Why do Disparities in Health Care Exist Among US Citizens

Causes of Health Care Disparities in the USA

Introduction

Health care is a very important aspect of every society . The obvious benefits from a quality health care is the improvement of the quality of life (QOL ) of the citizens as there is lower possibility of having diseases and diseases are easily cured resulting to lower morbidity and mortality rate , and longer life expectancy . However , inequality or disparity in health care exists in almost every nation . In the USA for instance , health care disparities exist as shown in the report of the

National Academy of Science 's Institute of Medicine entitled 'Unequal treatment : Confronting Racial and Ethnic Disparities in Health Care . In the said report , it was found out that blacks ,and in some cases Hispanics , have been deprived of medical care that most whites take for granted , including routine medical procedures that prolong life and improve its quality minorities are also less likely than whites to receive proper heart-disease medication , bypass surgery , dialysis kidney transplantation , maternal and child health services , mental health and intensive care (Sternberg , 2002 There are also wide life expectancy gaps among the citizens in the USA Between the years 1997 and 2001 , life expectancy in the United States ranged from 86 .7 for Asian females to 68 .7 for black males the life expectancy between males in South Dakota and females in Minnesota has a gap of 22 .5 years and the gap between the Native American males in various counties in South Dakota and the Asian females in Bergen County New Jersey is 33 years (Murray et al , 2006 ,

. 0002 These findings reflect that disparities in health care do exist across the country . The findings also reflect the possible reasons behind the existence of disparities in the health care . Generally , inequality in the health context can be unequal quality of health care and /or unequal access to health care services . This then aims to investigate on the causes of health inequalities among the US citizens

Population Diversity and Health Care

Diversity in population is generally the variations of race , ethnicity gender , nationality , culture , lifestyle and socioeconomic position of people in a country . Various studies (see Satcher , 1999 Navarro , 1990 Mutchler Burr , 1991 ) pointed to race and socioeconomic status as the main culprit of health care disparities in the USA . Socioeconomic status which is characterized by income , literacy , and social class is closely related to race (Navarro , 1990 on Fiscella et al , 2000 ,

.2580 . That is , more people who belong to the minority groups also belong to the lower class , with lower income and lower level of education

In the United States , according to Fiscella et al (2000 ,

.2579 lower socioeconomic status is associated with lower overall health care use , even among those with health insurance . The obvious reason for this is that people with lower socioeconomic position cannot afford for high quality health care thus they cannot receive various medical tests and health care services such as ambulatory and intensive hospital care , surgery , prenatal care , cardiovascular procedures , kidney transplants and other important health care . For instance , Latinas receive less prenatal care and fewer cardiovascular procedures Asian Americans receive fewer influenza vaccinations Native Americans receive less prenatal care and elderly blacks receive lesser care from specialists compared to whites (Fiscella et al , 2000 , pp . 2579-2580

Aside from having lower income , cultural , language and communication barriers also cause disparities . Culture is shaped by race , ethnicity nationality , language and socioeconomic status (Betancourt et al , 2002 br

.1 ) and varies from person to person thus there is a great possibility that cultural differences among the patients and health care providers exists in country with a diverse population like the US . These cultural differences sometimes lead to miscommunication Miscommunication often results to poor adherence or conflicts to treatment , misunderstandings mistrust , dissatisfaction and poor diagnosis . In the mental health care for example , communication between the patient and the physician is very significant that when there is communication barrier between them , which may be due to cultural differences or language difference , the root cause of the patient 's illness will not be known and the illness may not be diagnosed easily . Miscommunication also happen due to conflicting health beliefs and lack of proper knowledge about health care and treatments . Additionally , the attitude and preferences of patients are shaped by culture which often result to conflicts . For example , African Americans do not agree with the acceptance of death and palliative care and are reluctant to withdrawing life-prolonging therapy and organ donation which raise conflicts between the physicians and patient or patient 's family (Cort , 2004 ,

. 64 Cultural mistrust , which is the mistrust of minorities to white Americans and to the American systems such as the criminal justice and health care systems (Cort , 2004 ,

. 65 ) also causes health care disparities . The fear of racism , discrimination and unfriendly treatment that they may encounter in dealing with health care providers cause such cultural mistrust and serve as the hindrance to seeking health care . The US health care system is dominated by white Americans (Cort , 2004 ,

br 66 ) and lack of diversity in the health care workforce and leadership is cited as one of the potential barrier to care because in general minority health care providers are more likely to understand and take into account cultural issues associated with providing health care including cultural mistrust (Betancourt et al , 2002 ,

. 3-4

The diversity of population also resulted to complex health care needs Due to its complexity , the health care system has been regarded to be poorly designed and responsive to the the varying needs of patients of different socioeconomic status and ethnicity (Betancourt et al , 2002 ,

br 4 . Typically , a health care system is composed of facilities , health care providers , health education , policies and regulations . This system can be considered to be not responsive to a diverse population when not all citizens cannot be able to use or access a facility , are provided by health education , and policies and regulations are bias or unfair for some individuals . For instance , most African American do not have a regular physician while hospice philosophy does not take into consideration the beliefs of African Americans thus African Americans are underrepresented in the hospice patient population along with other minorities (Cort , 2004 ,

.63

Geographic location is also an underlying cause of health disparities usually among those who live in the urban areas and those in the rural areas . In the 1999 Access to Care s of the Medicare Current Beneficiary Survey , it was found out that Medicare beneficiaries living in rural counties have more difficulty going to doctors and hospitals and are lacking of health care resources (e .g . drugstores ) compared to the beneficiaries in the urban areas (MedPAC , 2001 . From this , it can be viewed that health disparities exist between individuals who can easily access a health care facility and those who live farther from physicians and hospitals . Although there are community hospitals hospitals in the urban area are usually more advanced in terms of services and facilities

Conclusion

Based on various earlier studies , health care disparities exist among the US citizens due to population diversity . Diversity in population is characterized by the differences in culture , socioeconomic status language , and physical locations . Health care disparities are mostly felt and experienced by the minority groups as their characteristics are different from the majority of the US population

References

Betancourt , J , Green , A Carillo , J (2002 ) Cultural Competence in Health Care

Emerging Frameworks and Practical Approaches , Field Report : The Commonwealth

Fund , Retrieved online on April 15 , 2007

HYPERLINK "http /www .cmwf .org /usr_doc /betancourt_culturalcompetence_576 .pdf http /www .cmwf .org /usr_doc /betancourt_culturalcompetence_576 .pdf

Cort , M (2004 ) Cultural Mistrust and Use of Hospice Care : Challenges and Remedies

Journal of Palliative Medicine 7 (1 : 63-71

Fiscella , K , Franks ,

, Gold , M Clancy , C (2000 ) Inequality in Quality

Addressing Socioeconomic , Racial and Ethnic Disparities in Health Care , JAMA 283 (19 : 2579-2584

MedPAC (2001 . Report to the Congress : Medicare in Rural America

Washington , DC : Medicare Payment Advisory Commission

Murray CJL , Kulkarni SC , Michaud C , Tomijima N , Bulzacchelli MT , et al (2006

Eight Americas : Investigating mortality disparities across races counties , and race-counties in the United States . PloS Med 3 (9 ) e260

Sternberg , Steve (2002 ) Study : Minorities receive lower-quality health care , USA Today

Retrieved online on April 15 , 2007

HYPERLINK "http /www .usatoday .com /news /health /2002-03-20-minority-health-care .htm br http /www .usatoday .com /news /health /2002-03-20-minority-health-care .htm ...