Health disparities are defined as the preventable and yet persistent burden faced by economically disadvantaged groups when interacting with the healthcare industry in the United States. These groups are burden by poorer health outcomes and access to medical services systemic to the U.S. brand of healthcare. Disparages are usually attributed to economically disadvantaged minorities and women. Ethnic minorities and women are burden at a disproportional rate; however, it is safe to say that poor people of every persuasion are at a disadvantaged dealing with the U.S. healthcare system.
Health inequities are systematic barriers to good health that define disparities. Health disparities are avoidable. African Americans, Latinos, Native Americans, Asian Americans and women are usually underserved.
The key to understanding and eliminating health disparities is to acknowledge that they are not the result of individual behaviors. Instead, poor health outcomes require solutions based on social justice.
Social justice is the distribution of advantages and disadvantages within a society and their consequences. It focuses on the relative position of one population subset in relationship to another subset of society, as well as on the root causes of disparities and what can be done to eliminate them. Thus, reducing health disparities may necessitate altering social policies, social systems and social institutions to remove unequal treatment and outcomes in health care system.
Obesity and Chronic Health Conditions are caused in part by inadequate access to fresh food. Public health strategies designed to improve social and physical environments creating conditions suitable for healthy eating and physical activity, pay dividends of improving clinical outcomes.
Food Deserts Lead to Health Disparities
Food deserts are defined, as places in the United States where supermarkets with fresh fruits and vegetables are more than one mile travel time. Many residents in these areas lack adequate transportation to get to a supermarket. Healthy food accessibility to neighborhoods causes them to rely on small grocery stores or convenience stores, which carry few if any fresh fruits and vegetables. Unhealthy eating is often the result of structural inadequacies in food distribution and sale, not personal choices around diet.
The connection between healthy diets and good health outcomes is well established. The existence of food deserts contributes to the continuation of health disparities. Efforts designed to improve access to healthy foods can help change dietary habits, resulting in dietary changes for residents of food deserts leading to better health outcomes.
40% of ALL Food Supply in U.S.A. is Wasted
Americans throw away roughly 40% of all the food grown, processed and prepared is never consumed. To put this into perspective that amounts to 1,400 calories per person per day, $400 per person per year, and notably, 31 million tons of food dumped in landfills each year. USDA’s Economic Research Service approximate that 133 billion pounds or $161 billion worth of food was wasted in 2010. Food is lost during cooking, natural shrinkage (for example, moisture loss) loss from mold, pests, or inadequate climate control. Municipal solid waste department state that food waste is the single most discarded material that reaches landfills and incinerators.
Wholesome food that could have helped feed families in need is sent to landfills. USDA’s Economic Research Service (ERS) defines food waste as the edible amount of food, postharvest, that is available for human consumption but is not consumed for any reason. The land, water, labor and energy used in producing, processing, transporting, preparing, storing and disposing of discarded foods are pulled away from uses that may have been more beneficial to society.
How is it possible that America possesses both food deserts and still throw away almost half of the food produced. One of the leading causes of food waste is expiration dates placed on perishable items. Many people either will not purchase an item if it is close to that date or they throw out anything in their refrigerator that approach it’s expiration date. Some if not most expiration dates mean nothing. Unaware consumers robotically trash items that are safe to consumer.
Blacks and Whites Experience Different Medical Care
Studies reveal a stark difference in health outcomes for black and white patients with the same conditions even when the same doctor treats them. Diagnoses, treatments and quality of care can vary for population groups depending on a variety of factors including language, household income, geographic location (both locally and nationally) as well as differences occur based on the particular ethnic group
The Urban Institute reported, in September 2009, that preventable diseases drive health care costs up by $24 billion annually, including $15.6 billion in the Medicare programs. Preventable diseases that are prevalent among Latino and African Americans drive up cost. The most frequent of these include type 2 diabetes, hypertension and stroke. Reducing or eliminating these common medical culprits would reduce healthcare cost.
As the population of Latinos grows the associated health, cost will continue to rise. Over the next decade, the total cost is approximate $337 billion. Unchecked, these annual costs will more than double by 2050 as the representation of Latinos and African Americans among the elderly increases.
African Americans are becoming increasingly health conscious; health literacy tends to vary by generation. Older African Americans may be suspicious of clinicians, because of experiences from the. Younger African American have heard about the Tuskegee experiments on African-Americans, they too may experience reservations. This reluctance sharing personal or family information hinders the trust building process, which can be crucial in the treatment process.
Understanding the patient’s cultural norms allows providers to build rapport and ensure effective patient-provider communication. Efforts to reduce health disparities must be holistic, addressing the physical, emotional, and spiritual health of individuals and families. Not all patients from diverse populations conform to stereotypical culture-behaviors, beliefs, and actions. Practitioners need to work on making connections in the communities they practice and recognizing conditions that are unique to that community.
Disparities in healthcare are large subsets of overall quality problems. Poor quality results in less-than-optimal care and disproportionately worse care for many. Therefore, as embodied in the Closing the Health Care Gap Act, any policy solution for health disparities must start with improving the general quality of care.
One idea is to link payment, effectively and efficiently, to outcomes that patients value, such as healing better and faster. The idea should be to cultivate a health care system that encourages providers and patients, with properly aligned incentives, to work together to improve care.
In this health system, patients and providers would decide how to structure a productive clinical interaction. For care to improve, physicians need time to build rapport to ensure all the patient’s concerns are address. The healthcare system has to shift from the rushed 10-minute appointments toward a model which allow doctors to be doctors. This type of system requires lawmakers understanding that they created a system which fosters disparaging poor and middle-class patients.
Health information technology (HIT) is critical. Reliable care information and the ability to access it helps providers and disparaged communities redesign clinical practices in ways that will improve quality. HIT is a great way for providers to connect with a community and better recognize the needs of a particular population. HIT will help physicians and nurses who are working closely with a community provide higher-quality care at lower cost.
Disparaged communities must be able to assess the clinical care given to improve the quality of that care. Performance measures need to be uniform and transparent. Standardized healthcare practices across regional locals, creates a measuring stick for gauging improvement. Therefore, a fundamental step will be to develop appropriate measurement tools. Specifically, universally accepted health programs should be designed and implemented as a uniform set of performance measures so that all consumers and providers can make informed, evidence-based decisions about health care.
Providers need to be incentivized to promote innovative clinical design to improve the overall quality of care. The current system is based on pay for a visit, not quality and outcomes. Many have begun to rethink these strategies. A better system would base payments on results rather than visits and procedures. Regulators have started to encourage pay-for-performance programs. Also, providers should be incentivized to develop care strategies that eliminate health disparities.
Translating Science to Health Outcomes
Finally, it takes too long for innovative research to be widely adopted. Research has to begin to evaluate potentially significant ethnic and gender clinical differences. Funding is critical in this area. Research need to move quickly from the lab to the end users. Lastly, research geared toward quality improvements techniques that help providers make scientifically based decisions at the point of care should be promoted and funded.
This last point is important, as we seem to be moving closer and closer to politicizing scientific discovery. Right-leaning groups who favor religious doctrine over scientific research is to blame. Another force that drive research funding are those that are easiest to monetize. Which equates to only those discoveries, which has the potential of turning a quick profit, are adequately funded. All of these are excellent how to examples for maintain healthcare disparities.
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