another reason is that healthand health care disparities will limit the health and the quality of care forthe entire population and hinder improvements and expansions in health careoverall. Some important elements in gauging a health care system are access,equity, and health outcomes. Newacheck, Hung, Park, Brindis and Irwin (2003)studied and collected data about disparities in adolescent health and healthcare, which showed a strong correlation between socioeconomic status and accessand utilization of health care. Data showed that adolescents with lowsocioeconomic status had a low health status overall, with many lackinginsurance coverage and a source of primary care. This, in turn, is directlyassociated with lack of access, utilization, and continuity of care. Thebiggest factor contributing to health and health care disparities issocioeconomic status. The gap between high-income individuals and middle to lowincome with continues to widen and grow.
It is the widening of this gap thatincreases the importance of confronting health and health care disparities andthe issues that arise with them. To suggest more effective mechanisms to address andreduce health and healthcare disparities, the health behavior attributed to lowsocioeconomic status must be analyzed. Smoking, risky behaviors, and poor dietsare all associated with groups of low socioeconomic status. However, it needsto be emphasized that these behaviors result from, and do not necessarily causehealth and healthcare disparities.
In the U.S., there is an emphasis on anti-smoking,physical activity and diet as simple initiatives to promote health. However,these behaviors vastly differ from low to high socioeconomic status groups. Peoplewith low socioeconomic status often have low paying, high-stress jobs thatrequire extreme labor and long hours. This alone can put anyone in a verydisadvantaged position health-wise. The stress most likely also follows themhome due to struggling with finances and making ends meet, making their stresschronic, and turn to smoking as a way to cope.
In terms of physical activity and diet, that relatesin some way to finances and time. A low socioeconomic status definitelyprevents one’s ability to join gyms or purchase healthy, organic fruits andvegetables. America’s built and social environment strengthens the fast-foodindustry’s position as a manufacturer of illness. This highly saturated cheap, fastfood environment has become a contributing factor to unhealthy diets andobesity among individuals with low socioeconomic status. In general, the weak social and health position thatlow socioeconomic groups are put in decreases their motivation to excludeunhealthy behaviors from their lifestyle to improve their overall health.
Forexample, many manual workers have to deal with daily exposure to toxic substancesand perform daily extreme and strenuous labor, which are very likely to haveadverse long-term effects on health. Those same workers are not going to quitsmoking because regardless, they are exposed to toxic fumes daily. They alsoprobably are less likely to visit a doctor for their developed respiratoryproblem or back problem. They know that all the doctor is going to suggest isfor them to quit their physically demanding and dangerous job, which,obviously, is not going to happen. The amount of money and time that healthy behaviorsrequire is quite de-incentivizing.
Pampel, Krueger, and Patrick (2010) argue that”increased risks of premature death brought on by worse social conditions amonglow-SES persons make health behaviors less beneficial. Low-SES groups maybelieve they gain little in terms of longevity from healthy behavior and feelfatalistic about their ability to act in ways that extend their lives.” This disregard of long-term health costs alsomight explain why groups of low socioeconomic status do not really utilizehealth care resources until they are in critical condition. The high-stresslife, isolation, and marginality of groups with low socioeconomic status makesit hard for them to continue through with treatments, be consistent withmedication, and actively seek out preventative health care resources. Even though health and health care disparities in theU.
S. are well-documented and researched issues, they continue to persist andgrow, despite active efforts to eliminate them. In the U.S. many only considerthe patient, provider and health care system when assessing disparities.
However, social and environmental factors have to be increasingly taken intoaccount when assessing the social determinants of health, and the health caresystem’s ability to support the reduction in health and health caredisparities. Disparities in health andhealth care not only affect the individuals facing the disparities but theyalso restrict any attempts to enhance the overall access quality of care andhealth for the population as a whole. For many years, there has been an increasedawareness about these disparities and a focus on reducing them and expanding initiativesto address them at a societal, federal and state, provider and community level.The ACA has been an effective attempt to improve healthcare and reduce the growing disparities. With provisions like the exclusions ofpre-existing conditions and guaranteed issue, the ACA has really madehealthcare more accessible.
Although the ACA has in no way perfected the U.S.’shealth care system, the recent narrowing of its mandates is going to haveserious social health implications. With the gap between the upper and middleto low classes widening, it is becoming increasingly important to addressfactors that within, and ones that extend beyond the health care system. It is definitely communities and surroundings thatcontribute to behavior. According to Pampel, Krueger, and Patrick (2010),affluent communities are more likely to give access and provide the resources forhealthy behavior. For example, high-SES communities seem to be full of gyms,healthy restaurants, fresh produce markets and recreation and health facilitieswhile low-SES communities are saturated with fast food restaurants, tobacco andliquor stores, with little recreational facilities, supermarkets, or healthclinics.
Another disadvantage that low-socioeconomic groupsface is the lack of social networks. Low-socioeconomic groups face marginality andisolation, and therefore are excluded from the strong, tight-knit socialnetworks of high-socioeconomic groups. For example, a high-SES individual isgoing to find it easier to quit smoking because he/she will be about tosurround him/herself with non-smokers, go to therapy, ease the symptoms ofwithdrawal, etc. On the other hand, a low-SES individual will find it almostimpossible to quit due to the continuous high-stress of his/her lifestyle andthe lack of resources. The exclusion of low-SES groups from these socialnetworks further widens the disparities discussed and strengthens the influenceof unhealthy behavior among the groups. Across the U.S.
, there are community efforts thatemphasize a public health approach to reduce disparities. However, theseefforts need to expand to a national scale to reduce the toxic environmentaland social conditions that lead to these disparities. This expansion will alsoshift the nation to focus more on health promotions and offering effective,affordable and accessible preventative services instead of spending massiveamounts of its budget treating diseases that could have been easilypreventable. Communities in the U.
S. need to reach out to low-SES groups andintegrate them into society to further their opportunities and access toresources. Thisidea has always received a lot of attention and has always been supportedthroughout communities. However, this idea of social outreach, support andcohesion hasn’t really been expanded to a national level and effectivelyintegrated into our healthcare system. Changing America’s social and environmentalfactors and turning them into more positive determinants of health isdefinitely easier said than done. However, it is critical in closing the gapbetween health and health care disparities between groups with differentsocioeconomic status.