Guest Author: Katharine Pitt
BSN, RN
“The country is in a state of healthcare denial. The U.S. lags other industrialized nations in many important health measures. Citizens of certain races, ethnicities, and incomes experience poorer versions of U.S health care than others. The disparities are glaring” (Brown, 2015).
Indeed, the American healthcare system eerily resembles and favors an archaic class system.
At the top of the class are the elite, with the best healthcare that money can buy, and at the bottom are the impoverished, with a decreased life expectancy.
To put the crisis of healthcare disparities into perspective, let’s create an example.
Alexa is a thirty-year-old, upper-class, Caucasian-American woman that has scheduled her delivery at the number one hospital in her area; she feels confident and equipped for delivery, as she has the best OB-GYN and birth team.
Alexa has had excellent prenatal care throughout the duration of her pregnancy and has taken birthing classes with her husband.
Tasha is a twenty-seven-year-old, lower income, impoverished African American woman. Tasha did not see a doctor until she was five months pregnant. Tasha will be a single parent, has no birth plan, and just learned that she has gestational diabetes.
Two women, close to the same age, however the difference in class will be the disparity in their deliveries.
A healthcare disparity is defined as a difference in health due to one’s economic, social, or environmental status (SL, 2017).
Addressing healthcare disparities is of the utmost importance, as they indirectly affect the entire population.
Lifespans are shortened, quality of life is decreased, lives are lost, and the economic burden from the fallout is heavy on the healthcare system.
The most powerful nation in the world must work to eliminate these disparities.
It is due to multiple factors nevertheless; research has shown that minorities are disproportionately affected when it comes to healthcare disparities (Brown, 2015).
However, in order to eliminate the disparities, one must understand the root of the issue.
Thousands of minorities face disparities in health care due to social determinants, rather determinants of health (Brown, 2015).
Discrimination, financial status, education level, culture, and one’s physical location all play a deeply rooted role in one’s health. Discrimination in the workforce results in being passed over for the higher paying job.
Not getting the opportunity to be promoted means no opportunity for one to increase their salary.
Without the salary increase, one cannot afford to move to a cleaner, crime free, neighborhood that is in a better school district.
A lower rated school results in a lesser quality education.
A lesser quality of education may result in literacy issues.
One struggling with literacy issues is excluded from higher paying career opportunities automatically, thus repeating the determinants of health cycle once again.
As a psychiatric nurse caring for patients in a culturally diverse city, it is imperative that I identify any disparities in my patients upon admission.
Although the city of Norfolk is very diverse, over half of the patients that I care for are minorities that suffer from mental health issues.
The majority of my patients enter homeless, many of them struggle with literacy, do not have a high school diploma, are noncompliant with medication, and are not aware of what medication they are even supposed to be taking.
I have seen many patients be re-admitted, as many of them did not have a firm discharge plan in place.
The hospital does not prefer re-admissions, as they are penalized for them financially under the Affordable Care Act (SL, 2017).
However, it is not feasible for a middle-aged African-American, homeless, schizophrenic male to prioritize taking his medication twice daily.
It is not feasible for that same male to find transportation in order to attend his follow-up appointment.
It is not feasible for that same male to check his blood sugar three times daily.
It is not feasible for that same male to maintain a healthy diet as he lacks the financial resources in order to do so.
Failing to identify the disparity upon admission, fails the patient upon their discharge.
As it is imperative to reduce and thereby eliminate the disparities in the U.S. healthcare system, the options for how to accomplish this must be decided upon.
As previously stated, the disparities identified are due to systemic racism, socioeconomic status, lack of education, and geographic location.
Systemic racism has negatively impacted hundreds of communities, so steps must first be taken in order to reduce the negative impact.
Communities of opportunity may be established with the goal being to provide access where there is none (Williams, 2019).
These communities would provide childcare, head-start programs, and accredited public schools. Providing early child developmental resources would allow working parents to attend work without worry and further financial strain.
Furthermore, if a child is well-loved and cared for, they tend to thrive mentally. If a child is not worrying about whether they will have food to eat or are going to be cared for, they are then able to focus on the educational challenges set before them.
Reducing the lack of educational opportunities within a community in turn greatly reduces the poverty level within the community (Williams, 2019).
However, these opportunity communities must not end at providing resources for children only.
Opportunity communities would also need to provide work opportunities, and stable safe housing for adults.
In fighting to eliminate health disparities, there must be diversity in the healthcare workforce, preventative healthcare strategies, and targeting the patient’s social needs.
According to research, many physicians have had unconscious bias when treating minority patients (Nesbitt, 2016).
Education in the form of conferences, round tables, and symposiums are needed in order to remove the bias physicians may have when treating their patients.
Working in healthcare is a practice in diversity training, when already diversified, however, one tends to individualize their care better.
The physician must be aware of the patient’s social needs prior to prescribing or educating.
Is the patient able to read the handout that you provided? Does the patient live near a pharmacy? Does the patient have access to the healthier food options that you are suggesting?
If these disparities are targeted and addressed, they can be eliminated.
If the goal is to eliminate healthcare disparities in the U.S., the solution must be to improve access to care, while simultaneously reducing social determinants of health (Haggerty, 2018).
The solution, while imperative to carry out, is a multi-faceted one.
Improving access to high quality care for all will require legislation.
In order to reduce the social determinants, however, physicians will need to undertake cultural sensitivity training, hospitals and offices will need to diversify their staff, and opportunity communities will need to be raised up.
The legislative changes must happen, however, that legislation must not be in vain.
If the social determinants are not reduced, then the legislation is only as good as the paper it is written on.
Ethics must always be taken into consideration when implementing a solution.
Healthcare providers have a duty to practice ethically, and even in eliminating healthcare disparities they must do so.
Nevertheless, the act of even attempting to eliminate the determinant is the provider practicing the principle of beneficence.
The goal of a healthcare visit is to contribute to the welfare of the patient, and targeting their social determinants is contributing to the patient’s welfare.
On the contrary, to not address patient’s social determinants at all would be nonmaleficence (Gillon, 2015).
It would be callous to prescribe treatment, or to educate without recognizing the barriers in the patient’s way.
By addressing the social determinants, this naturally brings about the principal of fidelity.
Taking all these principals into account, the provider must not forget to allow patient autonomy.
The provider can attempt to eliminate the disparities; however, it must be in partnership with the patient.
In improving access to higher quality care, there must be healthcare providers willing to practice within underserved communities.
Location determines accessibility, if the higher quality care is not located within an impoverished community there is no access.
Reducing the other determinants of health will require a change in the package of the healthcare system.
Providers will need to be of various cultural backgrounds.
Providers will need to be educated not only on targeting social determinants but listening and responding appropriately to them.
Providers will need to attend semi-annual cultural sensitivity training in order to re-evaluate their possible bias in their delivery of healthcare.
Lastly, providers will need to become members of health-care organizations that are invested in eliminating disparities.
Healthcare disparities result in deaths daily, reduce the overall quality of care, and cause economic strain on the healthcare system.
In order to eliminate the disparity, the provider must first identify that it exists.
It is crucial that the provider targets and treats based on the social determinants of the patient.
To not identify the determinants is to continue exacerbating the disparity.
In targeting the disparities, the system must have providers that look like the patients in place as well.
These changes must be implemented expediently and ethically.
We must work to narrow the disparity gap every upon every admission.
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