Problem Statement
The selected public health issue is health equity in the US. Although it is a fundamental concept, health equity is not easily achieved. Health inequities are inequalities that are considered unnecessary, unfair, and unjust. Consequently, they must be avoided, decreased, or eliminated through policy action. Health equity is described as the lack of avoidable variations among socioeconomic and demographic groups or geographical locations in health states and outcomes (Gómez et al., 2021). Therefore, a state of health equity exists only if all individuals and populations become healthy as much as possible without curtailing their right to healthcare access. However, despite being the wealthiest country in the world, the US has not achieved health equity since it lacks well-organized and integrated social and health systems and devotes less of its resources to support public services. Accordingly, fewer people have access to primary care. Also, more people lack insurance, engage in risky health-related behaviors like drug use, and live in poverty. Children receive poor-quality education, and less money is allocated to safety net social programs. As a result of these conditions, US residents’ health state differs by race/ethnicity, gender, income, education, sexual orientation, gender identity, and residency location throughout their lives (Healthy People 2020, 2010).
National legislation has been enacted, or bills proposed to tackle these avoidable health disparities by demographics and location across the US. For instance, if passed into law, the Health Equity and Accountability Act of 2020 (HR 6637) would deal with socioeconomic determinants of health, increase access for marginalized populations, deal with problems in maternal health and mental health, and combat firearm violence (Congress.gov, 2020). Another example is the renowned Affordable Care Act (ACA), which passed in 2010, improving racial and ethnic gaps in health insurance coverage (Griffith et al., 2017). HR 6637, which focuses on systemic changes to build an equitable health care system for all individuals and populations, is the best course of action to take in tackling health inequalities.
Background
Substantial racial and ethnic disparities in health and well-being have been the norm In the American landscape. For instance, the 2015 midcourse evaluation of nationwide health progressive status toward Healthy People 2020 objectives showed significant inequities. Among the common health-related and social goals assessed, there were only slight improvements in inequalities in health. According to the findings, the Healthy People 2020 target was reached or surpassed for 36.9% of Whites, 27.2% of African Americans, 34.8% of Latinos, 26.6% of American Indians/Alaska Natives, 47.8% of Asians, and 43.9% of Native Hawaiians (National Center for Health Statistics, 2018). In terms of life expectancy, the coronavirus pandemic decreased the average life expectancies for African Americans, Latinos, and American Indians/Alaska Natives more significantly than the Whites (Arrazola et al., 2020).
Along with access to healthcare services and general care quality, American populations’ health varies significantly between states (Adhikari et al., 2020). Wide racial and ethnic health disparities are prevalent and are caused by internal and external factors influencing health care service delivery. Many underserved populations experience higher-than-average poverty rates, a predominance of workers in low-wage industries, and a disproportionate density of individuals in high-risk locations. These circumstances contribute to the disproportionate impact of the coronavirus pandemic (Krieger et al., 2020).
Disparities are also a result of problems with cost, access, and affordability of care. Populations of color—Blacks, Latinos, and Asians—are less likely to have coverage for their medical coverage, more likely to encounter cost-associated obstacles in receiving care, and more likely to accrue healthcare debt (Mahajan et al., 2021). Additionally, people of color are less likely to have a regular care source or to routinely obtain preventative therapies like vaccinations (Baumgartner et al., 2021). Additionally, many people of color experience personally mediated discrimination when working with physicians, and they frequently receive poorer-quality care (Clair et al., 2020).
Landscape
There is an increasing recognition that the public, nonprofit, and private sectors must all work together if the necessary improvements to accomplish health equity in the US are to be made. As a result, resolving health inequalities requires concerted efforts by individuals and groups from multiple sectors, such as housing and education. The primary stakeholder in promoting health equality in the US is the Office of Minority Health (OMH) of the HHS. In 2010, the OMH engaged various stakeholders, including the Federal Interagency Health Equity Team (FIHET), regional health equity councils, states, tribes, communities, and partners, to form the National Partnership for Action (NPA) to eliminate health inequalities (Baumgartner et al., 2021). The foundational pillars set forth by the NPA were founded on inclusionary ideals that emphasized the value of community engagement, the need for cultural-linguistic competence to serve all communities, and no discrimination in all activities, services, leadership, and collaborations.
Options
First, the Health Equity and Accountability Act of 2020 (H.R.6637) is a bill that intends to improve health equity and eliminate health and health care inequities through structural reforms to establish a healthcare system that guarantees opportunities for all people and communities based on their needs. In terms of targeted impact, the law would be beneficial because it would reduce racial and ethnic health disparities, reduce maternal deaths, foster health data gathering and research, increase access to mental health care, address firearm violence, enhance linguistic access in healthcare, and diversify America’s healthcare workforce (Congress.gov, 2020). The proposed law would also address how race and ethnicity, immigrant state, age, disability, gender identity, sexual orientation, language, and socioeconomic state connect with health disparities. HR 6637 is an outstanding and comprehensive bill, but it will not result in an equitable healthcare system until it is passed by Congress and enacted into law.
