Initial Post (For context)
Using 500 to 750 words, address the following prompts:
Why are there racial and ethnic disparities in health in the United States?
What are two policies to improve health equity in the United States? Make clear if these policies are adopted, proposed, or ones you would recommend.
Replies (This assignment)
Reply to at two of your classmates. Each of your reply posts should be 200 to 400 words. You should cite one to two sources that add new information in response to your classmate’s post, with at least one of the sources from the Week 3 Learning Materials.
This week’s sources:
Derose, K., Gresenz, C., & Ringel, J. (2011).Understanding disparities in health care access.
You cannot get to the full article in Health Affairs to this reading. However, if you sign in and cut and paste the following into the search engine on the Regis College library website, after a few clicks to the FULL TEXT you will get to the full text article: Derose, K., Gresenz, C., Ringel, J. (2011). Understanding Disparities in Health Care Access.
Hayes, S., Riley, P., & Radley, D. (24 August, 2017). Reducing racial and ethnic disparities in access to care. Has the Affordable Care Act made a difference? The Commonwealth Fund.
Munoz, P., Kim, M., & Chang, M. (2015). The color of wealth in Boston.
Ndugga, N., & Artiga, S. (2021, May 11). Disparities in health and health care: 5 key questions and answers. Kaiser Family Foundation.
Robert Wood Johnson Foundation. (May 1, 2017). What is health equity?
Seervai, S. (2022, June 3). A strong public health system depends on making the invisible visible (26:36 minutes). [Audio podcast]. The Commonwealth Fund.
A transcript for this podcast is available on the site.
Classmate 1:Health equity is something that every nation strives for, yet few achieve it. Unfortunately, the United States has some of the worst health outcomes while spending the most on healthcare per capita. There are many factors involved when looking at racial and ethnic disparities in health. Our nation was born under colonialism and racism; we discriminated against American Indians and enslaved African Americans until the end of the Civil War. There is an underlying structural racism that has yet to be dealt with. In addition to this, many decades of policy decisions at the local, state, and federal level has created economic suppression, unequal access to education, and residential segregation.
Health care disparities are the differences in health and health care between groups that began with broader inequities (Ndugga & Artiga, 2023). Health disparities are driven by economic and social inequalities. Health outcomes include those factors as well as genetics, health behaviors, and access to care. A person’s choice to use health services includes many facets including demographics, whether they have health insurance, their health beliefs, income, and illness level (Derose et al., 2011). There are other factors that are specific to underserved populations including the homeless, rural populations, immigrants, migrant workers, and American Indians. Disparities occur across socioeconomic status, age, geography, language, gender, disability status, citizenship status, and sexual identity and orientation. Research also suggests that disparities occur across the life course, from birth, through mid-life, and among older adults (Ndugga & Artiga, 2023).
The passage of the ACA helped reduce some of the healthcare disparities by increasing coverage for many, but the people of color and other marginalized groups are still most likely to be uninsured. There have been policies implemented to improve health equity in recent years especially during and after the pandemic. The Office of Climate Change and Health Equity started the UNITE Initiative to address structural racism and racial inequities in biomedical research (Ndugga & Artiga, 2023). This will help improve funding for research projects that will help improve the health outcomes of minority ethnic groups. The current administration has been taking steps to address the Maternal Health Crisis which includes high rates of maternal mortality and morbidity among Black people. One action was to extend Medicaid coverage of postpartum care from sixty days to twelve months; the other was the Human Resources and Services Administration announcing $12 million in awards for the Rural Maternal and Obstetrics Management Strategies Program (RMOMS), which is designed to develop models and implement strategies to improve maternal health in rural communities (Ndugga & Artiga, 2023).
References
Derose, K., Gresenz, C., & Ringel, J. (2011). Understanding Disparities In Health Care Access–And Reducing Them–Through A Focus On Public Health. Health Affairs, 30(10). https://doi.org/10.1377/hlthaff.2011.0644
Ndugga, N., & Artiga, S. (2023). Disparities in Health and Health Care: 5 Key Questions and Answers. KFF. Retrieved May 15, 2024, from https://www.kff.org/racial-equity-and- health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question- and-answers/
Shi, L., & Singh, D. (2021). Delivering Health Care in America: A Systems approach. Jones & Bartlett Learning.
Classmate 2:Racial and ethnic disparities within the United States are still prevalent today, and unfortunately, these are characteristics that predispose populations to vulnerability (Shi & Singh, 2021). It is shown that races and ethnicities such as African American and Hispanics overall tend to have a lower quality of health, care, access and lower insurance coverage (Kumar & Encinosa, 2021). This is due to preexisting problems within the Unites States, as both structural and interpersonal racism are shown to be causes of health inequities, disparities and disease (Centers for Disease Control and Prevention, 2023). These populations are at higher risk for prejudices and racism, affecting their social determinants of health and ultimately impacting their health in a negative manner (Mass.gov, 2024).
In order to counteract this, Massachusetts developed a team, called the Health Policy Commission or HPC, that assesses health care spending growth and provides policy recommendations to ensure equitable health through independent policies (Mass.gov, 2024). One policy they have proposed is the reduction of health care disparities using four principles – research and report, convene, partner, and market monitor (Mass.gov, 2024). For research and report, the HPC’s goal is to find data that highlights areas of inequality and ensure that they are brought to attention. Convening focuses on hosting or attending events to raise awareness and further discuss inequalities found through their research. They then attempt to partner with other programs who also have the drive to fix our health care system to limit inequalities by developing standards of care. Finally, they market monitor, or review market changes and their impact on access and equity (Mass.gov, 2024).
Health care systems are in place to target health disparities and ensure health care is being provided equally, however when looking at the bigger picture, equity needs to take place externally as well (Shi & Singh, 2021). This brings us back to the social determinants of health. The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) understands that approaching health care as a “one-size-fits-all” does not promote equal care but can actually widen disparities (Centers for Disease Control and Prevention, 2022). To counteract this, they focus on health equity approaches to prevent and manage chronic disease. They are doing so by addressing social determinants of health that can ultimately lead to poor health, such as those living in poverty, unsafe or unhealth environments, lack of food security, and limited access to education or careers that pay livable wages (Centers for Disease Control and Prevention, 2022). From there, they are creating partnerships throughout society whether it be individually or through communities and organizations. Health care should be equal and accessible by all, regardless of a person’s ethnicity or race. Policies can be proposed and put in place by many to ensure good health becomes more equitable, and these two examples given are only the start of change that has been proposed thus far.
References:
Centers for Disease Control and Prevention. (2022, December 8). NCCDPHP’s approach to Advancing Health Equity. Centers for Disease Control and Prevention. https://www.cdc.gov/health-equity-chronic-disease/nccdphps-approach-to-health-equity.html
Centers for Disease Control and Prevention. (2023, August 16). Impact of racism on our nation’s health. Centers for Disease Control and Prevention. https://www.cdc.gov/minorityhealth/racism-disparities/impact-of-racism.html
Health equity. Mass.gov. (2024). https://www.mass.gov/info-details/health-equity
Kumar, V., & Encinosa, W. (2021). Racial disparities in the perceived risk of covid-19 and in getting needed medical care. Journal of Racial and Ethnic Health Disparities, 10(1), 4–13. https://doi.org/10.1007/s40615-021-01191-5
Shi, L., & Singh, D. A. (2021). Delivering Health Care in America: A Systems Approach (8th ed.). Jones & Bartlett Learning. https://ecampus.vitalsource.com/books/9781284249484
