ACA

Framing the Health Disparities Problem

This past week, I had the opportunity to attend the National Institute on Minority Health and Health Disparities Grantees Conference. Over 1,000 people attended, all representing different parts of academia and the non-profit world, all coming together to collaborate and present research regarding health disparities. The National Institute on Minority Health and Health Disparities is a branch of the National Institutes of Health. It’s mission is “to lead scientific research to improve minority health and eliminate health disparities.”

What are health disparities, exactly? The Healthy People 2020 initiative defines it in the following terms: “If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.” Health disparities can be seen, for example if we look at something like infant mortality.

Infant mortality rates in the US by race

Infant mortality rates in the US by race

Since 1980, the US infant mortality rate has dropped from 12.6 deaths/1,000 live births to 6.17. This is okay (though it should be noted that we rank as having the 55th lowest rate for the wealthiest country on the planet). This rate takes on a new life when we break it down by race. For Non-Hispanic Whites, the infant mortality rate is 5.5 deaths/1,000 live births. For Non-Hispanic Blacks, the rate is 12.8 deaths/1,000 live births. We can see disparities again when we look at childhood obesity rates. At the conference I learned that for the first time, the national child obesity rate seems to be plateauing; yet for white, upper class children, this rate is actually declining, and for Hispanic and Black children, this rate continues to climb rapidly.

It is probably not surprising that health disparities are closely linked to what is termed, “the social determinants of health,” which can include everything from one’s education level to how close one lives to a landfill. It is important to remember that long histories of power inequality have led to many of these social determinants, and therefore, the increased health status of some groups over others.

In the United States, health disparities are certainly a reality. What struck me most at the conference, though, was a question posed at one of the panel discussions. The facilitator asked, “How can we combat health disparities, when the work requires that we give more to those at the bottom, while giving less to those at the top?” Though it caught me a bit off guard, this idea makes sense. Have-nots need more resources and support so that they can “catch up” so to speak, to the Haves. Though similar, this is not exactly Robin Hood logic. The rich wont necessarily be loosing out so that the poor can gain. The way the question was framed insinuated this, and it made me realize that this is exactly how some people think of health equity work. Potential supporters can be turned off to a cause when it seems like they will be deprived of something. We have seen this argument come up again and again with the Affordable Care Act. Saying things like “they’re going to make us ration health care if everyone is covered” or “we will have to wait longer to get appointments” fosters this exact type of thinking. The problem is that we’re framing it all wrong.

We need to highlight that it is important to give those at the bottom more support than we give those at the top, not even because they deserve it, but because they need it and the people at the top do not. A salient example is one from Chile, where everybody is covered for health insurance. Their public insurance option is tailored towards equity as opposed to equality—those who need more support get more support and those who need less support, well, they wont be missing out on any free services, because simply put, they don’t need them. New mothers in the lowest income bracket receive, among other things, free baby carriages. If the health sector were to view patients as equal, they’d give these to the wealthiest mothers, too. The majority of mothers in higher income brackets would probably not take the low-cost baby carriage, if they can and want to buy one of their choosing. Equity, on the other hand, still means that all mothers can and will have baby carriages, but that we should be intentional with how resources are delivered, targeting those most in need.

So, how can we in GlobeMed at Tufts use this idea of framing to combat health disparities with our partner organization, PHASE Nepal? Right now, we are fundraising through our individual giving campaign. So far we have raised almost $4500 for, our project right now, which is hitting an important determinant of health: that of childhood education. PHASE Nepal will take the funds we raise this year and hire a teacher trainer, who will work with currently employed teachers in elementary schools in the communities that PHASE serves. This trainer will help teachers utilize methods to foster creative thinking and problem solving among students of Nepal. He/she will also support child clubs, which operate as extracurricular forums for the children to play, learn, do local development projects such as planting gardens, and talk about child rights. Additionally, we envision the formation of a health curriculum to be taught as supplementary material in the Child Clubs, so that these children can begin to learn about the importance of having a healthy body and mind.

When we think about how to bolster our fundraising efforts, we need to be able to discuss how the situation in Nepal came to exist, and about the power structures that perpetuate such inequalities. When we talk about this stuff, we have to know how to frame it in a way that will help us build support for our chapter, PHASE, and the global health movement at large.

To learn more about PHASE’s work, please visit http://phasenepal.org/

To donate to our project, please visit https://www.globalgiving.org/projects/child-health-education-program-in-nepal/

Rachel Weinstock is a senior majoring in Anthropology and Community Health. She is a member of the policy team.

Advertisements

ACA Individual Mandate: Why You Should Stop Criticizing and Start Caring

ACA Blog picThough the Patient Protection and Affordable Care Act, commonly referred to as simply the ACA and Obamacare, is approximately 2,400 pages long in total length, there are key components of the act that spark a significant amount of controversy and debate. Enough debate to have the nation essentially split directly, and ultimately to have been a key factor in the recent government shutdown effective as of October 1st. Coincidentally and ironically, it was because of this government shutdown pertaining to the ACA that I could not obtain access to some documents on it. Fortunately there are many other non-government affiliated documents on the subject, and I’d like to hone on one major factor of the ACA, a contentious component that I feel is one of the most imperative, known as the individual mandate. The definition of the individual mandate, to go into effect with the anticipated implementation of Obamacare, is defined by kaiserhealthnews.org as “a provision of the federal health law that requires you, your children and anyone else that you claim as a dependent on your taxes to have health insurance in 2014 or pay a penalty. That coverage can be supplied through your job, public programs such as Medicare or Medicaid, or an individual policy that you purchase. The health law is setting up online health insurance marketplaces, also known as exchanges, to help you shop for plans.”

Republicans see it as a power-hungry move by the government for control and an infringement on their rights; however, if the end goal is of benefit to society as a whole, and literally promote the general welfare, that view cannot truly be upheld. On the side of Democrats, though in favor of the act, one of the controversial views regarding this mandate is that although its goal is aiming to close the disparity in those who can afford health insurance and those who cannot, it isn’t fully solving the problem in providing a universal health care system for all members of society in the United States. What I feel people are neglecting to remember, however, is that it is a step in the right direction, and if there are enough current issues between the two parties on simply obtaining this first victory, delving straight into the ultimate goal is inefficient and unrealistic. In addition, it is always positive to have two varying views on an issue in order to keep it in perspective.

The mandate of health insurance for all American citizens will additionally aid in eliminating the rising problem of individuals and families being denied health insurance, or charged higher, for preexisting health conditions, whether minor or not. Currently insurance companies have the power to dictate who gets what type of insurance in an attempt to ensure that they have the healthiest clients, in turn resulting in a vicious cycle of less fortunate citizens, monetarily and health-wise, continually receiving less care and a higher probability of health problems. Though it is easy to criticize new initiatives, the important thing is that it is still just that: new, progressive, an idea. And as Cardinal Mahony stated, “Any society, any nation, is judged on the basis of how it treats its weakest members ; the last, the least, the littlest.”