Disparities Among Racial and Ethnic Communities in the U.S.
Identify an example of an inequitable distribution of health in the region or Country of your choice. Discuss briefly, how public health has explained this health inequity in the past? Then use a current public health model to show how this health inequity is produced and understood today.
Health inequities have persisted from time to time in the United States of America, with the most outstanding health inequities being based on ethnicity or race and the socio-economic status of individuals. This paper is aimed at discussing how the public health system in the United States has explained racial based health distribution inequalities. Further a current public health model is applied to show how this health inequity is produced and understood today. Finally, a conclusion is drawn based on the discussions and the key points obtained from the discussion that outlines the areas that could be improved to help reduce ethnic-based health inequities.
“There are continuing disparities in the burden of illness and death experienced by African Americans, Hispanic Americans, Asian/ Pacific Islanders, and American Indians/ Alaska natives, as compared to the U.S. population as a whole,” as indicated in Bryant, Raphael & Rioux, 2010. Pg. 222. These racial/ ethnic disparities exist in aspects of life expectancy, infant mortality and other health status indicators. According to Bim, Pillay & Holtz (2009), the infant mortality rate among the African- Americans is more than twice that of the population of European descent. Moreover, the death rate from chronic health conditions, such as heart disease, lung, and colorectal cancer, is also higher among African-Americans than the population as a whole.
There is substantial evidence that the minority ethnic communities are more often than not disadvantaged on various indicators of health across the different geographical regions, including the United States (Gerrish & Lathlean, 2015. Pg. 58). Different classes of statistics can be used to elaborate the racial or ethnic inequities within the United States system of health. As outlined in Americanprogress.org (2016), the racial health inequities among the different ethnic groups living in the United States of America. Covering such key inequity factors as; health coverage, chronic health conditions, and leading causes of death, based on data from the American health system between the years 2005-2007.
An analysis of the key inequity aspects of the different ethnic communities is as follows:
African Americans/ Blacks
Health coverage- 79% of African Americans had health coverage in 2009 compared to the Americans who had 88% health coverage. Also, 16.6% of the Blacks aged 18 years and above have no usual source of health care while close to half (46%) of the nonelderly black adults without insurance report have one or more chronic health conditions.
African Americans/Blacks
Chronic health conditions-13% of this group of people report having poor health; adult obesity rates are higher compared to those for the whites at 37% of men and 50% of women among the African Americans being obese; higher hypertension and heart disease rates also exhibited among the blacks. 15% and 8% for the blacks and the whites respectively, having diabetes. Additionally, asthma prevalence among the blacks is also highest, with black children having 260% emergency department visit rate, 250% hospitalization rate and 500% death rate due to asthma attacks compared to other races. Furthermore, the incidences and mortality rates, from cancer that could otherwise be earlier diagnosed and treated, are higher among the blacks.
Leading cause of death- the leading cause of death among the African Americans are heart diseases, cancer, and stroke. Infant deaths stand at 13.24% per 1000 live births among the blacks.
Hispanics
Health coverage- 68% had insurance coverage as by 2009 compared to 88% of White Americans, while 35% nonelderly Hispanics who are not insured report having chronic health conditions, nearly one third of them lacking regular health care whereas 46% of those uninsured among this group experiencing chronic health conditions without access to regular health care.
Chronic health conditions- those who report having poor health conditions among this group of people is 10%. Obesity rates among those aged 20 years and above was 37.9% compared to the total population in 2008, with women having higher obesity rates, 43%, compared to men, 34.3%. Moreover, the rate of diabetes diagnosis stands at 14% for the Hispanics compared to 8% for the whites. Their rate of contracting cervical cancer is twice that of the women. Furthermore, language barrier hinders one in every five Latinos from seeking medical care.
Leading causes of death- among this group, heart disease, cancer, and accidents are the leading causes of death. They have longer life spans compared to other Americans and lower infant mortality rates; 5.52% infant deaths in every 1000 live births.
Native Hawaiian/ other Pacific Islander
Health coverage- between the years 2005-2007, about 80% of this racial group had insurance coverage.
Chronic health conditions- 8% of this racial group report of having poor health conditions. They exhibit higher smoking, alcohol consumption, and obesity rates compared to other ethnic groups and lower access to cancer prevention and control programs. Diabetes rate was twice that of the whites. Likelihood of death from diabetes is more than 5.7 times as likely as white. The probability of being diagnosed with cancer is 30% compared to whites.
Hispanics
Leading causes of death- cancer, heart disease, accidents, stroke, and diabetes are the leading death causes among this ethnic group. Infant mortality rate is 9.6% per 100 live births. This is 1.7 times higher than that of non-Hispanic whites.
