Human Health Through Digital Humanities

Narrative

Introduction

Access to high-quality medical care is an essential part of public health that should be available to everyone, regardless of their social and economic status, race, or gender. Nonetheless, extensive research and data from the World Health Organization (WHO) show that inequalities in healthcare quality continue to exist, having a greater impact on marginalized populations. This story intends to investigate these differences using socio-economic status, race, and gender as the perspectives, based on recent research and the WHO's Global Health Observatory (GHO) data.

Socioeconomic status (SES) is among the most crucial factors affecting health results. People of higher socio-economic status usually have easier access to quality healthcare, while individuals from lower socio-economic backgrounds often encounter obstacles. These obstacles consist of expensive fees, absence of insurance, and restricted access to healthcare establishments.

A thorough investigation by the Agency for Healthcare Research and Quality (AHRQ) pointed out that socio-economic inequalities in healthcare are widespread. Individuals with lower incomes are less inclined to access preventive healthcare, receive early diagnosis, or undergo effective treatments in comparison to those with higher incomes. This pattern can be seen in developed and developing nations, where financial obstacles greatly impede the ability to obtain necessary medical care.

Race worsens the disparities in healthcare access and quality. Minorities, especially Black and Hispanic people, are often provided with less quality care than white individuals. This results from the intersection of structural racism, socio-economic barriers, and unconscious prejudices in the healthcare system.

A report from the Commonwealth Fund revealed that Black and Hispanic patients have lower chances of receiving suggested preventive services and are more prone to facing delays in accessing healthcare. These differences were clearly shown during the COVID-19 pandemic, with minority groups experiencing higher rates of infection, hospitalization, and death in comparison to white populations. 

Furthermore, healthcare professionals' implicit biases play a significant role in these disparities. Studies indicate that healthcare professionals frequently possess unconscious biases which impact their clinical judgments, resulting in disparities in treatment suggestions and results depending on the patient's race or ethnicity. For instance, there is a disparity in pain management between Black and white patients, indicating a historical bias in the understanding of pain tolerance across races.

Gender inequalities in healthcare are equally notable, especially impacting females, who commonly encounter gender prejudice in diagnosis and care. Frequently, women are not diagnosed correctly or at all for conditions like heart disease and are also less likely than men to receive aggressive treatment.

A comprehensive study on Medicare Advantage plans discovered that women, particularly women of color, receive unequal treatment. The report highlighted that although there have been some enhancements, substantial disparities still exist in the level of care given to women in comparison to men. This gap is even more evident for impoverished women who encounter multiple obstacles because of their economic standing and gender. The Women's Health Initiative (WHI) is a key point of reference for examining the intricate relationship between socio-economic status (SES) and gender disparities in healthcare.

Women who are not white and immigrant women experience multiple types of bias rooted in their race, culture, and gender when receiving healthcare. The combination of systemic racism, along with language barriers and cultural insensitivity, leads to disparities in treatment outcomes and patient satisfaction.

Gender and socio-economic status intersect to affect reproductive health outcomes. Women facing socio-economic disadvantages encounter difficulties in obtaining family planning services, prenatal care, and maternal health assistance. These differences lead to negative health outcomes for mothers and infants, regardless of their socio-economic status or race. 

Link to video: https://www.youtube.com/watch?v=xAlxtog_4ns 

Addressing gender-based disparities requires comprehensive policy interventions, including expanding Medicaid coverage, ensuring access to essential health services (including reproductive health), and prohibiting gender-based discrimination in insurance coverage and healthcare delivery. A study conducted in Oregon demonstrated that Medicaid expansion significantly improved access to preventive care and overall health for low-income individuals, particularly benefiting people of color. However, persistent disparities in quality and outcomes indicate that further policy interventions are necessary.  The "Reducing Racial Disparities in Health Care by Confronting Racism" initiative, highlighted by the Commonwealth Fund, offers a model for addressing racial disparities. This initiative involved training healthcare staff to recognize and mitigate racial biases and creating patient registries to track and improve treatment completion rates among minority groups. As a result, treatment completion rates improved significantly among Black patients.

Policy Interventions

Broadening Medicaid and other insurance schemes to include a greater number of low-income individuals can greatly minimize inequalities. Policies should also prioritize meeting the unique needs of racial and gender minority groups. It is essential to establish thorough training programs for healthcare providers to target implicit biases and enhance care for various populations. Continuous training should be incorporated into the standard practices of the healthcare system. Healthcare professionals require training that is both gender-sensitive and culturally competent in order to reduce biases, enhance diagnostic accuracy, and improve patient-centered care for individuals from various socio-economic and cultural backgrounds. Allocating resources to community health programs that prioritize preventative care and health education for marginalized communities can help close the divide. These programs need to be customized to fit the cultural and socio-economic backgrounds of the communities they cater to. 

