NYU Health & Medical Insight to Healthcare Inequality Discussion

Health care providers take an oath to provide care to all equally, but certain population groups experience differences in care because providers tend to consider patient factors (such as patient preferences and behaviors) as more important contributors to racial differences in care than provider factors (such as bias or poor communication). Racial inequalities in health care access and quality are a vexing issue for US health systems, organizations, and policymakers.1 Although the causes are complex and multilevel, there is widespread consensus that health care providers contribute to racial health care inequalities and play an important role in their elimination. Providers have articulated many ways in which unequal health care access, insurance differences, limited time, lack of interpreters, and bias, labeling, and stereotypes contribute to racial differences in patient experience and treatments (Gollust, S. E., et. al. 2018).

The role of unconscious bias can lead to false assumptions and negative outcomes. This is especially dangerous in healthcare, where decisions can mean life or death. As more attention is paid to health disparities in the United States, there is increasing evidence that unconscious bias leads to negative outcomes for minority groups in healthcare settings. This, in turn, contributes to health disparities, in which certain groups experience inequalities in the provision of and access to healthcare. The role of discrimination is a socially structured action that is unfair or unjustified and harms individuals and groups. Discrimination can be attributed to social interactions that occur to protect more powerful and privileged groups at the detriment of other groups. While not all stressful experiences negatively affect health or occur because of discrimination, many do impact health and can be related to discrimination. Structural racism is defined as the macrolevel systems, social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups. The term structural racism emphasizes the most influential socioecological levels at which racism may affect racial and ethnic health inequities.

Health disparities impact everyone, not just the groups that are discriminated against. Disparities limit the quality of health for the broader population as well, by curbing innovation and reducing overall quality of care. There are vast social, moral, and fiscal implications that will only become more pertinent as our population diversifies.

Political, social, and economic factors also contribute to health outcomes. Social and economic policies are not considered part of health services infrastructure, such policies may influence health and disease by altering social determinants of health. Social policies may indirectly influence health on social or economic outcomes (including income, education, employment, housing, marriage). Since these social and economic factors are also causes of health, they can then, in turn, can affect health (Osypuk, T. L., Joshi, P., Geronimo, K., & Acevedo-Garcia, D. 2014). Social and economic inequalities are strong predictors of health inequalities and increased income inequality at a societal level is strongly associated with worse health outcomes including life expectancy, infant mortality, obesity, and mental health, as well as social outcomes such as trust, education level, and social mobility. There is evidence that political ideology and personal interests can exert substantial influences on policy-making processes relevant to health, leading to marked evidence policy gaps (Barnish M, Tørnes M, Nelson-Horne B. 2018).

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