Poverty as a Factor in the Distribution of Health and Healthcare - Essay Example

Sociology and Health: Poverty as a factor in the distribution of health and healthcare. Project Submitted By Executive Summary This brief write up discusses the impact of poverty and stratification of society on access to medical facilities and health care for the economically challenged classes in societies, taking into consideration the current scenario globally and with respect to the various views and theories expressed by eminent sociologists. The paper is an attempt at finding solutions to the problem. Introduction Sociology concerns itself with the situational analysis of mankind, in relation to the culture, mode of life, use of resources and facilities, and faith... It varies in analysis from group to group. The vast geographical differences and variations deter the sociologist from predicting or recommending any one universal solution. Culture plays a very important role in the life of ethnic groups, and various races of people. Faith and belief have been handed down for generations and it is not easy to modify the way of life without meeting large scale resistance. Modern societies which have a high degree of refinement and achievements in technology and science also suffer from the gap in the cultures of the community that makes up the state. In UK the problem is more complex. Poverty exists not only within the English society but also in the ethnic groups who are diverse like the Irish, Welsh and Scottish people. Added to that immigrants and settlers from the East and other European nationals who are the citizens of UK are to be considered. While the English society has class distinctions based on ancient work culture, with other communities it is more complex. Many things and factors intervene. Religion and belief in a system will also hamper any attempt to introduce a new concept. For example birth control measures require the use of a condom. The same condom is also necessary to prevent infection from sexually transmitted diseases. However we find that many communities oppose the use of this device either for birth control or for safe intercourse. This is because the underlying currents of religious and ‘moral thing to do’ attitude is stronger in people than the factual logic that can suggest the use of the condom. Similarly poverty between the social classes and the stratification of society locks out many social amenities, the chief being medical and health facilities followed by education. Both the important aspect of human life, health and education are denied to vast groups of people, either because they are not affordable, or because of prevalent notions that ‘it is against our community’ or ‘against religion’ attitude. We cannot address the deprivation caused to many who belong to religious sects or groups who are subject to deprivation on account of the religious tenets, which may in extreme cases, dictate that ‘prayer to the lord is better to cure diseases than medicine’.1 There is however a singular issue where the affluent get the benefit of health care and the lesser classes go without it on account of want of resources. This can be addressed to see if we can provide a better solution making healthcare and allied activities affordable and within the reach of such marginalized classes. The situation in UK is very peculiar, as we have stated above, with multiple classes and the ‘minority’ classes, as distinct from the strata of the English, Welsh, Scottish, and Irish people all of whom are having strata or ladders of inequality based on occupation, income or situation in life. Definitions Defining disparities in health care Disparities can be defined in a modern context as the denial of facilities to a group of people in a state or location on account of their economic, political, social or race concerns. In other words, what is available to the community as a whole is denied to a class of citizens based on their difference. It is in particular to health concerns, a result of - “Disparities in health can arise from personal, socioeconomic, and environmental characteristics—variables that are external to the health care system and exist prior to the individual entering the system. Disparities in health status are known to correlate with income levels, adequacy and safety of housing, employment status, education level, lifestyle choices (e.g., tobacco use, alcohol use, diet, exercise), environmental conditions (e.g., air and water quality, pesticides, green space),and social conditions (e.g., crime rates, employment opportunities).”2 The disparity where income is a consideration can arise on account of the financial status of the community or the class they belong. The group is barred entry to accessing health care for want of material and financial resources and the apathy of the healthcare professionals. “Disparities in health care access are most often associated with barriers of entry into the health care delivery system. Factors impeding access to health care include a lack of financial resources, a cultural preference that discourages health-seeking behavior, low health literacy levels, language barriers, lack of diversity in the health care workforce, and a mistrust of the health care system due to a prior negative experience. Additional impediments to access include systemic barriers such as the lack of available and proximate providers, the lack of transportation, the lack of or poor health insurance coverage, the lack of access to a regular source of care, and legal or bureaucratic barriers to receiving public aid. Health”3 Income related Disparities – Poverty and Health Care The status of developed countries and developing countries in this regard vary. In some countries like Ethiopia and Angola, poverty alone is not a