Ethical Concerns in Health Care Disparities - Research Paper Example

?Ethical Concerns in Health Care Disparities Racial and ethnic disparities in American healthcare system had long been a national concern with respect to healthcare access, quality of care, insurance coverage, and health outcomes in a diversified population of the country. Literatures purports that health care disparities is the result of inequalities in health care distribution, individual’s autonomy of choice or preference in lifestyle and beliefs, environmental and socio-economic discrimination, or some other factors of health status determinants affecting the minorities in the community. The U.S. policy makers had been vigilant in seeking resolutions to address issues on health care disparities in order to uphold justice and respect to the people. This paper presents the general concepts about health care disparities, focusing on the issues concerning ethics raised commonly raised by the people, as well as on the management of these issues that confronts the health care system of the U.S. First, it is important to convey a unanimous thought of the commonly used terms in this study. According to the Agency of Healthcare Research and Quality (2011), “health care seeks to prevent, diagnose, and treat disease and to improve the physical and mental well-being of all Americans.” In the 2003 National Healthcare Disparities Report, “disparity” means “the condition or fact of being unequal, as in age, rank, or degree”, synonymous with the word inequality, unlikeness, disproportion, and difference. It shall be noted that “health disparities” and “health care disparities” are two different terms, though both have close association in concept (Agency for Healthcare Research and Quality 2004). “Health care” refers to the access to or quality of services in the traditional Western medical care delivery system” while “health” refers to “overall health status and outcome related to a complex variety of influences and life expectancies, including access to high-quality preventive and curative care as needed” (Meyers 2007, p. 4). Health disparities then, as adapted from the U.S. Department of Health and Human Services definition, is the “differences in the occurrence, frequency, death, burden of diseases and other unfavorable health conditions that exist among specific population groups, including racial and ethnic minority groups” (American Society of Clinical Oncology 2009). Health care disparities, on the other hand, refers to “different people’s access to insurance, preventive services, and medical care or lack thereof,” while health status disparities refers to “the individual differences in disease prevalence, habits, and risks factors between various races and ethnicities” (National Business Group on Health 2011, p. 5). Differences in race are base on the physical (such as skin color, facial features, etc.) and genetic aspects among subgroups while differences in ethnicity consider the subgroups’ cultural, religious, political, and socioeconomic variables (Tobin 2010). The four major ethnic/racial groups frequently noted in literatures are the African Americans, Hispanics, Native Americans, and Asian Pacific Islander, and together with the poor, the mentally retarded, and the immigrants, these groups have experienced unequal burdens in health and health care observed from high morbidity and mortality rates (Baldwin 2003). To delimit the broad scope of disparities in health, this study focuses on health care disparities, per se, more specifically on the issues of ethical concerns. Furthermore, the World Health Organization or WHO (2011) presented the determinants of health that affect the individual or the community’s healthy status and these include: (1) the social and economic environment (income, culture, social status); (2) education; (3) physical environment; (4) social support networks; (5) health services; and (6) the person’s individual characteristics (genetic, gender) and behavior (lifestyle, exercise, eating patterns). Evidence showing the prevalence of disparities in the healthcare system of the U.S. was purported in the National Healthcare Disparities Report 2007 or NHDR (2008) of the AHRQ. The report stated the following: “Overall, disparities in quality and access for minority groups and poor populations have not been reduced since the first NHDR. Based on 2000 and 2001 data compared with 2004 and 2005 data, the number of measures on which disparities have gotten significantly or have remained unchanged since the first NHDR is higher than the number of measures on which they have gotten significantly better for Blacks, Hispanics, American Indians, and Alaska Natives, Asians, and poor populations.” (Agency for Healthcare Research and Quality 2008). Another review of literature showing prevalence of disparities in U.S. health care system in terms of the percentage of subgroups that lack primary care were 32% of Hispanics, 19.5% of black Americans, 16.8% of Asians, and only 10.4% of whites (Tobin 2010). One particular example is the infant mortality as a health indicator, where, in the