This past week I was very lucky to be given the opportunity to attend the Virginia Public Health Association’s Conference on Health Equity. The conference was held in Richmond, Virginia’s capitol, and welcomed people from around the state who were interested in learning more about inequalities in our health care systems, health outcomes and policy priorities.
The main point made at this conference was that inequities in health outcomes are caused by more than just individual behaviors or biological predisposition. Instead, quality of health can be attributed to comprehensive and systemic factors.
Like what? Think big: infrastructure, geography, education, language. Surprise, surprise -- our nation’s system is currently designed to disenfranchise, dis-empower and disregard our most vulnerable populations’ needs when it comes to wellness.
Let me paint a picture to better illustrate this idea:
Like most of the people in his neighborhood, Mark is a working class black man with no insurance coverage. Since the economic downturn, most of the nearby shops are empty storefronts and the nearest grocery store is two bus rides away. The closest sources of food and basic supplies are corner stores and fast food restaurants.
Many people in Mark’s neighborhood were laid off when the economy took a dive, and lack of job opportunity has forced several families into transitional housing or onto the streets. When property values fell and businesses moved away, public services were stretched thin, and the neighborhood school closed. Mark’s three children were forced to commute to a school located further away.
Mark is worried that his children are hanging with the “wrong crowds”, especially as drop-out and crime rates increase in the area. Unfortunately, there are no community centers or after-school programs for his children to attend, meaning they spend a lot of time un-supervised and un-engaged.
Mark’s apartment is often damp and smells of mold, but his landlord is not responsive to service requests. His youngest child has trouble breathing and was once diagnosed with asthma that worsens in the damp apartment.
The nearest health provider is the emergency room hospital, which is expensive to visit and difficult to get to.
Statistics indicate that Mark, as a working class black man with no insurance, is more likely than his white or higher-income peers to be obese, have diabetes, high cholesterol or heart conditions. He is less likely to get screened for cancer, more likely to remain low-income for the rest of his life, and less likely to attain higher education. His age expectancy is (on average) 68.
Now -- let’s tell Mark to practice some basic preventive care that would improve his health outcomes.
- Exercise and eat a healthy diet rich in fresh fruits and vegetables.
Most corner stores only have packaged or canned foods, and fast food restaurants provide the most affordable, filling and convenient meals.
Poor transportation make it difficult for Mark to even get to a grocery store, and when he does the prices are high. It is nearly impossible for Mark to make the time or find the space to exercise in a neighborhood that is not always safe.
- Go to a yearly check-up to prevent illnesses from going untreated.
The health department in the community only provides essential services -- mostly immunizations for children, prenatal care, and STD testing.
Mark has a high enough income that he is not eligible for Medicaid, and the free clinic’s lines are long and only focus on people who are already sick.
- Go back to school and get a better job so you can have insurance.
Even if there was still a community center or school in the neighborhood that offered night classes to adults at a reasonable price, it would be difficult for Mark to find the time in between work shifts to attend class, study AND fulfill his responsibilities to family.
- Move out of the damp apartment that is making your children sick.
The apartment buildings throughout the community in Mark’s price range have similar conditions and local landlords are known for disregarding the requests of black tenants.
- Minimize stress to promote mental health and overall wellness.
It is clear that there are larger systemic issues at play in this scenario -- a made up, but highly common story. From the poor transportation systems to the lack of food options to the policies and politicians that allow landlords to ignore tenants’ complaints, odds are stacked against this family ... and many others like it!
Moving beyond one-on-one patient care, these systemic barriers are what our health experts and advocates must address in the hopes of overcoming inequalities in health status. We have our work cut out for us!
Thanks to the Virginia Public Health Association for contributing to this ongoing conversation. Please feel free to express your opinion on health equity below!
Edited by Jody Smith