By Amy Caron
There are many dimensions of health disparities in the United States. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status and environment all contribute to one's ability to maintain overall wellness. Access to quality education, nutritious food, clean water and air, housing, and safe neighborhoods all contribute to good health, in addition to access to health care services regardless of income or insurance. The social determinants of health or the conditions in which people are born and live are mostly responsible and create extreme differences in health status within and between populations.
According to the Center's for Disease Control Health Disparities and Inequalities Report US 2013:
- Rates of premature death from stroke and coronary heart disease were higher among non-Hispanic blacks than non- Hispanic whites.
- Infant mortality rate for non-Hispanic black women was more than double that of non-Hispanic white women in both 2005 and 2008.
- Among persons with asthma, attacks were more frequently reported for children than adults, adults with incomes <250% of the poverty level than adults with incomes >450% of the poverty level.
- Rates of blood pressure control among adults with hypertension were lowest among Mexican Americans, persons without health insurance, and those born outside of the US.
- Diabetes prevalence was highest among males, persons 65 and older, non-Hispanic blacks and those of mixed race, Hispanics, persons with less than a high school education, those who were poor and those with a disability.
- During 2010, two to five Hispanic adults and one of four non- Hispanic adults were classified as uninsured.
According to a study by the Commonwealth Fund in 2012, 41% of adults reported they had a hard time paying their bills, even with insurance and had been contact by a collection agency or had to change their way of life in order to pay for medical bills. A Kaiser Family Foundation poll showed that 28% of middle income families (income between 30-75k) stated they were having a serious problem paying for health care or health insurance.
Overall the United States is quickly becoming the worst healthcare system in the world among developed nations. Our healthcare expenditures are the highest among this group at about 15.3% (Organization for Economic Cooperation and Development). We spend inefficiently according to the Congressional Budget Office that estimated that nearly 5% of that spending did not improve health outcomes and our prescription prices are about 35-55% higher than in other developed countries. In addition to the lack of price controls or regulations on pharma companies to control drug pricing.
Our broken health care system impacts us all, some groups more so than others, and it's safe to say that that all would agree that the system is broken. To achieve health equity, or to eliminate all disparities and improve the health of all groups, all groups must be valued equally and society as a whole must work together to address inequalities that lead to health disparities. In the US, this is what divides us.
Brief History of Health as a Human Right in the US
In 1812, Theodore Roosevelt said "We pledge ourselves to work unceasingly in State and Nation for the protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American Use." In 1944, Franklin Roosevelt called for "a second Bill of Rights under which a new basis of security and prosperity can be established for all." These rights included "the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment." He died in 1945. His wife, Eleanor Roosevelt, went on to be a major contributor to the UN's Universal Declaration of Human Rights of 1948 which states:
- Article 25: Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, medical care, and necessary social services, and the right to security in the event of unemployment sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
- Article 12: States that agree to the covenant should create conditions which would assure to all medical service and medical attention in the event of sickness.
- Article 12.2 Requires parties to take specific steps to improve the health of their citizens.
President Jimmy Carter signed the Covenant, but the United States stands with Comoros, Cuba, Myanmar, Palau, and Sao Tome and Principe and has not ratified. In total, the Covenant has 164 parties.
So why not ratify? The problem is the distinction between a "positive" and a "negative" right.
- Positive Rights: Provide the right holder with a claim against another person or the state for some good, service, or treatment.
- Negative Rights: Restrain other persons or governments by limiting their actions toward or against the right holder.
Our Bill of Rights, written in the 18th Century, embodies negative rights that were designed to prevent government oppression. The ICESR leans in towards positive rights. This marks a sharp divide in the United States.
Here are some arguments:
- Health care is broad and too hard to define. It includes preventative services, health education, promotion, and treatment for established illness. But does the right to health care also mean the right to clean water, food, organ transplantation, or infertility treatment? To be considered a right, it must be easily defined.
- Rights imply a duty on the part of others, and who/what would that be in the case of health care? Would doctors, hospitals, or governments take responsibility? This would impose an intolerable burden on others and should be seen as a provision of benefits instead.
- As a right, health care would impose forceful obligations on taxpayers and providers. No one can "give" health care without first taking away something from someone else.
Our Constitution was written as a series of negative rights and all amendments made before the 1930's basically aim to protect the people against its government. They call for government to refrain from acting. This is the simple explanation why so many believe healthcare can't be a human right. This core value of "every man for himself" simply sums up why we rank last or close to last on measures of health.
Does Healthcare Have to be a Right?
