Agency for Healthcare Research and Quality. 2021 National Healthcare Quality and Disparities Report Executive Summary. Rockville, MD: Agency for Healthcare Research and Quality; December 2021. AHRQ Publication No. 21(22)-0054-EF. https://www.ahrq.gov/research/findings/nhqrdr/index.html. Accessed 20 June 2024.
This document, the “ 2021 National Healthcare Quality and Disparities Report” (NHQDR) is a comprehensive document that summarizes the status of health and healthcare delivery in the United States. The NHQDR is prepared by the Agency for Healthcare Research and Quality (AHRQ) with contributions from multiple data partners, including various states and agencies within the Department of Health and Human Services. From this report for 2021, it seems that across nine core measurements - health insurance, timely access to care, and availability for access to services when needed - are improving in the United States. In spite of that, the report also notes the ongoing shortage of healthcare workers for racial and ethnic minorities, leading to significant disparities that are caused by race, ethnicity, household income, and the location of residence. For instance, people in poor and low-income environments often experience a less ideal quality of care compared to those in high-income households. While there have been substantial improvements in areas such as the increased coverage of health insurance and reduction in death rates such as with HIV or colon cancer, the opportunity for access to that healthcare and treatment is still low, as there is a barrier to entry with the pricings and opportunity. Ultimately, it underscores the need for continued efforts to address healthcare disparities and improve the overall quality of care.
Becker, Gay, and Newsom, Edwina. “Socioeconomic Status and Dissatisfaction With Health Care Among Chronically Ill African Americans.” American Journal of Public Health, vol. 93, no. 5, 2003, pp. 742-748, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447830/. Accessed 19 June 2024.
This publication addresses findings from a study on healthcare accessibility for chronically ill African Americans from middle and low-income groups. From our research, we know that socio-economic status, or SES, affects the quality of healthcare individuals receive; this article discusses some of the many ways in which the healthcare quality is diminished. The study examined and compared the types of insurance that middle and low income Americans received, discovering that they primarily receive insurance from private organizations and government programs, respectively. Government programs in particular have been known to be underfunded and have seen budget cuts in certain states.
The study also found that, due to their insurance group, low income Americans spent more time on average dealing with healthcare bureaucracy, which contributed to a lower overall satisfaction with the quality of healthcare they receive. These bureaucratic roadblocks include having to wait a very long time to get a doctor and doctors are inattentive when they do end up visiting one. As such, the study concluded that an individual with low SES using government insurance was one of the most significant predictors of quality and quantity of healthcare which patients receive. It goes on to reflect the experiences of African Americans and the high levels of mistrust in the healthcare industry.
Ben-Umeh, Kenechukwu C, and Jaewhan Kim. “Income disparities in COVID-19 vaccine and booster uptake in the United States: An analysis of cross-sectional data from the Medical Expenditure Panel Survey.” PloS one vol. 19,2 e0298825. 20 Feb. 2024, doi:10.1371/journal.pone.0298825. Accessed 20 June 2024.
Scientists observed differences in COVID-19 vaccine and booster shot rates among various income brackets in the United States using information from the 2021 Medical Expenditure Panel Survey (MEPS). Those with lower incomes were much less likely to get COVID vaccines and boosters than those with higher incomes, and those in the lowest income group had a 55% reduced chance of being vaccinated. The research also shows that women with lower earnings experienced greater differences in vaccination availability compared to men in the same income group. Furthermore, individuals with private insurance had higher vaccination rates than those under Medicaid, Medicare, or uninsured.
Higher vaccination rates were linked to factors like having a regular healthcare provider and more frequent visits to the doctor's office. The study also indicates that older adults were more inclined to receive vaccination than younger adults, with differences in vaccine acceptance observed among various racial/ethnic groups and regions. The differences highlight the necessity of focused actions to tackle the issue of vaccine access, especially since the government no longer covers the cost of newer COVID-19 vaccines, potentially worsening access challenges for lower-income populations. Suggestions consist of eliminating economic obstacles, enhancing engagement with communities, and guaranteeing consistent financial backing to ensure fair distribution of vaccines and reduce health disparities.
