The New England Journal of Medicine pp997-999 |Perspective| “Health Equity-Are We Finally on the Edge of a New Frontier? By Michele K. Evans, M.D.
Graphic source (diversitynursing.com)
Data Presented
Type of Health Insurance Coverage by Race and Hispanic Origin
Private Health Insurance: White, Not Hispanic 75%, Black 50%, Asian 70%, Hispanic (Any Race) 47%. Public Health Insurance 30%, 40%, 25%, 32% and Uninsured 5%, 10%, 6%, 18%
As of 2018 27.5 million Americans or 8.5% lack health insurance.
As of 2020 unemployment 16.1% among Black Americans, 16.7% among Latinx Americans and 12% among White Americans.
11.9 million children the United States live in poverty-73% are children of color
Academic Medical Faculty are 63.9% White (Whites are 60% of Population), 3.6% Black (Blacks are 13.4% of Population), 3.2% Latinx (Latinx are 18.3% of Population). 5% of practicing physicians are blacks and they constitute only 2.3% of medical oncologists. 5.8% of practicing physicians are Latinx.
Summary of Perspective
Definition of Health Equity. “the absence of avoidable differences among socioeconomic and demographical area in health status and health outcomes such as disease or mortality”.
The COVID-19 has highlighted American health inequity in “a daily body count.” “Black, Latinx and Indigenous Americans are dying from COVID-19 at disproportionately high rates, and this increased lethality is coupled with disparate prevalence of hypertension, diabetes and obesity.” Some of this inequity has roots in past history and the resulting intergenerational poverty. It is systemically reflected in the “failure to provide minority patients with preventive and therapeutic care of quality equal to that provided White patients.” Lack of “stable health insurance coverage may have the most profound effect. As half of those insured are covered by “employer-based plans” the effect of higher minority unemployment is a clear driver sustaining this disparity. Living in “hypersegregated low-income neighborhoods with higher risks of exposure to toxins in the air, dumped in the soil or leached into drinking water-perhaps the most potent influence on health and persistent health inequities." On a regional basis, living in state that did not expand Medicaid under the Affordable Care Act has increased inequity as well. Similarly, systemic racism limits educational opportunity and results in minority underrepresentation in healthcare professions. It’s important that “minority patients to be cared for by trusted clinicians who fully understand their culture.”
Solutions call for a return to “medicine’s ethical roots” and the American “social contract…justice, self-determination, equity, and equality.” This will require policy changes and many actions but it must “begin by recognizing health care as a human right.”