DNP 835 Topic 3 DQ 1 Describe two causes of health disparities in the United States, or in your local community, that lead to health inequity
DNP 835 Topic 3 DQ 1 Describe two causes of health disparities in the United States, or in your local community, that lead to health inequity
Topic 3 DQ 1
Reflecting on the “IHI Module TA 102: Improving Health Equity,” describe two causes of health disparities in the United States, or in your local community, that lead to health inequity. What ethical issues inhibit access and quality for care for these issues? Outline an initiative, integrating your faith and ethical principles surrounding practice, to reduce these health inequities and sustain the change within the health care system.
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Discussion Questions (DQ)
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One key element of the sustainable development goals is achieving universal health coverage by 2030. It means that all and sundry can access health services at their convenience, without financial constraints. However, this remains a fantasy, with only seven years remaining to evaluate the goals (Frisina et al., 2022). Thousands of people succumb daily to minor ailments as they cannot receive health services due to financial constraints or other social hindrances. Ironically, health is a right, yet only a handful of citizens in the United States can afford healthcare services. Despite the government’s efforts to boost health services by viding social insurance schemes, there are still significant barriers to achieving universal health.
Racism is a paramount factor contributing to the health disparities in America. The COVID-19 pandemic unmasked this in several ways. For instance, people of color, blacks, and Hispanics live in informal settlements that potentiate the rapid spread of communicable illnesses (Frisina et al., 2022). They lack white-collar jobs because they are stereotyped as criminals, and even the education system is biased. Multiple reports about racism towards black children in schools are unprecedented. Therefore, these cohorts are deprived of better education and jobs, which significantly contribute to health and well-being. Additionally, they are perceived to be the “carriers” of the infection and therefore shy away from seeking timely medical attention.
Poverty also contributes to health disparities in America. The saying that health is wealth is a misnomer, and the converse seems true. Without wealth, then health remains to be a mere dream in America. Despite having Medicare, and Medicaid insurance schemes, poor individuals with chronic illnesses remain the victims of fate (Cromer et al., 2019). These schemes do not cover certain services, so people have to pay for them upfront. Additionally, the poor immigrants who come to America for greener pastures end up in misery since they are not privileged to these insurance plans. Poverty also predisposes them to lifestyle diseases since the poor cannot afford a healthy diet and eat fast foods to sustain their daily energy requirements.
In conclusion, racism and poverty are significant contributors to health disparities in America and hinder achieving the 2030 goal of universal health. People of color, blacks, and Hispanics mainly encounter these challenges. Therefore, mitigating them requires multidisciplinary efforts from the government, non-governmental organizations, healthcare workers, and citizens.
Cromer, K. J., Wofford, L., & Wyant, D. K. (2019). Barriers to healthcare access facing American Indians and Alaska Natives in rural America. Journal of community health nursing, 36(4), 165–187. https://doi.org/10.1080/07370016.2019.1665320
Frisina Doetter, L., Frisina, P. G., & Preuß, B. (2022). Pandemic Meets Endemic: The Role of Social Inequalities and Failing Public Health Policies as Drivers of Disparities in COVID-19 Mortality among White, Black, and Hispanic Communities in the United States of America. International Journal of Environmental Research and Public Health, 19(22), 14961. https://doi.org/10.3390/ijerph19221496
. You bring to the discussion some important factors associated health disparities. A few I would like to expound upon. The issue of free health care or universal health care by 2030 is a pipe dream because the burden of cost distributed across populations. Who will pay for this healthcare? Currently, the he seasonally adjusted U-6 real unemployment rate from the Bureau of Labor Statistics for December 2022 was 6.5%, but often this figure is not reported because it is not popular. The more comprehensive U-6 rate, often called the real unemployment rate, is an alternative measure of unemployment that includes groups such as discouraged workers who stopped looking for a new job and the underemployed who work part-time because they are unable to find full-time employment.
With respect to current health insurance statistics, since the enactment of the Affordable Care Act (ACA), number of uninsured individuals remains well below pre-ACA levels (Tolbert et al., 2022). The uninsured rate declined throughout 2021 and early 2022 and reached a historic low of 8.0%with 5.2 million people who gained coverage since 2020 (Lee et al., 2022). Moreover, Chen et al.(2022) finds that enrollment in Marketplace coverage for all racial and ethnic groups increased from 2020 to 2022, with the largest increases in enrollment number among Black (49%) and Latino enrollees (53%). Finally, Mykyta et al. (2022) report that between 2020 and 2021, uninsured rate among children decreased 0.6 percentage points to 5.0%.
In summary of the most current data that I can cull, the percentage of US citizens who are insured has greatly improved over the last 13 years.
Another thought based on a statement you made about the link between wealth and health, I have learned over the last 3 years about the American financial system and the dollar. First, the current US debt is over $31 trillion dollars, but our monetary system is fiat currency or paper money and the US Federal Reserve is not a federal agency but a private organization through which the banking systems have been centralized. There are concerns that the dollar, in its “fiat” state will not survive much longer because the US dollar is not backed by anything of value like gold or silver like it used to be in 1971 at which time Pres. Nixon removed the US dollar off the gold standard.