study of Breen, Loyal, Littleton, Seblega, Paek, Meemon, Ellis, and Wan (2008, p. 14), the African-American mortality rate is more than twice the rate for white infants. Worse, the infant mortality rate of white women without even a high school diploma is better than that of college-educated African-American women (Breen, et al. 2008). The American Society of Clinical Oncology (2009) or ASCO also presented facts and figures of the prevalence of cancer in racial/ethnic minorities (ASCO data were derived from the National Cancer Institute). The data showed that total incidence of cancer and death rates are higher in minority populations: lung, prostate, and breast cancers have higher death rates among African-American and Hispanic patients (ASCO 2009). Now that it has been evidently proven that disparities is apparent in the U.S. health care system, the issue of ethical concern to address with is to identify the factors attributable to these inequalities. Ethical/moral framework, as the basis for the efforts of resolving health care disparities, is presented in the report of Dr. John Stone (n.d.) of Creighton University, as he cited Powers and Faden’s literature, which states that: All have equal and significant moral worth. All are due equal and substantial respect and care. Justice must be a guide. All have a right to health and other conditions that promotes a sufficient level of well-being, given practical constraints. Institutions and professionals must be trustworthy regarding this moral framework. Since health care deals about different aspects of human life (health and wellness, diseases, death, nutrition, support, etc.), ethical concerns with respect to inequalities are continuously raised by many people. Again, it shall be emphasized that health care disparities is the inequality in quality of care, distribution or access to health services, health insurance, and other preventive measures to safeguard health (such as immunization, vaccination, cancer screening), where ethical concerns herein explored are centered. The common ethical concerns mentioned in literatures that disparities result from the inequalities in the distribution or access to care services, individual’s autonomy, and the racial, environmental, and socioeconomic factors. As to distribution, the ethical dilemma that minorities often receive a lower quality of care that their non-minority counterparts, regardless of socioeconomic status, is often the core ethical concern among health care disparity issues (Breen, et al. 2008, p. 15). Ethical concern whether health care services are distributed using “rights” and “utility” bases of approach were tackled by Johnson (2011), where rights-based approach stresses the autonomy of an individual, while the utilitarian approach stresses the good of the whole. The rights-based approach holds that individuals have rights to care they need at any given time, while utilitarian approach is based on a cost-benefit analysis where the minimum standard of care is meant to be distributed over the widest possible area (Johnson 2011). Similarly association to health care distribution is the access to health care in the form of health insurance coverage by which, according to Crowley, Neubauer, Fleming, Bronson, Centor, Gluckman, Holm, Liebow, Mayer, McLean, Musana, Reynolds, Rudy, and Yehia (2010, p. 4) of the American College of Physicians, “providing all legal residents with affordable health insurance is an essential part of eliminating racial and ethnic disparities in health care.” Crowley, et al. (2010) furthered that consequences of lack of access to adequate health insurance impairs the individual’s ability to receive preventive care and in the management of health problems such as chronic diseases. In the study of Crowley, et al. (2010), minorities are less insured compared to whites with rates as follows: nearly 32% of Native Americans/Native Alaskans are uninsured; about 31% of Hispanic; and only about 11% of whites have no health insurances. The next ethical concern in health care disparities is the individual’s autonomy of personal choices (lifestyle, diet, exercise, visiting a doctor, grabbing the opportunity of the government’s free health programs, services, and assistance, etc.), being the reason of inequalities. According to Tobin (2010), because everyone is born with free will, health-related decisions (such as the kind of lifestyle, health patterns, choice of treatment, acceptance or refusal to medication, etc.) are autonomous to the individual’s preference. Thus, physicians and other health care professionals should respect and maintain confidentiality of the patient and his records, likewise promoting health and wellness through patient education. Also because of personal preferences that people’s lifestyle patterns vary from one another. One may be physically active and maintains healthy diet while others may have a sedentary lifestyle and do not pay attention to the kind of food that they eat. In Tobin’s (2010) review, rates of obesity are as follows: African-American women-53%; Mexican-American women-52%; and Caucasian women-34%. Hence, researchers