LOVELL’S FOOD FOR THOUGHT – Do We Really Want To Successfully Address Health Inequities?

Are we really addressing the health disparities/inequities gap in a serious and meaningful way?

Dr. Lovell Jones | 1/21/2018, 10:34 p.m. | Updated on 1/21/2018, 10:34 p.m.
Answer this question, given the number of centers focused on health disparities/inequities and the emphasis by major foundations on this ...
Dr. Lovell A. Jones retired as Professor Emeritus from the University of Texas M.D. Anderson Cancer Center

The World Health Organization (WHO) defines Health Inequities as differences in health status or in the distribution of health determinants between different population groups. For example, there are differences in mobility between elderly people and younger populations or differences in mortality rates among people from different social classes. The WHO makes it clear that it is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. Where I differ with the WHO is that they indicate that in the first case it may be impossible or ethically or ideologically unacceptable to change the health determinants and so the health inequalities are unavoidable. While in the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health. I believe that although some inequities are related to biological variations, it is addressing all of the variations, biological, psychological, sociological, environmental & physical environment and others, that is the key to addressing health inequities.

According to the Health Resources and Services Administration, health disparities are defined as population-specific differences in the presence of disease, health outcomes, or access to healthcare.” In the United States, health disparities are a well-known problem among ethnic minorities such as African Americans, Asian Americans, Native Americans, and Latinos.

People also use the term health inequities. In this piece I will use the terms health disparities and health equities interchangeably as defined by Paula Bravemann. It do like reinventing the wheel. As Dr. Bravemann states “Health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups—such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination—systematically experience worse health or greater health risks than more advantaged social groups. (“Social advantage refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category—e.g., the wealthiest, the most powerful racial/ethnic group—and all others, not only between the best- and worst-off groups" (http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.27.021405.102103).

So, what is some of the basis for stating that we are not truly successfully addressing health inequities, and the key is on the work "truly". All you need to do is think of the silo policies that are being put in place. However, most important to this line of reasoning is the publication by the Agency for Healthcare Research and Quality (AHRQ) released July 2017. (https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/index.html). This should have been a clarion called to tell us what we are doing is not really working in the way it should and make us ask the question – Do we really want to successfully address health inequities. As Einstein once said “insanity is doing the same thing over and over again and expecting a different outcome.” Given that the AHRQ Report, and many others, have stated that the health disparities gap is not getting significantly better, and is some cases getting worse, are we insane or is it a matter of how we value human life, especially those people of color and more particularly African Americans? After being on the front line for more than 50 years, I am inclined to believe the latter rather than the former. During the month of Dr. Martin Luther King’s birth, I bring forth this quote – “We need leaders not in love with money, but in love with justice. Not in love with publicity but in love with humanity.” To this I would add we need leaders not interested in gaining credit for the solution(s), but willing to share in its implementation.