Health & Health Care Problems

Basic Concepts of Health Disparities

• Health Disparity:

  • Defined as inequalities in health outcomes experienced by one group compared to another.
  • Factors include race, ethnicity, class, and gender.

• Causes of Health Disparities:

  • Social Determinants of Health: Influences that affect health outcomes include:
  • Economic stability
  • Neighborhood & physical environment
  • Education opportunities
  • Food access (availability of healthy/unhealthy food)
  • Example:
  • Healthy food involves less processed items and more fresh fruits & vegetables while unhealthy foods are often highly processed and feature minimal nutritional value.

Social Determinants of Health

• Importance of Social Factors: Health is influenced by social factors, not just individual behavior.
• Key Factors include:
  • Community context
  • Health Care System
  • Economic Stability
  • Food Access
  • Housing
  • Literacy & Education
  • Safety and crime rates
  • Access to healthy options

Health Inequalities by Geography and Race

• Example of Health Disparity:

  • Significant differences in life expectancy exist within Washington, D.C.:
  • Northwest DC (largely white, high income) vs. Southeast DC (low-income, predominantly Black).
  • A 21-year life expectancy gap illustrates how place affects health outcomes.

• Growing Mortality Gap:

  • The death rate gap between wealthy and poor counties has risen significantly (from 9% in 1980 to 61% in 2020).
  • This is largely attributed to untreated chronic diseases.

Key Health Care Problems in the U.S.

• Health Expenditure:

  • U.S. spends 17% of GDP on healthcare, the highest among wealthy nations.
  • However, the U.S. has the least coverage, with over 9% uninsured and 29% underinsured.
  • Consequences of lack of insurance include:
  • Over 45,000 annual deaths due to lack of healthcare.
  • Medical debt is the primary cause of personal bankruptcy.

• Prevalence of Chronic Diseases:

  • Highest rates of obesity at 40% as well as high incidences of chronic diseases such as heart disease and diabetes.
  • U.S. life expectancy is lower, and infant mortality is higher than in other wealthy countries.

Power and Economic Interests in Healthcare

• Health Care as Commodity vs. Human Right:
  • The healthcare industrial complex includes:
  • High-priced hospitals (non-profits more profitable than for-profits).
  • Pharmaceutical industry with drug prices 50% higher than other countries.
  • Insurance companies (with high administrative costs compared to Medicare).
  • Other industries impacting health include food, beverage, and tobacco.

U.S. Healthcare System Structure

• The U.S. does not have universal coverage like other wealthy nations:
  • Predominantly private (60% for-profit insurance) versus government programs (40% Medicaid/Medicare).
  • Proposed Options for universal coverage:
  • Public Option: Individuals can buy insurance from the government.
  • Single Payer: Government insurance covers all health care costs.
  • Health Savings Accounts (HSAs): Tax breaks for individuals saving for healthcare.

Healthcare Spending and Access Issues

• International Comparison:

  • Other wealthy countries spend about half per person compared to the U.S. ($10,966 in the U.S. vs. an average of $5,697 for peer countries).

• Insurance Coverage:

  • Nearly a quarter of working-age adults face underinsurance.
  • Many can’t afford necessary prescriptions or medical treatments due to cost constraints.

Diabetes and Insulin Pricing Issues

• Significant price disparity in diabetes care costs, especially insulin, which can be up to 10 times the cost in the U.S. compared to other countries.
• The trend shows that insulin prices have tripled over the last decade, leading to many patients underusing necessary medication due to financial constraints.

Obesity and Diet-Related Health Concerns

• Obesogenic Environment: 80% of food advertisements promote unhealthy food, particularly targeting children.
• Americans consume excessively high amounts of sugar, leading to an increase in diabetes and related health issues.

Nursing Shortage in Healthcare

• The nursing workforce faces a significant shortage, with many leaving due to factors such as:
  • Staffing and workload challenges.
  • Poor career advancement opportunities.
  • Compensation issues.
  • High turnover rates across hospitals, especially within the first year.