Berger, J. T., & Miller, D. R. (2021). Health Disparities, Systemic Racism, and Failures of Cultural Competence. The American Journal of Bioethics, 21(5), 41-49. https://doi.org/10.1080/15265161.2021.1915411 . Accessed 19 June 2024.
Berger and Miller's paper critically examines the current cultural competence frameworks commonly used in medical education. The authors contend that despite good intentions, these frameworks fall short in tackling the deep health disparities caused by systemic racism and structural inequalities. They assert that the cultural competence approach is ethnocentric as it typically interprets cultural differences from the perspective of the dominant culture, thus potentially perpetuating stereotypes and biases instead of addressing them.
The criticism also applies to the flawed assumptions that cultural competence frameworks often operate on. For example, these frameworks frequently assume that educating healthcare providers about various cultures is all that is needed to improve healthcare disparities. Yet, this fails to consider the wider, systemic problems present, like biased actions in healthcare institutions, economic obstacles, and policy-driven inequalities that unfairly impact marginalized groups.
Berger and Miller highlight the common absence of a strong ethical basis in cultural competence training. The lack of clearly defined ethical values results in inconsistent implementation and impact of the training programs. Additionally, by neglecting to specifically confront systemic racism, these initiatives do not confront the underlying forces that sustain health inequities. In order to overcome these constraints, the writers suggested a strategy to prioritize grasping and resolving the underlying reasons for inequality instead of just raising awareness about cultural distinctions.
Caballo, Brian, Suchona Dey, Pranav Prabhu, Bhata Seal, and Peter Chu. "The Effects of Socioeconomic Status on the Quality and Accessibility of Healthcare Services." Across the Spectrum of Socioeconomics, vol. 1, no. 4, 2021, pp. 1-15. DOI: 10.5281/zenodo.4740684. Accessed 20 June 2024
This paper observes how socioeconomic status can affect the quality of healthcare and treament outcomes in the United States, focusing on disparities that have become more prominent due to the recent pandemic. These disparities are especially seen in factors such as inadequate resources, a more expensive treatment needed , and the strain of the pandemic on a person’s daily lifestyle. Within this paper, they measured a person’s socioeconomic status with metrics such as race, income, and education, where the data is collected from households through an online questionnaire. Their results indicate that satisfaction with healthcare quality and accessibility increases with income. Higher-income participants report better interactions with medical staff and shorter wait times, while lower-income participants face greater challenges in accessing healthcare due to transportation issues and costs. The study also reveals racial disparities, with Black/African American participants reporting the lowest satisfaction levels compared to other racial groups, suggesting that race and someone’s socioeconomic status is influential in the quality of healthcare that a person may recieve. Overall the authors emphasize the importance of expanding this current research to include more data from diverse populations and in different geographical areas for a better understanding of the healthcare inequalities in the United States. Most importantly, the findings from the authors underline the need for policy changes to address these systematic inequality in order to improve healthcare outcomes for marginalized groups.
FitzGerald, Chloë, and Samia Hurst. “Implicit Bias in Healthcare Professionals: A Systematic Review - BMC Medical Ethics.” BioMed Central, BioMed Central, 1 Mar. 2017,bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0179-8#author-information. Accessed June 18, 2024
This study was a meta analysis, looking at previous peer reviewed papers and articles in order to come up with its conclusions. In all, 42 articles were looked at, deemed eligible, and used for this meta analysis in an attempt to figure out the severity and effects of implicit biases in healthcare professionals. Of the 42 articles, 25 used a method where vignettes were given to healthcare professionals in order to observe the professional’s attitudes and decision making based on the characteristics of the patient. 35 of the 42 articles also found evidence of implicit bias in healthcare professionals. All studies that looked at correlation found a negative correlation between implicit bias in professionals and quality of care. Although the correlation does not imply causation, it can be reasonably deduced how implicit biases can impact the level of care given to different types of people. This conclusion becomes more concerning in its assertion that healthcare professionals exhibit the same amount of implicit bias as the general population, which can be extremely detrimental in their professional work. With the influence and power healthcare professionals have over one’s health, which ultimately contributes significantly to that individual’s quality of life, it is important to ensure that they provide consistent and fair care. There should be a higher standard required for people in these positions, as they are given power that allows them to affect many people in immense ways.