believe that 30% of an individual’s mortality can be determined by his lifestyle (Tobin 2010). Another ethical concern is the racial, environmental, and socioeconomic factors claimed by some as contributors to health care disparities (Tobin 2010). Some people live in a kind of environment with greater health risks and hazards or others may reside in, somewhat, not usually accessible areas, particularly rural and remote locations far from health centers and health care facilities resulting to limit their access to some health care services. According to Braveman, Egerter, An, and Williams (2009) of University of California, San Francisco, Center of Social Disparities in Health, “both racial or ethnic group and socioeconomic factors reflect differential access to different resources and opportunities that can hurt or enhance health, over lifetime or across generations”. In the study of LaVeist, Thorpe Jr., Galarraga, Bower, and Garry-Webb (2009) of Hopkins Center for Health Disparities Solutions, found out that race disparities in diabetes may stem from differences in the health risks environments that African Americans and whites live but with these subgroups living in similar risk environments, their health outcomes are more similar. As to socioeconomic factor, those with high income have greater capacity to buy nutritious foods and supplements, can go for education and acquire knowledge about maintaining good health, and they can afford treatment and medication in the presence of diseases. Whereas, the poor or those with limited income have also limited capacity in terms of nutritive foods buying, limited access to health-related knowledge and education, and they cannot afford those expensive medical treatments and medicines. Thus, socioeconomic factors directly affect the individual’s access to goods, products, and services that promotes health and wellness. The study of Randolph (2008) of West Virginia University, showed evidence that communities in Appalachian region, in particular, who suffer adverse socioeconomic conditions (such as high unemployment, lower educational achievement, and lower per capita income) were associated in areas with more adverse socioeconomic status and adverse health outcomes. Consequently, the U.S. health care policy makers were not timid to just ignore health care disparities dilemma in the country. The Institute for Alternative Futures (2006, p. 3) report presented the most important disparity reducing advances in U.S. health care and public health which include community and environment efforts, technology, individual and family focused efforts, and prevention and treatment efforts by health care providers. Recommendations in this report were addresses to the three sectors: health care, community, government and business (Institute for Alternative Futures 2006, p. 15). Within the health care sector, recommended are: (1) diverse employment, cultural and linguistic competence, (3) the integration of screening, prevention, and health education, (4) the provision of mental health services and a stronger system of referrals, and (5) advocacy and role model behaviors from health professionals. For the community sector, greater involvement for community-based organizations is advocated, like in schools to promote health education, nutritious food, and physical activity programs among the students (p. 15). In the business sector, participation is encouraged with working conditions, provision of health insurance, community investments, and creation of more jobs, while in the government level, planning for investment in community infrastructure and services, support for research and development and regulatory policies to improve the livability of environments, are recommended (p. 16). To evaluate the effectiveness of policies implemented over the past few years addressed to resolve issues on health care disparities, the most recent 2010 National Healthcare Disparities Report showed the following recent updates in the U.S. health care status (Agency for Healthcare Research and Quality 2011): Health care quality and access are not good enough or below the optimal level, especially for minority and low-income groups. There is improvement in the quality of care but not in access and disparity. Immediate attention is assured on the improvements, quality, and reduction in disparities with respect to some services, locations, and subgroups including: diabetes management and cancer screening; central part states; rural and inner city residents; and inequalities in the access to care and preventive services. The flow of eight national priorities is uneven: improving in quality are (1) End-of-Life and Palliative Care and (2) Patient and Family Engagement; lagging are (3) Access, (4) Safety, (5) Health, and (6) Population; areas requiring assessment are on (6) Health System Infrastructure, (7) Overuse, and (8) Care Coordination. In conclusion, though it has evidently been conveyed on literatures and studies that health care disparities is still apparent in the U.S. health care system, improvements in some areas of concern, somehow, uplift