cause, as the entire nation has a very low GDP. The causes in such nations where very few are affluent are more or less a result of non availability of infrastructure and health care personnel. Poverty and the health care correlation in such countries are a faulty variable. In developing countries like the Middle East, China and India which have ample resources, Poverty does play a very critical role. However the government of these countries have taken steps to provide free medical aid based on income at most districts by opening free hospitals called ‘General Hospitals’ where all treatment is free. National programs like inoculation, vaccination is also free for all citizens. However even though the provision is present, where disease is something of a more serious nature, like Cancer, AIDS and heart or kidney trouble, then the income gap tells upon the service. Such treatment is closed to the low income classes who are dependent on small ‘dispensaries’ for their health needs. In most countries medical insurance is an unknown thing. Socialist governments provide for employees welfare by running subsidized hospitals which are instrumental in providing compulsory health care to employees. In India, the ESI act4 makes it mandatory for employers to contribute to the fund which provides employees and their dependants with medical care at hospitals. However, 70% of the agrarian community finds no scope in the act. It is not therefore possible to seek the universal situation and we have to confine ourselves to the working of the capitalist society and developed nations where the Income – Resource disparity still exists. Poverty and denial – What is denied? Insurance The high cost of insurance which is not afforded by the lower economic strata robs them of a great source. This not only point out to economic disparity but also racial inequalities. Regular Medical Help Patients who are not in affluent circumstances will not get the attention of doctors and other practitioners except at charity clinics and public hospitals that attend to patients for a nominal fee. This results in this class of people doing away with consulting, and relying on quack remedies until something very serious develops to be admitted in emergency care. In any emergency, the persons who lack resources not only are denied the services on account of their indigent condition, but become indebted on account of borrowing. Therefore this is a very important issue that merits serious consideration, for it not only weakens the society but creates debts and strife. The Classical Sociological Views The effects of income disparity has been taken up and explored by many sociologists like Durkheim, Karl Marx, and Weber. Durkheim has explored the division of labor in depth and has come up with the theory of Functionalism - The sociological perspective concerned with how various parts of a society or social system affect other parts within that system, and how they function in the overall continuity of that system. This together with considering the system as an organ whole needs that each individual part be kept in proper shape to maintain the entire system. “Common among industrial societies as the division of labor increases. Though individuals perform different tasks and often have different values and interests, the order and very survival of society depends on their reliance on each other to perform their specific task.”5 Thus there cannot be neglect of any one individual and his well being is of paramount importance. To neglect or leave to their fate a group in the interwoven society will result in chaos. “"...Even where society relies most completely upon the division of labor, it does not become a jumble of juxtaposed atoms, between which it can establish only external, transient contacts. Rather the members are united by ties which extend deeper and far beyond the short moments during which the exchange is made. Each of the functions that they exercise is, in a fixed way, dependent upon others, and with them forms a solidity system."6 Karl Marx on the other hand saw the class struggle in perspective of the affluent that cornered the resources and the labor which slaved for them. Social justice demanded that a part of the surplus produced by the labor class be handed back as incentives. “From the moment when labor can no longer be converted into capital, money, or rent, into a social power capable of being monopolized, i.e., from the moment when individual property can no longer be transformed into bourgeois property, into capital, from that moment, you say, individuality vanishes. You must, therefore, confess that by "individual" you mean no other person than the bourgeois, than the middle-class owner of property. This person must, indeed, be swept out of the way, and made impossible.”7 To overcome disparity among the classes, Marx suggested that the following ten percepts will help mankind overcome deprivation in general: 1. Abolition of property in land and application of all rents of land to public purposes. 2. A heavy progressive or graduated income tax. 3. Abolition of all rights of inheritance. 4. Confiscation of the property of all emigrants and rebels. 5. Centralization of credit in the banks of the state, by means of a national bank with state capital and an exclusive monopoly. 6. Centralization of the means of communication and transport in the hands of the state. 7. Extension of factories and instruments of production owned by the state; the bringing into cultivation of waste lands, and the improvement of the soil generally in accordance with a common plan. 8. Equal obligation of all to work. Establishment of industrial armies, especially for agriculture. 9. Combination of agriculture with manufacturing industries; gradual abolition of all the distinction between town and country by a more equable distribution of the populace over the country. 