American Indians and Alaskan Natives
Health coverage- 68% of those fewer than 65 years of age had health insurance in the period between the years 2005 to 2007.
Chronic health conditions- they exhibit higher overweight and obesity prevalence in preschoolers, school-aged children, and adults. 31% and 26% of men and women respectively, in this group aged 18 years and above smoke. In this racial group, adults generally have 60% likelihood of having a stroke than their white adult fellows.
Leading causes of death- heart disease, accidents, suicide, and accidents. The youths experience more mental health problems including anxiety, substance abuse, and depression. Infant death rates per 1000 live births are 8.28%
Asian American
Health coverage- nearly 82% of Asian Americans had insurance coverage in 2009, as compared to 88% of white Americans.
Chronic health conditions- the people who report having poor health conditions is 8%. They do not experience obesity problem. The rate of cervical cancer exposure among the Vietnamese- American women is five times that of white women.
Heart disease, stroke and cancer often cause leading causes of death- deaths in this racial group. The rate of committing suicide is highest among the Asian- American women compared to all other women above 65years of age in the United States.
There are various factors that affect racial disparities in health distribution. On this ground, the public health had in the past provided different explanations to racial inequity in health distribution. It is notable that, the past explanations of public health, with regards to racial disparities of health distribution in the United States, point to economic, social and environmental exposure, such as income levels, lifestyle choices, occupational, employment status, educational factors, nutrition, cultural beliefs and housing, as indicated in Rothstein, 2003. Pg. 271-272. According to Morgan & Bhugra (2010), social selection factors contend that genes affect health. This explanation is contradicted by the fact that “disease-related genes cannot have changed so rapidly in a uniformly positive direction as to have created enormous improvements in population health, as realized in the United States,” (Morgan & Bhugra, 2010. Pg. 183).
The second explanation relates to the accessibility of health care, specifically relating to discrepancies existing both in public and private insurance, or health services obtained from the public health providers. Furthermore, other explanations entail discouragement of health providers from participating programs of medical assistance on which many other races depend on for their care, as a result of low reimbursement payments and administrative burdens. Additionally, yet other explanations explain lack of trust in the medical care and these other races not being familiar with resources, thus preventing these minorities from seeking early intervention and treatment.
Native Hawaiian/Other Pacific Islander
On the other hand, a current public health model can be applied to show how racial/ ethnic health inequities are produced and understood today. Laveist & Isaac, 2013, explain that there are recent explanations on the racial or ethnic inequities in health distribution, with the most recent public health models, when applied on racial disparities in health distribution, results into an explanation that constitutes certain factors that are seen today, to produce ethnic inequities. These include health system structure (that leads to disparate resources and services levels); biases of the health provider, either knowingly or unknowingly)- this is initiated at the national, local or state levels then perpetuated through policy practice and service provision levels (Rothstein, 2003). Some of the most important factors considered to produce ethnic health inequities in the United States are discussed below:
Health status of communities of colour
Despite having higher rates of chronic diseases infection such as heart disease, cancer, and diabetes compared to the whites, the race of colour is not likely to receive specialized technology treatment. Moreover, do not receive an early diagnosis of risk health conditions such as cancer, whose treatment and management depend on the early diagnosis. Moreover, most of the people from these races, such as the Hispanics and the African Americans have higher infant motility rates. This is as a result of lack of specialized maternal care and child care services. This explains the higher rates of chronic diseases prevalence and infant motility rates among these communities of colour.
Access to Health Care
Most of the individuals from communities of colour are uninsured compared to the whites Such insurance as Medicaid, does not cover Hispanic and African American children are not eligible to because of their immigrant status and fear of their parents to apply for these services (Gerrish, & Lathlean, 2015). Other families are not covered following that they work in small businesses or are self-employed. Most of these communities also get access to inadequate care, provided by community health centres and public hospitals. This further explains the inequity in health distribution.
Disparities in Treatment
It is clear, through the several studies findings that, even for those communities of colour members who are able to access healthcare, there are inequities in treatments based on ethnicity and colour. These people would be accorded cheaper treatment compared to their white counterparts. Rothstein, (2003. Pg. 277) highlights that; “African American patients are often assumed to be less likely to survive invasive medical procedures and less likely to respond to the standard course of treatment because of biological differences.” These people are moreover perceived to have less compliance with the medical procedures; very likely to engage in risky behaviours; possess less social support and be very harsh and have low intelligence levels. They are also believed to find it very hard to understand their medical conditions and regimens (Gerrish & Lathlean, 2015).