Initiatives to Bridge the Gap:

Kaiser Permanente has achieved success in boosting cancer screening rates among minority populations by implementing specific strategies like culturally tailored communication and providing diverse screening options. These initiatives emphasize the significance of using culturally sensitive strategies to address healthcare inequalities. The Women's Health Initiative (WHI) began in 1991 as a groundbreaking study due to the acknowledgment of the historical exclusion of women from clinical trials and medical research. This omission resulted in a major lack of knowledge regarding the differences in how medical treatments and interventions impact women versus men.

The start of the WHI marked a crucial change towards being more inclusive, with the goal of addressing these gaps by carrying out extensive, long-term studies that specifically concentrated on women's health concerns. Addressing this historical oversight, the WHI highlighted the importance of incorporating gender considerations in medical research and healthcare policy, providing crucial insights into women's specific health needs. Within my paper, the WHI exemplifies how recognizing and tackling gender inequalities in healthcare can result in fairer results, especially when combined with socio-economic status.

The GHO indicators from the World Health Organization offer extensive data to analyze and tackle disparities worldwide. By incorporating GHO indicators, we can achieve a more thorough grasp of the impact of socio-economic status, race, and gender on global health results.

GHO data can be compared with socio-economic factors to pinpoint areas and groups most vulnerable to maternal mortality rates. This approach, driven by data, enables focused interventions and allocation of resources to areas with the greatest need. 

Similarly, GHO indicators on disease prevalence and healthcare access can be used to track the effectiveness of health policies and programs aimed at reducing disparities. By continuously monitoring these indicators, policymakers can adjust strategies to ensure they are effectively addressing the needs of marginalized populations.

Conducting research on the intersectional impacts of gender and socio-economic status is essential for informing evidence-based policies and interventions aimed at reducing health inequities among women (BMC Medical Ethics, n.d.). This data-driven approach can guide systemic reforms to promote equitable access to quality healthcare services for all women, regardless of their socio-economic background or gender identity.

Research and Data Collection

Additional investigation into the distinct requirements of various racial, gender, and socio-economic demographics is essential in order to create precise healthcare policies and methods that target existing inequalities. By exploring these varied groups further, healthcare providers and policymakers can acquire a detailed comprehension of the distinct difficulties they encounter. Research can identify certain obstacles to accessing healthcare, like language barriers for immigrant groups or cultural preferences impacting treatment choices. Additionally, recognizing the socio-economic variables that influence health results, like job uncertainty or inadequate housing, can guide efforts to enhance health equality. This data-driven method not only detects deficiencies in current healthcare provision but also directs the creation of specialized plans to guarantee that healthcare services are welcoming, reachable, and efficient for all people, irrespective of their background or identity. By consistently conducting research and making policies based on evidence, healthcare systems can come closer to attaining fair health results and decreasing inequalities among various populations. 

Technology and Innovation

Using technology like telemedicine and mobile health apps can help increase healthcare access for marginalized communities. Telemedicine enables patients to remotely consult with healthcare professionals, removing geographical obstacles and enhancing access to specialized care, particularly in rural or isolated areas. Mobile health apps improve accessibility by offering tools for self-managing chronic illnesses, monitoring health metrics remotely, and providing immediate access to health information. It is crucial to design these technologies with accessibility as a priority, guaranteeing usability for all demographic groups, including individuals with disabilities or limited technological knowledge. Applying user-centered design principles like easy-to-use interfaces and various language choices can improve the functionality and efficiency of telemedicine and mobile health apps, leading to better healthcare access and outcomes for disadvantaged communities. Healthcare systems can empower individuals by embracing technological advancements that prioritize inclusivity, enabling them to receive quality care promptly, regardless of their location or socio-economic status.

Dealing with differences in medical care quality necessitates a comprehensive approach that takes into account the connections between socio-economic status, race, and gender. With the help of recent research findings and utilizing the WHO's GHO indicators, we can create specific plans to enhance healthcare fairness. This involves increasing insurance availability, providing cultural competency training, supporting community health programs, and continuously researching to guide policy choices. Dealing with these inequalities necessitates a multi-dimensional strategy that takes into account the specific obstacles encountered by these overlapping identities. By making these efforts, we can strive for a healthcare system that is fairer and offers top-notch care to everyone, no matter their socio-economic status, race, or gender. 

Application of Intersectional Lenses 

To further understand and address these issues in healthcare disparities, we can use established frameworks that have been studied and used as analytical tools within the digital humanities to incorporate humanistic principles within our data analysis of healthcare. 

