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“The improvement of medicine would eventually prolong human life, but improvement of social conditions could achieve this result even more rapidly and successfully.” - Rudolf Virchow, German Physician, 1879
A major public health milestone was achieved in The United States in 1985 when the Department of Health and Human Services published the Report of the Secretary’s Task Force on Black and Minority Health. This marked the inception of a new era in acknowledging minority health issues. While action has been taken nationally since to address the issues noted in the report, health inequity persists and remains a distinction within American society.
The World Health Organization defines health inequities as systematic differences in the health status of different population groups. Society suffers health inequity when not everyone gets to share in the opportunities and when distributions of resources are not equal—a failure of distributive justice. These inequities have significant social and economic costs both to individuals and their communities. Achieving health equity means that everyone has the basics to be as healthy as possible. There is substantial evidence that social factors, including education, gender, ethnicity, employment status, and income level have significant influence on a person’s health. This is why health equity is a multiple-industry concern.
There are a multitude of benefits gained from investment towards health equity, including reducing suicide rates among the transgendered, lowered readmissions, improved health outcomes, and reduction of health disparities to name just a few. Health equity is not only a moral issue, but also an economic one as well.
Wise policymakers, medical centers, insurers, and providers have realized that health equity affects the bottom line. A study published in 2018 by the Connecticut Department of Public Health noted that “race and ethnicity were associated with higher hospital charges and estimated excess charges (compared to white residents) of Black residents was over $1.2 billion and $378 million for Hispanic residents.” Higher utilization was found to be a prevention failure because of undiagnosed diseases such as diabetes and heart disease. Another study in the International Journal of Health Services published in 2011 found that nationally “eliminating health disparities for minorities would have reduced direct medical care expenditures by about $230 billion and indirect costs associated with illness and premature death by more than $1 trillion for the years 2003-2006.” Specifically for health insurers, racial health disparities alone were estimated to cost the U.S. $337 billion between 2009 and 2018 as reported by the Robert Wood Johnson Foundation. These are limited healthcare dollars, wasted away. Numerous measurements were used for estimating the economic impact in these studies include, but not limited to, the following:
Investing in disease prevention not only saves lives but yields a significant return on investment. For example, increasing access to arthritis treatment for 10,000 people, reducing their pain by 18% and increasing their productivity and quality of life, could save more than $2.5 million according to the Alliance for Health Reform. There are system-wide impacts as well. Increased healthcare costs erode company profits leaving less money to invest in equipment or expansion, and force companies to increase prices for their products. GM estimated that providing health insurance for its employees added $1,400 to the cost of every vehicle built in the U.S. in 2004.
Moral & Just Society
Award-winning 20th century philosopher John Rawls was interested in what makes a just and moral society. He formulated a hypothetical theory where people are equal to each other, and all humans have worth in the Original Position, and if we take a Veil of Ignorance with each other, a social contract would develop that secures basic rights for everyone and protects those in all positions of society. His theory goes on to say that the advantaged have a responsibility to the disadvantaged. Those that are disadvantaged could include those in poverty, those with chronic diseases that affect quality of life, the disabled, etc. Therefore, in the end, it is in our ultimate best interest to do this, because everyone has the potential to be in the lesser position (loss of job, health, etc.) Rawl developed these theories during the Great Depression, when people's lives regularly changed overnight. John Rawls said, “A just society is a society that if you knew everything about it, you'd be willing to enter it in a random place.” Consider that powerful thought: are you willing to be born into a low-income, Black family in Philadelphia or Chicago? Statistically, this population has the highest rate of health disparities in the country, and as a result, end up in unhealthy situations that produces another statistic: highest homicide rate in the country. At the core of Rawls theory is that no matter what our circumstance, environment, or influence, we are human, and all human interests must be observed to truly live in a moral, ethical, and just society. An example of this is the immoral nature of deep racial and ethnic disparities that remain when it comes to health coverage and equity. The refusal of nearly 20 states to expand Medicaid, particularly in the south, has left hundreds of thousands of Americans with these demographics uninsured.
Many health organizations are paying attention to health equity and they are doing so not just because it is the right thing to do, but because the financial incentives are increasingly aligning. Institutions that do not respect the importance of achieving health equity in their systems and communities will struggle as our country moves ahead toward a health system that is more patient-centered and accessible.
Kat is an award-winning writer, educator, reformer, health advocate, and believer of healthcare as a human right. She believes that most of us aren't comfortable watching people suffer when help is available, and when we assist each other in surviving, everyone benefits. She advocates for awareness, transparency, and a person’s right to know. Information about her most recent book can be found at www.toerrishealthcare.com/book-1.