Fox, M. “Sex Matters: Medical Research Overlooks Women.” The Fuller Project, 12 Dec. 2023, fullerproject.org/story/sex-matters-medical-research-overlooks-women/. Accessed 20 June 2024.
The article discusses inconsistent progress in physiology research for women, with the medical standard for pathology being the known symptoms for men. For example, researchers fail to adequately study how women are more likely to die from heart attacks, suffer from autoimmune diseases, and face higher mortality rates for conditions like lung cancer and Alzheimer’s. Though governmental intervention sought to change this trajectory through a 1993 Congressional directive to include women equally in clinical trials, inadequate progress has been made, especially for women of color and those with disabilities.
The new White House Initiative on Women’s Health Research draws attention to ongoing gaps in knowledge of women’s physiology and treatment for conditions like endometriosis and rheumatoid arthritis. As such, the initiative aims to combat historical underfunding of women’s health research, promoting inclusive clinical trials and a better understanding of the role of gender in pathology. Significant gaps still remain, especially with diverse populations and conditions primarily affecting women, despite increased female representation in trials.
The article critiques existing research practices that overlook sex differences in drug efficacy and treatment outcomes, citing examples like the Ambien sleep aid, which affected women differently due to varying metabolic rates. It highlights ongoing challenges in implementing comprehensive sex-specific analyses in clinical research and calls for stronger enforcement of inclusion policies by regulatory bodies like the FDA and NIH.
Gordon, T., Booysen, F., & Mbonigaba, J. (2020). Socio-economic inequalities in the multiple dimensions of access to healthcare: the case of South Africa. BMC Public Health, 20(1), 289. https://doi.org/10.1186/s12889-020-8368-7 . Accessed 20 June 2024.
This study delves into socioeconomic inequalities in healthcare accessibility in South Africa, using information from the 2012 South African National Health and Nutrition Examination Survey (SANHANES-1). With this information, the study aims to understand the magnitude of these disparities by understanding the different challenges faced by each socioeconomic class in searching, accessing, and utilizing healthcare.
The writers use various concentration indices and a decomposition analysis to assess and understand the differences in health and healthcare outcomes. The concentration indices show how health and healthcare services are spread among various socioeconomic groups, while the decomposition analysis identifies the main factors causing these disparities. In particular, the research noted that those with lower socioeconomic status face more obstacles accessing healthcare, as perpetuated by its high cost and subsequent financial constraints.
This research provides a new understanding of how socioeconomic background contributes to inequalities in healthcare access in South Africa. It provides commentary on how the National Health Insurance (NHI) can and should address these inequalities. This research is important in the fight to eliminate socioeconomic disparities in the healthcare system in South Africa as it provides insight on the challenges in healthcare access, and emphasizes the importance of implementing reforms so healthcare can be more equitable.
Martha Hostetter and Sarah Klein, “In Focus: Reducing Racial Disparities in Health Care by Confronting Racism,” Transforming Care (newsletter), Commonwealth Fund, Sept. 27, 2018. https://doi.org/10.26099/1hjp-ct50. Accessed 20 June 2024.
The article addresses ongoing racial inequalities in the American healthcare system, finding that minority groups frequently experience less quality care and worse health results than their white counterparts. The utilization of the Institute of Medicine's 2003 report, "Unequal Treatment," helped to provide context and emphasize discrepancies in preventative care and the quality of treatment. Despite various efforts since, progress has been limited, with implicit bias and structural racism to blame for the disparities.