Critical Race Theory

One of the more significant framework that we can utilize is with critical race theory, which addresses how racial inequalities are continuously prolonging the issues of healthcare disparities for marginalized communities. Using this framework, we can posit how racism within the United States can be a subtle factor in shaping the medical help and accessibility for people of color.  When viewing the history of medical services and institutions with these lenses, we can trace it back to structural inequalities within the healthcare system that has resulted in the segregation of treatments for people of color. This perspective is crucial in understanding how one's own racial and ethnic history and culture affects their own experience with healthcare. For instance, the recent NHQDR 2021 in their executive summary underlines the serious difference of healthcare access and quality for racial and ethnic minorities that are mainly attributed to household income and residential location. It states that "people in poor and low-income households experienced worse care than people in high-income households on more than half of quality measures (67 of 117 and 65 of 116 measures, respectively). The disparate measures reflected lack of access to health insurance, lack of access to healthcare services, and lack of timely access to care. " (2021 National Healthcare Quality and Disparities Report Executive Summary) Furthermore, this study by Khanijahani 2021 on COVID-19 disparities exemplifies this, showing that minority groups faced higher risks of infection, hospitalization, and death due to intersecting factors like poverty, poor housing, and low education levels. In particular, he writes "Though racial/ethnic minority groups were frequently identified as the most vulnerable populations during the epidemics, they are exceptionally vulnerable in the COVID-19 pandemic because the transmission of the infection is strongly associated with the background and socioeconomic characteristics of individuals" (Khanijahani 2021) Thus, we can see that in these examples from other researchers and official documents that CRT can help explain why certain patients of color are less likely to receive the recommended health services and the implicit biases that are held by healthcare providers within the country.  It emphasizes the importance of listening and ensuring that the needs of marginalized communities to be heard properly.  In that regard, a digital humanist conducting research on this cultural disparity can ensure that the perspectives and experiences of minority groups are properly accounted for by making them central to the design and implementation of health interventions.

Critical Disability Theory 

Critical Disability Theory changes the focus of lens from a person's color and ethnicity to their other unique conditions and attributes that are deemed impairments by societal norms and structures. CDT criticizes our current medical model that pathologizes individual impairments  within our medical field as it is the result of society imposing those terms to be barriers of accessibility. This frameworks allows us to question and observe if our medical and healthcare system have the necessary accommodations and service for patients with unique circumstances with their (dis)abilities.  Accommodations such as facilities with trained healthcare providers and adequate medical equipment for special circumstances.  A lack of accessibility not only limits the quality of care that (dis)abled individuals receive, but also systematically discourages them from seeking care initially. A study conducted by Caballo 2021, a Harvard faculty member, addressed this issue of accessibility through a survey that assessed how much participants agreed how a lack of adequate transportation has affected their ability to access a healthcare facility. The paper states that "lower SES decreases healthcare accessibility as a result of less available transportation", (Caballo 2021), and it can be tracked with the two figures below from the paper

Feminist Theory

Just as important as the previous two frameworks is feminist theory, which examines how the differences and intersection of gender creates a unique experience of oppression within a patriarchal structures that has marginalized women. Used in conjunction with the previous two theories, and we can see how healthcare systems in the past have targeted women that are of color and/or with (dis)abilities in particular.  In fact, feminist scholars have argued that healthcare systems have historically prioritized the study and well being of the male body, which leads to the neglect of women's health issues and other non-male gender specific needs. By applying this theory, we can take into account the history of how medical research has often excluded women from clinical trials in the past due to a lack of care or agency for how women might be affected differently with one disease or treatment. This oversight has significant implications for women's health, particularly in the diagnosis and treatment of conditions like heart disease, which are often underdiagnosed in women​.  An article titled " Sex Matters : Medical Research Overlooks Women" by Margie Fox addresses this lack of attention and care that should be given to women's health, stating that the "NIH applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women" (Fox 2023) when the majority of victims that experience medical emergencies or are at a higher risk are mostly women such as with heart or autoimmune disease. When combining feminist theory with CRT, we can then look at another study titled "Trends and Social Inequalities in Maternal Mortality" that further addresses an issue health disparity due to both racial, gender, and class differences. Within the study, Singh states that "Black women, women in lower socioeconomic groups, and women in rural communities continue to experience unacceptably high risks of maternal mortality", (Singh 2021) and we can observe with the two figures below on how there is a stark difference between white women and women of color with matneral death rates. The second figure on the right goes even further by incorporating how different socioeconomic levels in conjunction with racial differences affect maternal death rates as well. 

Thus, the  integration of CRT, CDT, and Feminist Theory provides a robust framework for analyzing and addressing healthcare disparities. By considering the intersections of race, gender, and disability, we can develop inclusive policies and practices that promote equity and justice in healthcare. Conducting research on the intersectional impacts of gender and socio-economic status is essential for informing evidence-based policies and interventions aimed at reducing health inequities among women. This humanistic yet data-driven approach can guide systemic reforms to promote equitable access to quality healthcare services for all women, regardless of their socio-economic background or gender identity.

Historical Context

Understanding these trends in healthcare quality can provide a better understanding about the economic forces challenging each socioeconomic class at a given time. For example, seeing significant drops in something like proportion of underweight adults in a specific socioeconomic group can indicate that group's general trend toward a better economic circumstance. However, it can also show other things like political movements and the emergence of new philosophies and diverging classes of thought. Seeing a drop in the vaccination rate can not only provide economic indications, but also detail the political climate, specifically the views the individuals in power have about vaccines, and also show the rise of the anti-vaccine movement. That way, in addition to knowing a movement happened or a President with a certain view held office, we are able to quantify the effects of these changes, such as calculating the drop in vaccination rates. This project creates a roadmap of our history, told through the medical system, and the journey the different socioeconomic groups have taken.