You can learn more about this with research: https://www.federalreservehistory.org/essays/gold-convertibility-ends
The point of all of this together is to lead to the World Economic Forum’s Agenda 2030. Curiously the WEF was established in 1971 by Klaus Schawb, as a not-for-profit foundation whose headquartered in Geneva, Switzerland, the same year Nixon took the US dollar off the gold standard. In 2016, Schwab unveiled his everyone will own nothing and be happy by the year 2030 speech. In 2020, we heard all about “The Great Reset.” Now, the WEF’s Agenda 2030’s 8 predictions include :
- All products will have become services.“I don’t own anything. I don’t own a car. I don’t own a house. I don’t own any appliances or any clothes…inhabitants borrow what they need on demand…” Moreover, if everyone will rent everything from homes to furniture, computers to clothes, there will still be some owners of these goods and services.
- 4. Farewell hospital, hello home-spital. Technology will have further disrupted disease, writes Melanie Walker, a medical doctor and World Bank advisor. The hospital as we know it will be on its way out, with fewer accidents thanks to self-driving cars and great strides in preventive and personalised medicine. Scalpels and organ donors are out, tiny robotic tubes and bio-printed organs are in.
As I consider the current inequities among minority populations and health disparities in the United States, the moral and ethical duty for those of us who have a Christian worldview understand that the love of Christ supersedes everything and should dominate our decisions, behaviors, and professional practice. However, to move into the the direction of the WEF negates the freedoms of human beings to enjoy life and eventually impact our ability to worship and practice our religion. I cannot envision how a group of powerful men and some women can become the ethical and moral directors of the lives of people around the world.
What are your thoughts?
Health disparities and social determinants of health are multifaceted problems ranging from income to behaviors (American Academy of Family Physicians, 2023). As a child growing up in one of the poorest neighborhoods in Fort Worth, I can truly understand the outcomes of health inequities. Insights on environmental threats, poverty, education, behavior and access to health care are a few of the many problems affecting disparities. In this case, I have chosen to focus on poverty and environmental factors as these are the basic needs and according to Maslow unless they are met it is impossible to reach any other level (American Academy of Family Physicians, 2023).
Poverty is a cyclic process often passed from one generation to the other. Families living in poverty often lack resources others take for granted. For example upper and middle class citizens may never understand having insufficient food or being hungry (Center on Budget and Policy Priorities, 2022). Perhaps the idea of having utilities disconnected for lack of payment is unfathomable however, these events happened often in my neighborhood. In this case cheap food such as canned vegetables and processed meats were provided. These foods lacked essential nutrients and were high in fat, salt and sugar all of which increased the probability of chronic illnesses. In addition, lower education levels and lack of transportation also decreased the probability of receiving necessary medical care (Center on Budget and Policy Priorities, 2022). The lack of resources to provide necessities means that instead of paying for the dentist or a check up, the basic needs are met. Thus substantiation of Maslow’s Hierarchy of Needs.
Initiatives to assist the poverty related inequalities include (Center on Budget and Policy Priorities, 2022):
Supplemental Security Income (SSI) for the elderly and disabled (in 1974)
Supplemental Nutrition Assistance Program (made nationwide in 1974)
Earned Income Tax Credit or EITC (in 1975) and Child Tax Credit (in 1997),
Subpar or insufficient environmental determinants of health negatively “influence human health, including physical, chemical, and biological factors external to a person, and all related behaviors.” Health threats to the environment can occur naturally or due to social conditions (Environmental Determinants of Health, 2023). For example, living in areas with high crime rates increases the probability of mental and physical trauma. In addition, urban areas are often surrounded by liquor stores but do not have grocery stores supplying fresh food and vegetables. Global aspects of environmental health disparities include “hazardous chemical risks, such as exposure to toxic pesticides, lead, and mercury tend to disproportionately impact children and pregnant women (Environmental Determinants of Health, 2023).” Finally when considering rural areas having disproportionately lower medical doctors including specialist people living in rural areas have poorer chronic disease outcomes ([email protected], 2023).
Initiatives to address environment include UNTs Safe Care Texas ([email protected], 2023):
Telemedicine program partners with libraries to provide virtual health visits to improve access to health care in rural or underserved communities/
Community Health Workers: Provides free training to people 16 or older on communication and mitigation strategies to assist their community in making informed decisions about their health and wellbeing.
For someone that has never experienced a disparity truly understanding the bleakness of the situation may be difficult however, most people enter healthcare because they want to make a difference. They choose this field because they care, however, we need this social and health outcome justice advocacy to become the new normal.
American Academy of Family Physicians. (2023). Poverty and Health – The Family Medicine Perspective. https://www.aafp.org/about/policies/all/poverty-health.html
Center on Budget and Policy Priorities. (2022). The Nation Has Made Progress Against Poverty But Policy Advances Are Needed to Reduce Still-High Hardship. https://www.cbpp.org/research/poverty-and-inequality/the-nation-has-made-progress-against-poverty-but-policy-advances#:~:text=Government’s%20increasingly%20effective%20role%20in,Credit%20or%20EITC%20(in%201975)
Environmental Determinants of Health. (2023). Environmental determinants of health. PAHO/WHO | Pan American Health Organization. https://www.paho.org/en/topics/environmental-determinants-health
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