Health Inequalities and Inequities

HCR 210 Ethics for the Healthcare Professional Health Inequalities and Inequities …and why should we care? Learning Objectives: • Define the concepts of health care equality, inequality, and inequity • Understand how these concepts are currently measured in the US health care system • Conceptualize how health care inequalities and inequities may be ethically handled • Summarize the ethical principles underlying the processes for understanding and addressing health care inequalities and inequities Key Terms What is health? How do we measure “health”? Key Terms What is health inequality? • Variations in health status across individuals within a population, or a difference in average or total health between two or more populations • Population groups can be based on race, ethnicity, gender, location, socioeconomic status Health Inequality Health Inequality When talking about health inequality, we may also talk about healthcare, such as: diagnosis rates, treatment, cost, insurance, survival, symptom reduction, or other measurable health outcomes • Examples: o Males are more likely to be diagnosed with autism than females (inequality of diagnosis rates) o Caucasians are more likely to receive pain medications than African Americans (inequality of treatment and symptom reduction) Key Terms What is health inequity? • Difference in health status that is judged to be morally unacceptable. • Based on beliefs about justice, fairness, and distribution of social resources Question: Non-Hispanic black Americans have the highest rate of infant mortality in the U.S. Is this a health inequality or health inequity? A. Inequality B. Inequity Health Inequalities vs Health Inequities Lisa is a 19 year old female who has always disliked the shape of her nose. She goes to a consultation with a plastic surgeon and decides to get a rhinoplasty. This procedure cost $3000, and Lisa’s insurance company covers all of the costs. Lisa’s friend, Jennifer, decides that she also wants a rhinoplasty. However, her insurance will not cover the procedure and she is unable to afford the costs of the surgery. Jennifer thinks its unfair that people under Lisa’s healthcare plan can get the surgery for free while people under her healthcare plan cannot. Is this an example of a health inequality or a health inequity? A. Inequality B. Inequity Question How do we determine what is a health inequality versus what is also a health inequity? The difference between a health inequality and a health inequity is that health inequities are considered morally unacceptable. All health inequities are health inequalities. Not all health inequalities are health inequities. What is “Morally Unacceptable”? What is “Morally Unacceptable”? Method 1 Method 1: Examining the health inequality relative to social positions of the different populations – if a health inequity disproportionally benefits a socioeconomically advantaged population or harms a socioeconomically disadvantaged population o Premise that health inequities exist because of structural inequities on the distribution of economic resources or historical patterns of race-based injustice o Ex: Women in the top 1% of income distribution live 10 years longer than women in the bottom 1% o Ex: African Americans have a higher risk of death from cardiovascular events What is “Morally Unacceptable”? Method 1 • This method would fit in with John Rawl’s Difference Principle; inequalities in distributive justice (including healthcare) should not exist unless it is to the benefit of the least advantaged members of society • Using this method, inequalities that are beneficial to the least advantaged members of society are not considered inequities What is “Morally Unacceptable”? Method 1 Limitations to this method: • How do you define which populations are “socioeconomically disadvantaged”? • How do you compare two populations if both are considered “socioeconomically disadvantaged”? • If a population is socioeconomically advantaged, does that mean health inequalities that harm the population are never considered health inequities? What is “Morally Unacceptable”? Method 2 Method 2: Examining the health inequality based on causes and consequences rather than looking at the affected population • Health inequalities are health inequities if the are systematic, avoidable, and unjust Systematic: inequality affects two or more populations and is not due to random variation Avoidable: technical, financial, and moral means exist to rectify the inequality What is “Morally Unacceptable”? Method 2 Just: • Natural or biological variations in health status • Freely chosen health-damaging behavior • The transient health advantage of one group over another when that group is first to adopt a health-promoting behavior (as long as other groups have the means to catch up fairly soon) What is “Morally Unacceptable”? Method 2 Unjust: • Natural selection or health-related social mobility involving the tendency for sick people to move down the social scale • Health-damaging behavior where the degree of choice of lifestyles is severely restricted • Inadequate access to essential health and other public services • Exposure to unhealthy, stressful living and working conditions What is “Morally Unacceptable”? Method 2 The stress of discrimination adversely affects health status. What is “Morally Unacceptable”? Method 2 The stress of poverty adversely affects health status. What is “Morally Unacceptable”? Method 2 Limitations • Some “freely chosen” health behaviors are tied to socioeconomic status o Increased incidence of cigarette use in lower socioeconomic status groups • Diseases can have multiple etiologies Unhealthy diet Genetic predisposition Chronic stress Sedentary lifestyle Diabetes Use of certain medications Older age Obesity Health Inequities Today Question Healthy People 2020 goal to “achieve health equity, eliminate disparities, and improve the health of all groups.” Do you believe that we have reached this goal? A. Yes B. No Small Groups Identify a health inequality regarding COVID-19 in the United States. What are the populations involved in this health inequality? Do you consider this health inequality to be a health inequity? If so, what makes this “morally unacceptable”? If not, what makes this “morally acceptable”? How to Eliminate Health Inequities Key Terms Horizontal Equity: Equal allocation of resources across a population; everyone gets the same treatment Do you see any problems with this idea? Key Terms Vertical Equity: Allocation of resources based on need. Similar concept to distributive justice discrimination based on need. Do you see any problems with this idea? Public Health As An Urban Solution | Leana Wen | TEDxBaltimore Eliminate Health Inequities Recipe for Health Equity by Renaisa Anthony: Research Education Collaboration Initiative and Implementation Public Health and Policy Empathy, Empowerment, Evaluation Questions? Assignment Quiz 3 due Sunday at 11:59 PM AZ time