Neurological

The importance of equity in addressing health inequalities

COVID-19, more than any other disease, has highlighted the significant racial differences in care in the United States. COVID-19 did not create these health inequalities, but the national conversations and expanded literature on inequalities have clearly been influenced by this global pandemic. A greater recognition of the role of health inequalities and the different effects of certain diseases in some populations has led to more discussions about equity both inside and outside of health care.

During the height of the pandemic, there were significant racial differences in the rates of COVID-19 testing, infection, and hospitalization for black and Hispanic populations. Rather than mistakenly concluding that there is a biological basis for this discrepancy, the medical community has recognized that the differences are likely related to social determinants of health. In this case, patients from these populations were more likely to be key workers who couldn’t work remotely, had to use public transport to commute, and lived in multigenerational families where isolation from COVID-19 or quarantine after exposure was difficult.

The early detection and observance of these differences led to a targeted strategy for solving the problem. This meant targeted contact with severely affected population groups by improving access to tests at the beginning of the pandemic and prioritization for subsequent vaccinations. From an ethical standpoint, this was an approach that focused on equality, not equality. Equality ensures everyone gets the same, but equality ensures everyone gets what they need. There is sure to be a place for equality. Everyone should equally have certain rights. For example, everyone should have the same legal protection and access to public education. But justice manages to restore conditions to promote justice.

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From an ethical point of view, health resources should not be distributed as a commodity, but rather as needed so that everyone has a fair chance of health benefits. Healthier populations promote prosperity by enabling more people to contribute to employment, increase productivity, preserve opportunities and reduce health costs. Healthier people can more easily participate in the democratic process.

The best metaphor for this concept can be found on the Culturalorganizing.org website in an article entitled “The Problem With the Graphic You Are Using,“ Equality vs Baseball Game Behind a Fence.2 The metaphor uses people of equal size, suggesting that the inequality in watching the game is not biologically determined. An equal approach to dealing with the problem would be to provide an equally sized box for each of the observers to see over the fence, but it would not solve the problem for the person at the lowest point on the ground. A righteous approach provides the highest box for the person at the lowest point on the floor, providing them with what they need to get the same result as the others. Giving one person a bigger box doesn’t take away anything from the other two and allows everyone to watch the game.

The debate about promoting justice remains. Some may argue that US cultural and economic history promotes the primary value of individual responsibility and that the obligation of institutions or governments is to promote equality, and not necessarily to achieve equality. Others may lean towards an equality approach, believing that justice is a zero-sum game and that giving something to one group means taking it away from another. Choosing what is fair and how it can be achieved continues to be the subject of heated debate in our society.

Opposing the gender-based arguments is the concept of the “curb-cut” effect, which is described in an article by Cory Collins on the Learning for Justice website entitled “The Curb-Cut Effect and Championing Equity”. Curb cuts are ramps that were built into sidewalks in the 1970s to create more livable outdoor spaces for wheelchair users. Curbs were originally designed to improve wheelchair access, but after their widespread adoption it became clear that many more people were benefiting from the change in sidewalk design, including the elderly with walking aids, people pushing strollers, travelers pulling suitcases , and skateboarders.

If we extend this metaphor to health care, the examples of the benefits of promoting justice are numerous. If we commit to better understanding, addressing, and managing the significantly higher maternal mortality rates among black women, not just them, but all women with potential reproductive potential. Understanding why black men and women have relatively lower cancer survival rates brings us closer to a better understanding of cancer biology (including its racial similarity), the impact of race on health, and the role of health care in achieving better outcomes . When we prioritized COVID-19 vaccination among colored communities, we helped reduce health inequalities for disadvantaged populations while maintaining the safety of other communities by reducing the incidence of COVID-19. From a public health perspective, seat belt legislation was originally developed to protect children in motor vehicles, but resulted in broader adoption that saved the lives of all passengers. Cycle lanes to protect cyclists also protect pedestrians.

An approach to equity has the potential to change the way we address health inequalities and help everyone have equal opportunities to be healthy. Progress in this area starts with having more conversations and dealing with what is “fair”.

David J. Alfandre, MD, MSPH, is a health ethicist and associate professor in the Department of Population Health, NYU School of Medicine, New York. The views expressed in this article are those of the author and do not necessarily reflect the position or policies of the VA National Center for Ethics in Health Care or the US Department of Veterans Affairs.

reference

Braveman P. What are health differences and health equity? We have to be clear. Public Health Rep. 2014; 129 (Suppl 2): ​​5-8.

This article originally appeared on the Kidney and Urology News

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