10. Free education for all children in public schools. Abolition of children's factory labor in its present form. Combination of education with industrial production, etc. 8 Weber argues that the rise of capitalism is a very important factor in erasing disparities among the population. According to him, when a political climate exists whereby the individual is able to expand his resources, benefits automatically follows in a situation where there is a free economy. Thus the poverty of the people will directly be related to the ability and will to perform functions in the society. He suggests that by interfering minimally it is possible to create infrastructures that can take care of the marginalized in the society. He expands this into a theory of geopolitics, using as a particular illustration the prediction of the future decline of Russian world power. “The broad view of Weber’s works shows that Weberian sociology remains intellectually alive and that many of his theories still represent the frontier of our knowledge about large-scale social processes.”9 In the modern economy, where we get to see all systems function in unison, like the capitalist states of USA & Europe, and the Communist China, Socialist states like India and many dictatorships all at once, we cannot deny that in all these systems, poverty is persistent, and does result in the disparities of medical access to poor people. It is not possible to isolate the phenomenon on the type of polity, but rather ought to be seen as a cumulative result of inadequate social and governing fabric, and unplanned allocation of resources. Tardiness in speculating on the what-if scenario in relation to the under privileged and the available resources in terms of infrastructure, personnel, and tools on a population – per capita availability and planning properly could result in this anomaly. The Distinctions and Developments in U.K. The class distinctions and the plight of the working class was highlighted by the Marxian philosopher Hegel. While he drew attention to the general plight and poverty, he made a very pointed reference to poverty which caused hunger and general fall in health. Health care in Britain came much later, and is entwined with its history. The poor laws provided for infirmaries for sick people. In the 1800s, the Pauper was admitted to the infirmaries and the requirement of being declared a pauper was removed in 1885. Though Britain began to institutionalize the health care in her colonies, we may observe that health care was left to the charity and voluntary agencies and private practitioners. The local government took over the Poor Law hospitals only in 1930, after the Poor Law Act was amended. These hospitals were then unified when the National Health Service was formed in 1948. According to Aneurin Bevan, the founder of the NHS, the aim of the scheme was to create a right to “be registered with a general practitioner, and the right to be medically examined. This generally means that a general practitioner must visit a patient on the list that makes a request, though it has been accepted that examination at a distance may be feasible. There is no formal right to receive any treatment. This is within the discretion, or 'clinical judgment', of the doctor.” Further the “NHS is held to protect all citizens. Access to health services depends on registration with a general practitioner. Homeless people in particular have great difficulty gaining access to primary care, because without an address it is generally impossible to register.”10 This highlights one of the important problems as related to poverty and consequent denial of health care. While the original idea was to provide free delivery of the services, charges were introduced “by the Labor government in 1950. They were substantially increased by the Conservative government after 1979. The 1988 Act removed free eye tests.”(ibid) “Complaints about the NHS tend to focus on the problems of hospitals: waiting lists, lack of spare capacity, and 'shroud-waving' in response to spending controls. The severity of the problems is possibly exaggerated. Enoch Powell, a former Minister for Health, commented on "the continual, deafening chorus of complaint " which characterizes the NHS. By contrast with the private sector, where people always pretend that things are better than they are, the system of finance in the NHS "endows everyone providing as well as using it with a vested interest in denigrating it"11 The government is proud of the service. Prime Minister Gordon Brown said: "No institution touches the lives of the British people like the NHS. It is part of what makes Britain the place it is. Yet no modern health service that aspires to respond to its citizen's needs and expectations can afford to stand still. I believe we need to listen to patients experience and expectations to forge a new partnership with doctors, nurses and other practitioners and together produce a way forward that will lead to an NHS that is changing to be truly patient-led and ever more responsive to their needs." 