The US is the only country among the group of wealthy nations that belong to the Organization for Economic Cooperation and Development (OECD) that does not guarantee healthcare to its people as a right. In most of Europe, healthcare must be accessible to the entire population, without discrimination, and is done do in different ways:
- Great Britain has a national health service and the government runs the hospitals and pays all staff.
- Germany and France have a mix of regulated private and public insurance companies and a law (like the ACA) that make it mandatory.
- Netherlands' mandatory health insurance coverage is provided by private insureres competing for business.
- Sweeden relies on innovative programs managed by their government to control costs and maintain the public's health.
In short, there are a mix of mechanisms and motivations for ensuring universal access to healthcare for all residents. In China, not an OECD member, healthcare access is a matter of law, not of rights, however healthcare coverage is growing just the same.
In the US, we spend the most and are the sickest, but we first need to define the problem to come up with solutions.
Do we need to see healthcare as the human rights issue of our time or an economic problem we need to solve?
Where can the Affordable Care Act take us and which country should we emulate?
What an interesting post. The statistics are staggering regarding both the disparities seen between ethnic groups as well as where US healthcare ranks in regards to other developed nations. It is ironic that it seems that the discussion of healthcare as a human right was really brought to global attention with the comments of Theodore Roosevelt through the work of his wife, Eleanor and yet the US has not ratified the International Covenant on Economic, Social and Cultural Rights. While I understand that if the US were to mandate universal or public healthcare there would be “growing pains” it seems so starkly apparent that a drastic change needs to occur, we cannot continue to bankrupt our seniors who cannot afford to pay for supplemental insurance in order to cover their growing healthcare expenses as they age, and we cannot allow our nations children who were not born into wealth to suffer a lifetime of ailments which if treated appropriately at a young age would allow them a better quality of life. Yes, perhaps the Affordable Care Act is a step in the right direction, but for our most vulnerable citizens is a tax break enough to allow them to purchase health insurance that allows them access to the high quality healthcare that those living above the poverty line demand? I do not have the answers, but as US citizens we should feel it is our civic duty to at least learn the facts and start the discussion of how to improve the current situation.
ReplyDeleteAmy this is a very profound post. Healthcare is 100% a human right of our time. Everyone is entitled to have proper healthcare and quality healthcare. Yet this country has made an economics focus, and not about the caring for people. I do understand how important it is so find ways to save regarding healthcare, yet many people do not have access to health insurance. With the population living longer, they are faced with more chronic diseases and need access to healthcare. Isn’t this a human right to have access to healthcare? We live in age were physicians are seeing 20 or 30 people a day and only have an average of 7 minutes with each patient. How can physician provide quality care to people, when they have to make sure they can see all their patients in one day? We need to ensure that the old and the young and everyone in-between, has access to care and the education needed to get quality care in the United States. It is very disrupting to think because of economic status, the quality of care you receive is different among each other and if you have access is different among each other. With the passing of the Affordable Care Act quality of care and access was a major factor in the development of the bill. We need to make sure as a country not to ignore the human rights of healthcare and how important it is to make sure everyone in the United States has access to healthcare.
ReplyDeleteAmy, You hit the nail on the head by beginning your post with a quote from Martin Luther King, Jr. where he describes inequalities in healthcare as a injustice. What I found to be most interesting about your post is how the inequalities in healthcare interact with economic and social inequalities.
ReplyDeleteYou brought up the argument that healthcare is too broad to define. That should be where it starts. We need to determine what should be regarded as a human right and what should be seen as an economic burden.
I disagree with the notion that "all would agree that our healthcare system is broken". To your point the short comings of our system does affect everyone to a different degree depending on a myriad of factors having to do with socio-economic conditions. To improve our healthcare system it needs to be worked from both angles and acknowledged that people living in poverty should take priority as they are the portion of the population that are most likely to get sick and often has the least access to quality healthcare. That is where entitlements come in and that is where the debate intensifies and the country becomes fragmented on this topic.
All Americans who live healthy lives with easy access to healthcare need to accept the burden of those who are sick, living in poverty, and those that have limited access to healthcare or in a nut shell all those who are wealthy and in good health need to take the responsibility of contributing to the well being of the sick and the vulnerable.
In my opinion basic healthcare (regular check ups, emergency room access, preventative procedures, affordable prescription drugs, health education, etc.) should be regarded as a human right. We also need to confront the economic inequalities that exist so the burden isn't to large to bear. Education needs to be improved so we are proactively investing in our youth. We can teach them about their health and put them in a position to take advantage of opportunities in the work force once they complete their education so they can then pay for and take advantage of an affordable healthcare system that we continue to improve. We should emulate the plethora of nations that have a system in place that are functioning more effectively and efficiently than our own including but not limited to those that you mentioned in your post.