The article presents several examples of health systems that are making efforts to address these issues. For example, the Greensboro Health Disparities Collaborative partnered with local health centers to improve cancer treatment outcomes for black patients through customized support and intervention programs. HealthPartners addressed concerns and promoted home screening tests to improve colorectal cancer screening rates among minority patients. Kaiser Permanente worked to reduce disparities in chronic disease management and maternal health by employing strategies like patient education, community engagement, and culturally tailored support. Success stories include the ACCURE Study, which increased cancer treatment completion rates among black patients through intervention programs that included nurse navigators and real-time patient tracking, and Mamatoto Village, which supported black women during pregnancy and postpartum through community health worker programs, resulting in better birth outcomes and higher postpartum care attendance.
In terms of strategies for combating these inequities, Hostetter and Klein encourage efforts to prioritize the measurement of health disparities and using data to inform interventions, engage patients and communities in developing solutions tailored to their specific needs. They also promote prioritizing racial equity in health systems by conducting training, demonstrating leadership commitment, and having open discussions about bias. The article promotes a thorough and organized method to tackle racial and ethnic health inequalities, highlighting the importance of healthcare providers recognizing and actively fighting against racism within their organizations.
Khanijahani, A., Iezadi, S., Gholipour, K. et al. A systematic review of racial/ethnic and socioeconomic disparities in COVID-19. Int J Equity Health 20, 248 (2021). https://doi.org/10.1186/s12939-021-01582-4. Accessed 20 June 2024
This review investigated the association between racial/ethnic minority status and socioeconomic status (SES) with health outcomes and access to healthcare during the COVID-19 pandemic. It was a meta analysis, combing through, and looking to analyze these previous evidence and studies. 77 studies were selected for a full review, and of those 77, 52 were used for the review. The review included evidence from late December 2019 to March 1, 2021, focusing on mortality, infection rates, hospitalization, ICU admission, mechanical ventilation, confirmed diagnoses, and testing access in order to understand the burden during lockdown.
The findings from this study indicated that racial /ethnic minority groups faced higher risks of COVID-19 infection, hospitalization, confirmed diagnosis, and death. Contributing factors included low education levels, poverty, poor housing, low household income, language barriers, and overcrowded living conditions. However, the studies showed inconsistent and limited results regarding the impact of health insurance coverage, unemployment, mechanical ventilation, ICU admission, and testing access on these populations. There was also significant variability in defining racial/ethnic minority groups and SES across studies. However, the review concluded that regardless of these inconsistencies, racial/ethnic minorities and low SES groups are still more vulnerable to COVID-19, and that more focus should be directed toward these populations.
Martino, Steven C., et al. "2020 National Level Results: Race, Ethnicity, and Gender." Centers for Medicare & Medicaid Services, 2020, www.cms.gov/files/document/2020-national-level-results-race-ethnicity-and-gender-pdf.pdf. Accessed 20 June 2024.
This study attempts to find racial and gender inequality within the quality of care provided by Medicare recipients, people over 65 without their own health insurance plan and some people with disabilities under 65, and excluding those that hold other insurance types. Because of these conditions, the usual separator for health care quality in the United States, income and the ability to afford better care, has been factored out due to the focus on public government provided health care. This allows the focus on race and gender to shine because one of the main confounding factors for care quality has been factored out. The study looked at both patient experience measures and clinical care measures to determine if there were disparities between the measures of care. There were 7 measures of care for patient experience and 44 for clinical measures.. It was found that Alaskan Natives, American Indian, Asian or Pacific Islander reported many of their patient experience measures to be worse than Whites, while Black and Hispanic people reported only a few of their patient experiences to be worse than Whites. For the clinical measures, it was found that very many clinical measures for Black and Hispanic people were worse than the clinical measures for whites. As for Asian or Pacific Islanders, there were few clinical measures that were deemed worse than Whites, and a majority of the clinical measures were similar to Whites.
Ogden CL, Lamb MM, Carroll MD, Flegal KM. Obesity and socioeconomic status in adults: United States 1988–1994 and 2005–2008. NCHS data brief no 50. Hyattsville, MD: National Center for Health Statistics. 2010. Accessed 20 June 2024.
