Health care is a very important aspect of every society. The obvious benefits from a quality health care is the improvement of the quality of life (QOL) of the citizens as there is lower possibility of having diseases and diseases are easily cured resulting to lower morbidity and mortality rate, and longer life expectancy. However, inequality or disparity in health care exists in almost every nation. In the USA for instance, health care disparities exist as shown in the report of the National Academy of Science’s Institute of Medicine entitled ‘Unequal treatment: Confronting Racial and Ethnic Disparities in Health Care’.
In the said report, it was found out that “blacks,and in some cases Hispanics, have been deprived of medical care that most whites take for granted, including routine medical procedures that prolong life and improve its quality; minorities are also less likely than whites to receive proper heart-disease medication, bypass surgery, dialysis, kidney transplantation, maternal and child health services, mental health and intensive care” (Sternberg, 2002). There are also wide life expectancy gaps among the citizens in the USA.
Between the years 1997 and 2001, life expectancy in the United States ranged from 86. 7 for Asian females to 68. 7 for black males; the life expectancy between males in South Dakota and females in Minnesota has a gap of 22. 5 years; and the gap between the Native American males in various counties in South Dakota and the Asian females in Bergen County, New Jersey is 33 years (Murray et al, 2006, p. 0002). These findings reflect that disparities in health care do exist across the country. The findings also reflect the possible reasons behind the existence of disparities in the health care.
Generally, inequality in the health context can be unequal quality of health care and/or unequal access to health care services. This paper then aims to investigate on the causes of health inequalities among the US citizens. Population Diversity and Health Care Diversity in population is generally the variations of race, ethnicity, gender, nationality, culture, lifestyle and socioeconomic position of people in a country. Various studies (see Satcher, 1999; Navarro, 1990; Mutchler & Burr, 1991) pointed to race and socioeconomic status as the main culprit of health care disparities in the USA.
Socioeconomic status which is characterized by income, literacy, and social class is closely related to race (Navarro, 1990 on Fiscella et al, 2000, p. 2580). That is, more people who belong to the minority groups also belong to the lower class, with lower income and lower level of education. In the United States, according to Fiscella et al (2000, p. 2579), “lower socioeconomic status is associated with lower overall health care use, even among those with health insurance”.
The obvious reason for this is that people with lower socioeconomic position cannot afford for high quality health care thus they cannot receive various medical tests and health care services such as ambulatory and intensive hospital care, surgery, prenatal care, cardiovascular procedures, kidney transplants and other important health care. For instance, Latinas receive less prenatal care and fewer cardiovascular procedures; Asian Americans receive fewer influenza vaccinations; Native Americans receive less prenatal care; and elderly blacks receive lesser care from specialists compared to whites (Fiscella et al, 2000, pp.2579-2580).
Aside from having lower income, cultural, language and communication barriers also cause disparities. Culture is shaped by race, ethnicity, nationality, language and socioeconomic status (Betancourt et al, 2002, p. 1) and varies from person to person thus there is a great possibility that cultural differences among the patients and health care providers exists in country with a diverse population like the US.
These cultural differences sometimes lead to miscommunication Miscommunication often results to poor adherence or conflicts to treatment, misunderstandings, mistrust, dissatisfaction and poor diagnosis. In the mental health care for example, communication between the patient and the physician is very significant that when there is communication barrier between them, which may be due to cultural differences or language difference, the root cause of the patient’s illness will not be known and the illness may not be diagnosed easily.
Miscommunication also happen due to conflicting health beliefs and lack of proper knowledge about health care and treatments. Additionally, the attitude and preferences of patients are shaped by culture which often result to conflicts. For example, African Americans do not agree with the acceptance of death and palliative care, and are reluctant to withdrawing life-prolonging therapy and organ donation which raise conflicts between the physicians and patient or patient’s family (Cort, 2004, p. 64).