Health inequalities or distribution of health by region, ethnicity, socioeconomic position, or gender and access to health care and their causes.
Global public health is a very complex, yet unique concept that many countries in the world aim to excel. With the complexity and uniqueness of this topic, there are several factors one should consider while addressing health inequities. First thing first let’s define what is health inequities. Health inequities are avoidable errors that tend to persist throughout groups of people who receive health care. These common errors are found in the socio-economic status of patients, geographical location, a specific characteristic unique to each induvial such as race, ethnicity, or disability; disease-specific characteristics such as HIV-positive patients, and many more.[1] Many of these inequities are unique to the low-and-middle-income countries, however, some of these still persist in the developed world. Let’s look at each of them separately.
Socio-economic status and geographical location of the patients.
In many low-and-middle-income countries, there is still ongoing discrimination against patients’ status. Let's take a look at some of the Caribbean islands. In St. Lucia’s low-income neighborhoods such as Vieux Fort, medical care is provided by medical students and visiting doctors. One of the standing hospitals which barely survived the fire is now moved to the stadium to provide care for patients.[2] So, some of the patients were literally under the open sky receiving medical care. However, if you move up north towards Castries town, there you can find a Tapion hospital. This is the only private hospital that currently has an MRI machine for the entire island. The observer can clearly see a socio-economic difference between Vieux Fort medical care and upper-class neighborhood such as Castries. This socio-economic health inequity could be also tied to geographical location. The paper on neurosurgical care by E. Zhalmukhamedov et al. discussed issues concerning surgical care on the island. Just imagine, the patient who receives a traumatic brain injury in Vieux Fort, may simply not make it to Castries to get MRI done and get appropriate neurosurgical intervention on time.[3]
Race and Gender
Race and gender inequity in public health is very unique to both LMICs and the developed world. One of the major concerns of public health and business initiatives in the United States right now is diversity and inclusion. Even though The United States has made some progress in abolishing slavery and restricting racism, certain incidents do happen. Some biases in medical care are particular to African-Americans and Caribbean descent races. [4] A huge scandal with the Black Lives Matter movement in the United States, especially with the epicenter of May 2020 - widened a bigger gap on this particular issue.[4] Nowadays, many African-Americans and Caribbean decent patients prefer to visit a “black” doctor, as they believe that a similar to their race provider will carry more. This particular issue poses 2 issues: one is the mistrust between ethnicities and 2 psychological biases on receiving a poorer service due to the color of the skin. [5]
In the LMICs the same issues persist, however, due to the overwhelming amount of racism existing in the country, many people are simply accustomed to the jokes and prejudice. The LMICs such as the Dominican Republic, Haiti, and Cuba. Even though people are accustomed to the matter, psychological disturbance is still pronounced in the targeted population. [6]
Disability and disease-specific inequities in healthcare.
One of the famous public health cases is about HIV/AIDS patients, especially in the pediatric community of LMICs. In Sub-Saharan Africa for example, a child who has symptoms and a confirmed diagnosis of HIV/AIDS will have better funds than a child without it. Many doctors have shown frustration already that funding for HIV/AIDS has blindfolded many other important diseases people are suffering from. This particular inequity is very important, especially in the times such as now – the COVID-19 Pandemic. The emergency funds must be properly allocated for people in LMICs to receive the needed care on time. Another very important topic of disease-specific inequity is COVID-19 vaccine availability for LMICs. While Big Pharma has profited largely by providing enough vaccines to cover half of the planet Earth, many LMICs still lack access to this potentially life-saving vaccine. (figure 1)
Figure 1. from Kaiser family foundation (Link)
Disability prejudice is another very important topic of health inequity. Even in the modern developed world, many urban countries are not designed with disability in mind. Public transportations to city parks and essential grocery stores are simply not providing enough to accommodate people with disabilities.[7] Some of the common disabilities like wheelchair-bound patients, blindness, and speech pathologies pose a significant challenge to everyday life in big cities. Most of the essential stores cannot accommodate a wheelchair due to their small size (especially in the cities like NYC where most of the real estate is small and crowded). While big cities such as New York has made some progress for the visually impaired population by implementing sound traffic lights, wider pedestrian line, etc. still, most of the areas in the city has not been properly designed or addressed up to the modern living (picture 2). We believe designing and building sustainable communities will play a major role in leadership and power worldwide.
Vessel | Hudson Yards in New York City from Unsplash. (picture 2)
References:
1. PatientSafetyLearning Team. (2021, November 11). What are health inequalities? (The King’s Fund). Patient Safety Learning - the Hub. https://www.pslhub.org/learn/improving-patient-safety/health-inequalities/what-are-health-inequalities-the-kings-fund-r4632/
2. Situation report on fire at St Jude’s Hospital ... - paho. (n.d.). Retrieved January 22, 2022, from https://www.paho.org/disasters/dmdocuments/FireStLucia-20090908-01-eng.pdf
3. Zhalmukhamedov, E., Magloire, C., Maidyrov, E., Soans, A., Elijio, L., Nossov, N., & Mahbub, S. (2019). Overview of neurosurgical capacity in St. Lucia. Romanian Neurosurgery, 33(3), 329–331. https://doi.org/10.33962/roneuro-2019-056
4. Smith, R. H., & Grench, E. (2021, January 7). For New Yorkers Brutalized in Black Lives Matter Marches, Capitol Response Brings Disbelief and Bitterness. THE CITY. https://www.thecity.nyc/justice/2021/1/6/22218114/for-new-yorkers-brutalized-in-blm-marches-response-at-capitol-brings-disbelief-and-bitterness
5. Kennedy BR, Mathis CC, Woods AK. African Americans and their distrust of the health care system: healthcare for diverse populations. J Cult Divers. 2007 Summer;14(2):56-60. PMID: 19175244.
6. Held ML, Lee S. Discrimination and mental health among Latinos: variation by place of origin. J Ment Health. 2017 Oct;26(5):405-410. doi: 10.1080/09638237.2016.1207220. Epub 2016 Aug 5. PMID: 27494663.
7. Pineda VS, Corburn J. Disability, Urban Health Equity, and the Coronavirus Pandemic: Promoting Cities for All. J Urban Health. 2020 Jun;97(3):336-341. doi: 10.1007/s11524-020-00437-7. Erratum in: J Urban Health. 2021 Apr;98(2):308. PMID: 32328866; PMCID: PMC7179953.