American Indians and Alaskan Natives
Culturally and Linguistically Appropriate Healthcare
Most healthcare organizations in the United States find it very difficult to incorporate culturally competent health care in their systems. They seem not to be aware of the importance of culturally competent health care. Whereas culturally competent health care helps to ensure good communication, trust and desired outcomes from the health care provision process, lack of this important element negatively impacts on the communities of colour. Due to language barriers, some people are not able to visit the hospitals to seek treatments (Laveist & Isaac, 2013).
Environment factors
Poor housing and environmental conditions, expose these communities to air pollution, asbestos, lead and other toxins from the minority themselves and low-income neighbourhoods. This possesses significant health risks to their lives. These people are also the most employed in jobs that have higher physical and psychological risks such as garment industry and factories, thus exposing them to stress due to the nature of their jobs.
The Impact of disparities in care treatment with pharmacogenomics-based drugs
Unequal treatment based on race or ethnicity results in biased decision rules for prescribing medication to the communities of colour (Ansell, 2017). For instance, the five possible situations with regards to pharmacogenomics: failing to prescribe to the patient any drug; offering the patient traditional medication, assuming that the pharmacogenomics drugs will be very expensive that they cannot afford; giving the patient a pharmacogenomics drug will lead to him continuously buying that drug from the market without genetically test based prescription, this could lead to adverse reaction; giving the patient a pharmacogenomics drug without education the necessary education or counseling about the drug; and prescribing the blacks pharmacogenomics drugs that are best suitable for the whites since they can afford them (Morgan, & Bhugra, 2010).
Conclusion
A number of factors, environmental, social, cultural and economic, contribute towards creating health inequity. However, it is undeniable that the government also contributes towards creating racial based health iniquities. The neoliberal government and international organizations’ policies have widened the economic gap between the rich and the poor, thus creating ethnicity-based health inequities (Murray, 2014).
Good health for everyone is an aspiration for every country, as it is one of the economic pillars of development. However, this is not the case with the U.S.A. and many other European countries, where a series of racial health inequities manifest themselves now and then. Ethnicity or race-based health inequity is a major flaw in the health care system of this noble nation, the United States of America. It is observable that the colour communities are greatly disadvantaged by the unequal treatment accorded to them by the health care system in this country. This calls for government intervention to improve the situation. It will be possible to achieve greater impacts on health outcomes for the minority ethnic communities if the country positively addresses the issue of ethnic inequities in health distribution. This can be done through developing and implementing policies and strategies that aim at attaining equitable health system for all, at every point where inequity in the health system is observed. For instance, “If it is access to resources that are at the root of health iniquities, then a more effective strategy to eliminate health disparities would be an equal distribution of resources that can be used to achieve health,” (Murray, 2014. Pg. 97).
References
Americanprogress.org. (2016). Available at https://www.americanprogress.org/issues/healthcare/news/2010/12/16/fact-sheet-health-disparities-by-race-and-ethnicity/ accessed on 20th May 2018.
ANSELL, D.A. (2017) The death gap: how inequality kills. University of Chicago Press.
BIM, A. E., PILLAY, Y. & HOLTZ, T. H. (2009) Textbook of International Health: Global Health in a Dynamic World, 3rd Edition. Oxford University Press.
BRYANT, T., RAPHAEL, D. & RIOUX, M. (2010) Staying alive: critical perspectives on health, illness, and health care. Canadian Scholars’ Press.
GERRISH, K., & LATHLEAN, J. (2015) Research process in nursing. Available at https://ebookcentral.proquest.com/lib/usherbrookemgh-ebooks/detail.action?docID=1936761. Accessed on 20th May 2018.
LAVEIST, T. A., & ISAAC, L.A. (2013) Race, ethnicity, and health: a public health reader. San Francisco, Jossey- Bass. Available at https://public.eblib.com/choice/publicfullrecord.aspx?p=875789 accessed on 20th May 2018.
MORGAN, C. & BHUGRA, D. (2010) Principles of Social Psychiatry. Hoboken, Wiley.
MURRAY, M. (2014) Critical health psychology. Macmillan International Higher Education. Available at https://nls.ldls.org.uk/welcome.html?ark:/81055/vdc_100045068488.0x000001. Accessed on 20th May 2018.
ROTHSTEIN, M.A. (2003) Pharmacogenomics: social, ethical and clinical dimensions. Available at https://public-eblib.com/choice/publicfullrecord.aspx?p=469849 [accessed on 20th may 2018].
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