This article makes use of data from the National Health and Nutrition Examination Survey to examine the relationship between obesity, income, and educational levels among American adults with additional reported factors such sex and race/ethnicity. Among men, there is no correlation across income levels, though the authors did note that higher income non-Hispanic black and Mexican-American men are more likely to be obese. Conversely, women in a higher income bracket were less likely to be obese than lower-income women, though a majority of obese women sampled were not low-income.
There was also no significant correlation between obesity and education among men. One was detected in women as women with college degrees were less likely to be obese. However, the researchers observed that obesity levels increased across all income and education levels between 1988-1994 and 2007-2008, with over 1⁄3 of US adults being obese in 2008. Obesity has been linked with an increased likelihood for chronic medical conditions such as diabetes, cardiovascular disease, hypertension, and certain types of cancer. The article concluded that most obese adults are not low-income, with a significant portion having incomes above 130% of the poverty level, and that education saw no significant trend among men. Also observed that though education in women has an inverse relationship with obesity, the general increase in obesity rates indicate that there is no significant relationship between obesity and socioeconomic status.
O’Neil, Adrienne, et al. The Impact of Socioeconomic Position on Women’s Health over the Lifetime. Maturitas, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273147/. Accessed 19 June 2024.
This study comprehensively reviewed previous literature pertaining to how Socio-Economic Position, or SEP, affects women’s health outcomes, based on a targeted search of topically related literature published since 1990. Unfortunately, people of lower SEP experience higher mortality as well as a higher risk of having other health conditions. This systematic literature review focuses on how SEP affects women specifically, and at different stages throughout their lifetime. Women and girls of low SEP status tend to experience a greater reduction in access to healthcare than their male counterparts, which can be due to cultural and societal biases. When previous data on SEP was analyzed by gender, it was found that women with low SEP specifically experienced a higher risk of coronary heart disease.
Correlations between SEP and health outcomes were observed at each stage of life, and the disparities between gender groups were found to vary between different countries and populations. For example, in childhood, girls in India with heart conditions are less likely to have their parents agree to important cardiac surgery than the parents of boys. The study found that disparities in the gender gap are related to gender-based biases related to the population and SEP in childhood, but as women transition into adulthood, the gap becomes more defined by educational attainment. For example, the negative health effects associated with coronary heart disease were much more pronounced for women with low educational background than for men with the same background. Overall, this literature review demonstrates the importance of taking gender into account when analyzing healthcare accessibility and outcome, which fundamentally also involves access to education and the social stratification of a region in addition to SEP.
Singh, Gopal K. “Trends and Social Inequalities in Maternal Mortality in the United States, 1969-2018.” International journal of MCH and AIDS vol. 10,1 (2021): 29-42. doi:10.21106/ijma.444. Accessed 20 June 2024.
The aim of the study was to analyze maternal mortality over time and how social and economic factors influenced said maternal mortality rate. The factors that were considered included race/ ethnicity, socioeconomic status, immigrant versus native status, marital status, and rural versus urban areas. Using national data, the study found that overall, maternal mortality rates were a decline of 68% from 1969 to 1998, probably due to better practices, sanitation, equipment, and general advances in medicine. However, the study found that maternal mortality in live births increased from 9.9 deaths per 100,000 in 1999 all the way up to 17.4 deaths per 100,000 in 2018. It’s also interesting when looking at these rates across races and seeing a disparity. Specifically, the mortality rates of Black women were 2.4 times higher when compared to those of White women. There were also other glaring disparities, such as a 6 times difference in the mortality rates between Chinese women and non-Hispanic black women, 7.0 vs 42.0. The study also found that unmarried, US born, lower education, and living in rural areas correlated from anywhere between a 50% to 114% increase in mortality rates. Unshockingly, there was an enormous difference of 120% increase in mortality rates for women in deprived areas as opposed to women living in the most affluent areas.