12 Modern Outlook & Implications The modern outlook on health disparities can refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. It has been studied for various variables like income, race, and other factors prevalent in a region. Often income and racial factors appear to go hand in hand. “In the United States, health disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos. When compared to whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes.”13 Much of the evidence on social differences in health in Britain is measured in terms of social or occupational class. The classification is done by the Registrar General. Usually men and single women are counted by their vocation. Children are counted by the vocation of the head of the house. Married women who are dependants are classified with the vocation of their husbands. There are thus eight social classes. The health of the population of a class are largely dependent on affluence to afford better diet, time for physical activities, access to gyms and sport venues, and individual sexual behaviour. Poverty alters the behaviour of the classes introducing undesirable variables like social exclusion, discrimination, shelter, and education. In modern Britain poverty binds many classes of people including the natives and immigrants, who are walled in to conditions where the social intercourse and access to health facilities are virtually denied. According to studies, poverty results in affluent countries in a lack of insurance coverage. “Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites.”14 While that is true at the U.S, in Britain the Insurance and better medical facilities including that of practitioners are not available to the underprivileged class, who must therefore settle for alternate remedies or quacks. Many diseases go unreported and untreated. Poor people are also discriminated against by the health care providers, especially where it is conducted by private enterprise: Health care providers either unconsciously or consciously treat certain patients differently than other patients. Poor people in rented accommodation tend to live in unhealthy neighborhoods, have poorer physical health, and be more socially excluded than home owners. Poor home owners, on the other hand, tend to suffer more from physical accommodation problems and poor mental health. Using the Poverty and Social Exclusion Survey, approach to the measurement of poverty, it is estimated that 25% of the adult population of Britain is poor. Amongst outright owners, the figure is 15%, and for people with a mortgage, 17%. In the private rented sector, over one third is defined as poor, and in the social rented sector, 61%.15 The Commonwealth Fund, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities: • Consistent racial and ethnic data collection by health care providers. • Effective evaluation of disparities-reduction programs. • Minimum standards for culturally and linguistically competent health services. • Greater minority representation within the health care workforce. • Establishment or enhancement of government offices of minority health. • Expanded access to services for all ethnic and racial groups. • Involvement of all health system representatives in minority health improvement efforts. 16 Easing Disparity Some lessons can be learned from the experience of the 5 year plans of India which has succeeded in creating an affordable health program for the indigent communities in the village level. Each village is equipped with a primary health centre that controls distribution of essential medicines, epidemic control and free inoculation. Free enterprises have set up mega hospitals that also provide for charitable wards with free treatment. The government hospitals and medical colleges provide free treatment for all diseases. The same effect was achieved by China which has mixed the traditional Chinese medicine and modern medicine to provide health care at the very grass root level. Is socialism the cure? We cannot be sure of the effectiveness of socializing the health sector. An alternate system which can cater to all persons whose income is below the normal tax payer limit in these lines as experimented in India will help end this denial to the weaker class in society. Conclusion In conclusion, we are able to note that there is a connection between denials of basic medical services to the poor class in the society. We may add that the state ought to introduce a state sponsored insurance policy whereby the premium is adjusted from the social security fund of individuals in such a way that all citizens receive the benefits of insurance for basic medical facilities. Further the employees of any enterprise can be protected by an organization that seeks their welfare especially in health to which the state, the employer and the employee contribute. Active planning and participation of the Sate, charitable organizations, medical professionals and the elite ought to bring about a social transformation. The NHS must be made free to the community, and its costs subsidized from the government funds. If developing nations like China and India, which reel from a very heavy population and demand for scarce resources can provide free medical facilities, it is not such a high task for UK. Reference & Bibliography Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Health Policy Institute of Ohio (November 2004). Reed Tuckson, M.D., Vice President,American Medical Association November 2004 Health Policy Institute of Ohio Understanding Health Disparities Randall Collins   Weberian Sociological Theory (ISBN-13: 9780521306980 | ISBN-10: 0521306981) Durkheim, Emile. 1933. The Division of Labor in Society Translated by George Simpson. New York: The Free Press. P Townsend, N Davidson, M Whitehead, 1990, Inequalities in health, Penguin J. McDonough, B. Gibbs, J. Scott-Harris, K. Kronebusch, A. Navarro, and K. A. Taylor, "State Policy Agenda to Eliminate Racial and Ethnic Health Disparities," Commonwealth Fund (June 2004). http://en.wikipedia.org/wiki/Health_disparities#References (07/07/07) http://www.marxist.com/150years/manifesto2.html (07/07/07) http://www.medicalnewstoday.com/medicalnews.php?newsid=63965 (ref on 07/07/2007) http://www2.rgu.ac.uk/publicpolicy/introduction/health.htm http://www2.rgu.ac.uk/publicpolicy/introduction/health.htm#UKH Kaiser Commission on Medicaid and the Uninsured (KCMU), "The Uninsured and Their Access to Health Care" (December 2003). Read More