Racial and Socioeconomic Disparities in Healthcare
Despite experiencing illness at high rates, having the lowest life expectancy compared to other demographics, and being one of the most economically disadvantaged racial groups in America, current challenges to healthcare are affecting African-Americans at disproportionate rates. Native Americans, Hispanics, and those of lower socioeconomic status are also subject to such difficulties and inequalities. Health disparities and a lack of accessibility to healthcare services are all major issues that philanthropy needs to take into further consideration.
Understanding Disparities:
Health disparities are defined as “population-specific differences in the presence of disease, health outcomes, or access to healthcare,” according to the Health Resources and Services Administration.
Some factors that cause these differences:
1) Limited accessibility
2) Environmental problems
3) Food insecurity
Limited Accessibility:
According to the Health Resources and Services Administration (HRSA), Health Professional Service Areas (HPSAs) illustrate healthcare provider shortages by using either geographic, population, or facility-based data, taking into account primary care, dental health, and mental health. The HRSA also defines Medically Underserved Areas and Populations (MUA/Ps) as geographic areas or populations that do not have sufficient access to primary care providers; MUA/Ps identify the populations (i.e. the homeless, racial groups, low-income) that experience inadequate health services. Both HPSAs and MUA/Ps are important for highlighting the imbalance between healthcare availability and needs of care among varying groups of people.
Some Facts:
1) About 80 percent of Americans living in rural areas are "medically underserved"
2) The number of rural doctors is expected to decrease over 23 percent by the next decade while the number of urban doctors remains consistent
3) 640 US counties are medical deserts
A lack of medical access to those of low socioeconomic status is the result of multiple different factors:
1) Rural hospitals are enticed to larger and more stable hospital systems. Some rural facilities may not be financially secure enough to exist independently, causing them to shut down, forcing those who relied on those hospitals' care to travel greater distances to receive care elsewhere
2) Urban areas have more resources and higher education rates, attracting more medical students and thus more service
3) Public transportation is not as common in rural areas
Environmental Problems:
Environmental hazards such as water / air pollution and exposure to toxic chemicals are more prevalent among low-income and minority areas.
"A 2016 study of New Jersey residents found that the risk of dying early from long-term exposure to particle pollution was higher in communities with larger African American populations, lower home values and lower median income. Studies of Atlanta, GA, found that particle pollution increased the risk of asthma attacks for zip codes where poverty was high and among people eligible for Medicaid," ("Disparities").
Food Insecurity:
Today, about 1 in 8 Americans live in food insecure households and do not have the resources to maintain healthy, active lives; these households typically experience unemployment and poverty. Among the 40 million people living in food insecurity, 10 million earn incomes above the poverty line ($25,100 for a family of four), which is too high to be eligible for federal nutrition assistance ("Food Insecurity").The IHS:
A combination of underfunding and a lack of access to care facilities are typical barriers among the Native American population. Through the Indian Health Service (IHS) and other health centers, the federal government is required to provide direct medical care to Native Americans and Alaska Natives. Unfortunately, this organization is severely underfunded and only receives a fixed amount of money each year. The facilities on the reservation lands do not have proper equipment (such as MRI machines), and free drugs are exclusively available through these IHS establishments, which are hours away. As a matter of fact, IHS spending per person was $4,868 less than national healthcare funding (Kaiser Health News).The IHS's response to the current pandemic has made matters worse. Some tribal-run facilities reported having difficulties in treating their COVID-19 patients due to a lack of testing resources and personal protective equipment (PPE); in addition, not all IHS testing sites acquired rapid tests. In general, staffing shortages have been a long-standing problem within the IHS—the vacancy rate for care providers is 25 percent, ranging from 13 to 31 percent across eight different IHS locations ("Indian Health Service"). Consequently, IHS establishments fail to provide their patients with quality care and resort to sending them to receive treatment elsewhere. Targeting this problem is an issue in and of itself, as the IHS does not have access to agency-wide information on its number of temporary workers, preventing it from pinpointing the specific facilities that need more resources to improve IHS services across all its locations. Immediate action is essential, given that Native Americans and Alaskan Natives have the shortest life expectancies and are more likely to die from preventable causes than any other race in the United States ("Indian Health Service").
What Work Needs to be Done?
Philanthropy has enabled us to identify health disparities and has broadened our understandings of their trends among the US population. Through foundation-supported research and data collection, many organizations have provided the resources necessary to combat the flaws of America's healthcare disparities / system. However, philanthropy alone cannot achieve health equity for all: increased collaboration between nonprofits, government agencies, and communities is imperative to tackle the root causes of health disparities. For example, some institutions could from partnerships with government organizations like the Environmental Protection Agency to figure out how to address the issue of the prevalence of air and water pollution among minority and poor communities.
Furthermore, philanthropic efforts need to concentrate on reforming policy. Many nonprofits stray away from working directly with legislators since their mission statements are typically focused on fundraising or working on projects with health institutions and the community.
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