Healthcare inequalities refer to the differences that exist among a diverse group of individuals as far as health status is concerned. Diversity among populations can be manifested differently due to age, race, socioeconomic status, culture and ethnicity, gender and form of governance. These collectively comprise the determinants of health that are distributed differently among people leading to different health status among individuals. There have been efforts to reduce the gaps that exist between individuals as far as healthcare distribution is concerned, but the goals have not been fully realized. Studies have been conducted previously to explore more about this phenomenon. This paper is, therefore, going to review the literature on the causes of health inequalities in a diverse and multicultural population of United States of America.
Causes of health inequalities
Multiple research has been conducted in the past to find the factors that lead to health care inequalities among the Americans. The studies were done different times, places and people. This was done to establish the consistency and accuracy of the findings for the reviews to be reliable. During decision and policy making, the available data should be secure for smooth implementation of interventions to bring out changes. Research reveals that inequalities in status and distribution of factors determining health are diverse, complicated in nature, continuously changing and interdependent. The causes are categorised into two significant clusters: structural and social elements (Braveman, & Gottlieb, 2014). Due to their complex nature, understanding the underlying factors leading unequal health distribution is essential to come up with solutions to promote equality in health.
Structural factors leading healthcare inequalities are quite a number. They are present at different levels in the society. Depending on the level at which they are found, these structures deny some individuals the opportunity to utilise healthcare services available to them. This leads to unequal health distribution. These structural factors exist at the individual, interpersonal, institutional and the systemic level in the country (Braveman, & Gottlieb, 2014). People experience barriers in accessing healthcare at either one degree or more. This result in healthcare disparities in and between societies.
At the individual level, there are factors that determine the health of individuals. These factors are referred to as the intrapersonal factors. They are what an individual does in efforts to maintain optimal health (Marmot, & Allen, 2014).Individual behaviour affects the health status of people. Some actions by individuals positively or negatively influence their health and its outcomes. Positive behaviours that promote health status include practising good hygiene, proper nutritional choice and having a physical exercise of the body (Marmot, & Allen, 2014). Negative behaviours include smoking which predisposes individuals to be cardiovascular and respiratory health conditions. Socioeconomic status of individuals also determine how individuals respond to healthcare problems (Pickett, & Wilkinson, 2015).
Interpersonal or communal factors among individuals also contribute to healthcare inequalities in the societies. How people relate and utilise services among each other is influenced by race, culture, gender, sexual orientation and socioeconomic classes in the community Braveman, P., & Gottlieb, L. (2014). In America, there are some parts of the country that discrimination is still high. Racial and ethnic discrimination is quite high even in public institutions such healthcare facilities. Some health care services are only available and accessible to certain gender, race and class in the society. Individuals who do not belong to the majority group usually find it hard to access and utilise healthcare services available within their reach.
Some institutions have rules and regulations that govern the delivery of healthcare. Such policies include prioritising the health of the women. Women and children have been for longtime regarded as the minority group. They use to have low access to healthcare as compared to men. Before the introduction of the Affordable Care Act by the American Congress in 2011, the number of women who had enrolled in Medicaid insurance program was minimal (Baciu et al., 2017). Due to the new features in the new act, the number of women covered by Medicaid has risen. Before then, health inequalities between men and women was vast. After the introduction of this act, the male population have been found to have more health problems than women due to the prioritisationof women health by institutions (Behavioral et al., 2016).
Society systems also influence the utilisation of care services by individuals. Such methods include the healthcare and education systems. These two systems usually place people in categories of according to their economic and education classes. This has resulted in biases in the delivery of healthcare (Baciu et al., 2017). Some healthcare providers such as insurance companies that provide health care coverage to people are discriminative. Insurance services are provided to the rich and the educated in the society leaving the poor people without any means of catering for the high healthcare costs. As a result, access to healthcare is limited to the reduced leading to health inequalities in the society.
Social environment or factors determine how people relate and utilise the resources around them to gain an optimal health status. These factors are the social determinants of health. They provide conditions for people to be born and grow, live, learn experience while through learning and work, and also offer ageing surrounding for the elderly the society (Braveman, & Gottlieb, 2014). These factors interact differently with the community and individuals experienced them separately. This results in health inequalities among people. Availability of resources, power and knowledge have been found to shape these factor in the society.
Availability of resources among people entirely determines the mode of life they are going live. Proper housing is significant for health (Marmot, & Allen, 2014). Some conditions such as respiratory problems have been associated with the inadequate housing. Individuals with resources can acquire good housing facilities as compared to those individuals without the financial ability to do so. As a result, respiratory conditions are more prevalent in people without proper housing such as street families and the homeless people. Adequate nutrition determines the health of an individual (Marmot, & Allen, 2014). Nutritional choices are made according to the available resources. Individuals without enough financial supplies usually have a problem with choosing what to eat. Individuals with diabetes and lack resources typically find it a challenge to manage their sugar levels nutritionally. Due to such, healthcare inequalities is still prevalent in most societies.
Employment and income enable people to meet their healthcare costs. The costs involve preventive and curative services that people receive in healthcare facilities (Kröger, Pakpahan, & Hoffmann, 2015).This is partly provided by insurance companies and individuals through the out-of-pocket method. The employed individuals can pay premiums to their insurers. This different in the case of the unemployed individuals (Pickett, & Wilkinson, 2015). Due to such difference, access to healthcare services is not even between the two groups of individuals. Therefore the status of health is unequal among people in the population.
Education and health are related complexly. The level of education among different individuals influences their health differently resulting to health inequalities in the society. Education influences the behaviour, employment, income and general development of an individual (Braveman, & Gottlieb, 2014).Individuals without advanced formal education have limited chance of getting employed and generating revenue. As a result, they usually have limited resources for acquiring proper food substance for health. Access to health care services is also restricted due to inability to meet the healthcare costs (Kröger, Pakpahan, & Hoffmann, 2015).This is not the same case for individuals with high level of education. They live in urban centres with proper housing and adequate nutritional supply and choices. They can meet their healthcare costs through the insurance covers and out-of-pocket services.
Healthcare disparities or inequalities is a significant problem that affects many societies across the world. Factors leading to such have been revealed by research to be many and interrelate with complexity in nature. These studies have also shown that these factors occur at different levels and environments. Some situations that have been identified to cause health inequalities can be controlled by individuals. They include behaviour and personality. Therefore individuals can play a role in reducing such disparities in health. Institutions have a role to play in reducing inequalities. Ensuring that all people have equal chances of accessing healthcare services will help in reducing such disparities. Policymakers have a role also in lowering healthcare inequalities. Adopting and implementing bills and policies that increase the access to health by the minority group in the society will reduce the disparities in health.
Baciu, A., Negussie, Y., Geller, A., Weinstein, J. N., & National Academies of Sciences, Engineering, and Medicine. (2017). The State of Health Disparities in the United States.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Kröger, H., Pakpahan, E., & Hoffmann, R. (2015). What causes health inequality? A systematic review on the relative importance of social causation and health selection. The European Journal of Public Health, 25(6), 951-960.
Marmot, M., & Allen, J. J. (2014). Social determinants of health equity.
Behavioral, D., Sciences, S., Committee on Population, & National Academies of Sciences, Engineering, and Medicine. (2016). Institutional Factors That Influence Differences in Women’s Health Outcomes.
Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: a causal review. Social science & medicine, 128, 316-326.