In 2011 the World Health Organization (WHO) held the World Conference on the Social Determinants of Health (SDH) in Rio de Janeiro, Brazil, bringing together participants to collaborate and mobilize goals surrounding the reduction of health inequities, improvement of health and the promotion of development. The WHO defines the SDH as, "the conditions in which people are born, grow, live, work and age," as shaped by "the distribution of money, power, and resources at global, national and local levels" (WHO, 2013). Broadly speaking, addressing the SDH is essential in the creation of solutions to address health inequities; social class and the realities of everyday life within a particular social class create a health gradient. Research has repeatedly indicated a direct relationship between social class and health inequalities as producing premature morbidity and mortality for certain groups (WHO, 2013).
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In 2010 the poverty rate in the United States was estimated at approximately fifteen percent by the United States Census Bureau, however this number conceals variation that occurs between subgroups and ethnic minorities. The expansion of health insurance through the Affordable Care Act (ACA) will provide insurance to forty-six million uninsured Americans and increase those who qualify for Medicaid on a state dependent basis, reducing a portion of health inequity. Providing agency to individuals and communities to play an active role in their healthcare will be encouraged through the ACA, as preventative and wellness care are offered at no cost and this may be one of the most powerful tools available to combat the health gradient created by differences in social class (HHS, 2013). Leonard Syme, Professor Emeritus of Epidemiology at the University of California-Berkeley, has argued that public health interventions will not have meaningful, lasting influence on improving population health until the "social forces in the community" are addressed through "(a) robust public policy and empowering communities to act" (WHO, 2013).
Although the ACA is a step in the right direction in reducing the impact that the SHD has on health, not much will change for those living in one of the twenty six states that voted against Medicaid expansion. As indicated in this map published in the New York Times the majority of states rejecting the expansion of Medicaid are "the very places where the concentration of poverty and lack of health insurance are most acute...it is their populations that have the highest burden of illness and costs to the entire health system" (NYT, 2013).
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| http://www.civisanalytics.com/pages/civis-uninsured |
In order to fully mobilize towards a reduction in health inequality in the United States of America, the ACA must necessitate the expansion of Medicaid in all states. Furthermore, health professionals require an education that underlines the fact that structural forces in society such as income, education, gender, ethnicity, employment, working conditions, and cultural influence heavily impact access to resources and the uptake and utilization of health services.
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ReplyDeleteDana you addressed an unfortunate situation regarding the ACA because the purpose of healthcare reform is to provide health insurance for all especially the poor. Initially, I was a strong supporter of the ACA especially since many articles have addressed how single mom families and black families are the most in need and I was raised in a black single mom household.However, after reading different articles regarding the ACA (http://www.nytimes.com/2013/10/03/health/millions-of-poor-are-left-uncovered-by-health-law.html?pagewanted=all) and the many issues that have not been resolved with the law, I am convinced that the states should be cautious because this bill could be disastrous despite it having good intentions. If our economy falls because of healthcare reform, then there will be no government aid to provide for anyone.
ReplyDeleteThank you for your comments Kenyatta. I think that if the expansion of Medicaid was federally mandated nationwide rather than on a state dependent basis, the outlook would be better. There is always room for improvement and this is no exception. Transformation is something with a beginning and no end, I only wish things would move faster.
DeleteThanks for your post, Dana. I really like your statement "transformation is something with a beginning and no end." I have never heard that said before but it is so true. I think people often get discouraged when trying to make change because the problems are so huge that the work seems insurmountable. If more people realize, as you say, that making a better world is a constant process, then maybe more people would want to get involved.
ReplyDeleteHi Dana,
ReplyDeleteGreat post and so relevant! I particularly liked this statement:"Furthermore, health professionals require an education that underlines the fact that structural forces in society such as income, education, gender, ethnicity, employment, working conditions, and cultural influence heavily impact access to resources and the uptake and utilization of health services." I could not agree more. However, I have been very disappointed by the lack of content that we have had on this topic in nursings school. Fortunately, many of us have previous experiences where this information was at least touched upon, but I still think that this is a gap in our education. If nurses do not understand the big picture of healthcare and SDH, how can nurses provide holistic care, which is at the very basis of the nursing model?
Dana- I appreciate this thorough post. I agree with your sentiment that the ACA fails where it doesn't mandate state-federal partnerships w/r/t medicaid and medicare expansion as such. In addition, the politicization of affordable care by many Republican controlled states has become problematic in not only the process of expanding healthcare, but also in the nurses' role of explaining health and healthcare to patients. As stakeholders scramble to protect their interests (in subsidies, voters, and adherence to "federalist" principles), misinformation about health and healthcare is spread and nurses, who are often affected and in the midst of healthcare changes and expansions, are tasked with (or obligated to) re-explain health principles and health care availability.
ReplyDeleteThe unfortunately reality of our country's political climate has made the success of the ACA uncertain. There are many who are hell-bent on making sure it fails, even if it comes at the expense of the public good. The states that refused to adopt the expansion of medicare benefits is evidence of this. I can only imagine how successful it could be if both political parties were trying to improve it instead of one trying to ensure failure.
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