Second, the Affordable Care Act (ACA) of 2010 also makes health equity-related provisions to address health and healthcare disparities. The ACA has significantly reduced the national uninsured rate in terms of targeted impact. According to Griffith et al. (2017), these general reductions also helped lessen racial and ethnic gaps in entitled reimbursement rates. Additionally, ACA coverage expansions, such as the extension of Medicaid to low-income individuals, have lessened coverage gaps, which has resulted in fewer disparities in care and health outcomes access (Guth et al., 2020). However, some have criticized the mandate that all Americans have health insurance and government involvement in healthcare, making the act contentious regarding political feasibility.
Recommendations
The best course of action for tackling health inequalities is HR 6637, which focuses on systemic changes to build a health care system that is equitable for all populations. This bill serves as a model for ambitious policy responses that address a broad range of health equality issues. The comprehensive law would have several beneficial outcomes. First, it would increase access to healthcare for everyone, predominantly rural and immigrant populations. Second, enhancing language access services, providing practitioner training on cultural sensitivity, and investing in a more diverse health workforce, would strengthen care for marginalized areas. Thirdly, it would remove obstacles and provide funding for initiatives that support the sexual, reproductive, maternity, and mental well-being of underserved and marginalized people. Finally, it would include the federal government in developing and supporting programs to address socioeconomic health determinants and target diseases that disproportionately affect minority groups (Congress.gov, 2020). Therefore, HR 6637 would be the ideal course of action to ensure that the eradication of health and health care inequalities is given priority and to offer the tools required to address health inequities.
References
Adhikari, S., Pantaleo, N. P., Feldman, J. M., Ogedegbe, O., Thorpe, L., & Troxel, A. B. (2020). Assessment of community-level disparities in Coronavirus Disease 2019 (COVID-19) infections and deaths in large US metropolitan areas. Health Policy, 3(7), e2016938. doi:10.1001/jamanetworkopen.2020.16938
Arrazola, J., Arrazola, J., Joshi, S., Dominguez, A. E., Poel, A., Wilkie, C. M., . . . Landen, M. (2020). COVID-19 mortality among American Indian and Alaska Native persons — 14 states, January–June 2020. Morbidity and Mortality Weekly Report, 69(1), 1853–1856. http://dx.doi.org/10.15585/mmwr.mm6949a3
Baumgartner, J. C., Collins, S. R., & Radley, D. C. (2021, June 9). Racial and Ethnic Inequities in Health Care Coverage and Access, 2013–2019. Retrieved from The Commonwealth Fund: https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/racial-ethnic-inequities-health-care-coverage-access-2013-2019
Clair, K., Chang, J., Ziogas, A., Tanjasiri, S. P., Kansal, K. J., Gin, G. E., . . . Bristow, R. E. (2020). Disparities by race, socioeconomic status, and insurance type in receiving NCCN guideline-concordant care for select cancer types in California. Journal of Clinical Oncology, 38(15), 7031–7031. https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.7031
Congress.gov. (2020, April 28). H.R.6637 – Health Equity and Accountability Act of 2020. Retrieved from 116th Congress (2019-2020): https://www.congress.gov/bill/116th-congress/house-bill/6637/text
Gómez, C. A., Kleinman, D. V., Pronk, N., Wrenn-Gordon, G. L., Ochiai, E., Blakey, C., . . . Brewer, K. H. (2021). Addressing health equity and social determinants of health through Healthy People 2030. Journal of Public Health Management and Practice, 27(6), S249-S257. doi:10.1097/PHH.0000000000001297
Griffith, K., Evans, L., & Bor, J. (2017). The Affordable Care Act reduced socioeconomic disparities in health care access. Health Affairs, 36(8), 1503–1510. https://doi.org/10.1377/hlthaff.2017.0083
Guth, M., Artiga, S., & Pham, O. (2020, September 30). Effects of the ACA Medicaid Expansion on Racial Disparities in Health and Health Care. Retrieved from Medicaid: https://www.kff.org/medicaid/issue-brief/effects-of-the-aca-medicaid-expansion-on-racial-disparities-in-health-and-health-care/
Healthy People2020. (2010, December). Healthy People 2020 Law and Health Policy. Retrieved from Health.gov: https://health.gov/our-work/national-health-initiatives/healthy-people/healthy-people-2020#:~:text=Overview,for%20improving%20the%20nation’s%20health
Krieger, N., Waterman, P. D., & Chen, J. T. (2020). COVID-19 and overall mortality inequities in the surge in death rates by zip code characteristics: Massachusetts, January 1 to May 19, 2020. American Journal of Public Health, 110(12), 1850-1852. https://doi.org/10.2105/AJPH.2020.305913
Mahajan, S., Caraballo, C., Lu, Y., Valero-Elizondo, J., Massey, D., Annapureddy, A. R., . . . Nas, K. (2021). Trends in differences in health status and health care access and affordability by race and ethnicity in the United States, 1999-2018. JAMA, 326(7), 637-648. doi:10.1001/jama.2021.9907
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