people’s hopes that justice will be achieved or at least minimize the burden of inequalities, eventually. Due to the complexities of many health care disparities issues that calls for resolutions, reaching the ideals of having the fairest, more effective, and excellent health care system will take a long way to be materialized. Healthcare professionals have the most important roles in the materialization of the country’s goal of closing the gap of disparities for they are the ones who interact directly to the individuals as patient. Thus, encouraged among all healthcare professionals is the personal initiative to uphold the standard of ethics in professional practice where all patients of diversity are being treated fairly as the core priority that deserves respect, utmost care, and safety, regardless of gender, age, background, color, race/ethnicity, and origin. References Agency for Healthcare Research and Quality. (2008). National healthcare disparities report 2007: At a glance. U.S. Department of Health and Human Services. Rockville, MD. Retrieved from http://www.ahrq.gov/qual/nhdr07/nhdr07.pdf Agency for Healthcare Research and Quality. (2004). National healthcare disparities report 2003: Summary. U.S. Department of Health and Human Services. Rockville, MD. Retrieved from http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm#WhatAre Agency for Healthcare Research and Quality. (2011). 2010 National healthcare disparities report. U.S. Department of Health and Human Services. Retrieved from http://www.ahrq.gov/qual/nhdr10/nhdr10.pdf American Society of Clinical Oncology. (2009). Health and disparities in the United States: Facts and figures. Retrieved from http://www.asco.org/ASCO/Downloads/Cancer%20Policy%20and%20Clinical%20Affairs/Quality%20of%20Care/Health%20Disparities%20Fact%20Sheet.pdf Baldwin, D. M. (2003, January 31). Disparities in health care: Focusing efforts to eliminate unequal burdens. Online Journal of Issues in Nursing, 8(1:1). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/DisparitiesinHealthandHealthCare.aspx Braveman, P., Egerter, S., An, J., & Williams, D. (2009). Race and socioeconomic factors affect opportunities for better health, 1-14. Robert Wood Johnson Foundation, Commission to Build a Healthier America. Retrieved from http://www.commissiononhealth.org/PDF/506edea1-f160-4728-9539-aba2357047e3/Issue%20Brief%205%20April%2009%20-%20Race%20and%20Socioeconomic%20Factors.pdf Breen, G.M., Loyal, M., Littleton, V., Seblega, B.K., Paek, S.C., Meemon, N., Ellis, N.E., and Wan, T.T. (2008). An ethical analysis of contemporary healthcare practices and issues. Online Journal of Health Ethics, 5(2), 1-20. Retrieved from http://www.ojhe.org/index.php/ojhe/article/download/111/148 Crowley, R., Neubauer, R., Fleming, D., Bronson, D.L., Centor, R.M., Gluckman, R.A., . . . Yehia, B. (2010). Racial and ethnic disparities in health care, updated 2010 (pp. 1-21). A Position Paper of the American College of Physicians. Retrieved from http://www.acponline.org/advocacy/where_we_stand/access/racial_disparities.pdf Institute for Alternative Futures. (2006). The DRA project: Accelerating disparity reducing advances. Retrieved from http://www.altfutures.com/pubs/DRA/Report_06_08_Most_Important_Disparity_Reducing_Advances_in_US_Healthcare__Public_Health.pdf Johnson, W. (2011). Ethical issues in health care delivery. eHow Health. Retrieved from http://www.ehow.com/list_5851631_ethical-issues-health-care-delivery.html LaVeist, T.A., Thorpe Jr., R.J., Galarraga, J.E., Bower, K.M., & Garry-Webb, T.L. (2009). Environmental and socioeconomic factors as contributors to racial disparities in diabetes prevalence. Hopkins Center for Health Disparities Solutions. Retrieved from http://www.nyshealthfoundation.org/userfiles/file/Hopkins_Diabetes%20Study.pdf Meyers, K. S. H. (2007). Racial and ethnic health disparities: Influences, factors, and policy opportunities, pp. 1-26. Kaiser Permanente Institute for Health Policy. Retrieved from http://www.kpinstituteforhealthpolicy.org/kpihp/CMS/Files/Meyers%20IHP_Disparities-Influences,%20Actors%20031907.pdf National Business Group on Health. (2011). Racial and ethnic disparities in the workplace: Achieving equity among the insured. Retrieved from http://www.businessgrouphealth.org/ppt/Racial_Ethnic_Health_Disparities_040411.ppt Randolph, M.B. (2008). Underlying socioeconomic factors influencing health disparities in the Appalachian region. Cancer Center/Office for Social Environment and Health Research, Department of Community Medicine. West Virginia University. Retrieved from http://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=9 Stone, J.R. (n.d.). Ethics of health disparities. Retrieved from http://chpe.creighton.edu/people/profiles/ppts/ethics_health_disparities.ppt Tobin, M. B. (2010). Racial and ethnic disparities in the U.S. healthcare system. Internet Journal of Catholic Bioethics, 5(1). Retrieved from http://icbbioethics.com/archives.php?entry=107 World Health Organization (WHO). (2011). Health impact assessment: The determinants of health. Retrieved from http://www.who.int/hia/evidence/doh/en/ Read More