Health Disparities: A Case Study

1) The National Institutes of Health (NIH) define healthcare disparities as “differences in access to or availability of facilities and services” (National Institutes of Health [NIH], 2018). These healthcare disparities result in health status disparities which are defined as “variation in rates of disease occurrence and disabilities between socioeconomic and/or geographically defined population groups (NIH, 2018). Essentially, disparate access to healthcare services amongst certain groups of people leads to variation in health-related outcomes compared to those with access. The outcomes of those suffering from healthcare disparities such as lack of insurance and lack of access to healthcare services, whether primary, emergency or mental health care lead to poorer health

outcomes.

Viewing health status disparities through a lens that only looks to healthcare disparities as the cause, loses sight of the impacts of poverty, lack of educational attainment and race on health status outcomes. In the United States, health disparities are both created by and serve to perpetuate the systemic oppression of different groups of people based on race and class which is both immoral and unethical. Failing to rectify health disparities resulting from systemic oppression represents the ongoing perpetuation of harm to groups of people based upon their race and/or class (Jones, 2010). This goes against the ethical principle of non-malfeasance which is foundational in the ethical principles of many health care disciplines. Therefore, inaction to eliminate health disparities is essentially taking action to continue to harm large groups of people in

our country.

Furthermore, health disparities matter because they result in increased direct and indirect costs for our country. Indirect costs to society result from decreased productivity and premature death (Ubri & Artiga, 2016). The direct costs result from the increased health care costs accumulated through failure to keep individuals healthy in the first place. It is estimated that up to 30% of health care expenditures for Blacks, Hispanics and Asians result from health inequities (Ubri & Artiga, 2016). Furthermore, income inequality is increasing in our country at the same time as our population is becoming more diverse. If we fail to address health disparities, larger and larger proportions of our population will suffer from poorer health outcomes and increased health care costs leading to health care expenditures taking up an even larger proportion of our country’s gross domestic product (GDP). The rising cost of health care in this country is already unsustainable and we spend a larger proportion of our GDP on health care with poorer outcomes as compared to other developed countries (Sawyer & Cox, 2018). By eliminating health disparities we can stop the perpetuation of an immoral and unethical system of oppression while also creating a financially sustainable health system which contributes to a healthier and more productive society.
2) Determinants of health are factors which influence health status (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). Determinants of health include, but are not limited to age, gender, race, income, access to health care, education, living and working environment, employment, social connectedness, exposure to crime, access to healthy food choices, exposure to toxins and access to transportation (Koh et al., 2010; ODPHP, n.d.).
3) In taking some of the implicit biases tests and reflecting upon my own biases, I think I am more judgmental towards middle and upper class white people who do not suffer many of the health care disparities and inequities that other people do and seem unable to maintain their health. For my entire career as a nurse, I have primarily worked with people who because of their race, socioeconomic status and other social determinants of health such as family cycles of violence and abuse, exposure to drug and alcohol addiction at a young age and family members with severe and persistent mental illness, I am accustomed to caring for individuals who have the deck stacked against them in more ways than not. When I care for someone who does not face those same challenges, I think I lack as much compassion for them when they seem unable to overcome and work through the challenges they are facing. I work through this by being aware of my biases and judginess to ensure that my own personal feelings do not impact my behavior or the care I provide. Talking with my colleagues and seeking clinical supervision helps with this.
4) In reviewing the Washington County Community Health Assessment (Repp & Mowlds, 2014), I was not surprised by their findings in terms of health issues affecting the region and the counties areas of focus. Of the nine priority health issues identified, four of them: (1) access to affordable health care; (2) culturally competent services and data collection; (3) mental health; (4) and substance abuse, all directly impact health outcomes and failure to adequately address them leads to the perpetuation of health disparities. Two of the focus priorities: (1) access to affordable health care; and (2) mental health with a focus on suicide prevention, directly involve the population of patients I work with and will continue to work with after obtaining my DNP. Washington County is the second most diverse county in Oregon and has a lower percentage of families living below 200% of the poverty level than the rest of the state (Repp & Mowlds, 2014). Oregon has the 8th highest suicide rate in the country and Washington County’s suicide rate has continued to grow (Repp & Mowlds, 2014). Accessing quality mental health services is a challenge for most individuals, not matter their race and socioeconomic status. The availability of services for individuals who speak little to no English is lacking. As I continue to work in mental health in the county, it will be important to work to ensure that we have the availability of quality mental health services to meet the needs of our diverse population in order work to prevent suicide and other negative outcomes of untreated mental health.