HCM632 Unit 4 Individual Project CH
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UNIT 4 INDIVIDUAL PROJECT
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Unit 4 Individual Project
Health Equity: A Public Health Issue in the American Healthcare System
Colorado Technical University HCM632
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Unit 4 Individual Project
Public health is the science of protecting people and promoting health through research and initiatives aiming to prevent illness, disease, and injury in a given population (Walden, 2023). This population can be as small as a neighborhood community or as large as the entire world. Public health professionals, alongside medical professionals and local, state, and federal governments, investigate the physical and environmental causes of diseases or injuries, research health trends, provide training on health improvement, and advocate for policies and laws that promote greater public health. Threats to general public health, including pandemics, air pollution, behavioral health, and chronic illness, are categorized as public health issues. These are only a few examples of public health issues plaguing America today. These issues vary in severity and scale, depending on the mode of transmission and strength of the healthcare system as a whole. Some public health issues have persisted for hundreds of years, such as communicable disease and socioeconomic, minority, and racial disenfranchisement, while others
developed more recently, like gun violence, antibiotic resistance, and climate change. It is crucial
to address and mitigate the damage of these public health issues to improve the health, wellbeing, and longevity of all people in America, as well as around the world. In recent years, the scope of public health in America has shifted to include the advancement of health equity and the elimination of healthcare disparities across the nation. Health equity, as defined by Braveman (2014), is the underlying principle of commitment to reduce and ultimately eliminate health disparities in part through focusing on those who are at
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greatest health risk, leading to the highest possible health for all people. Those considered at greatest health risk would be determined by socioeconomic conditions and social determinants of
health, such as individuals facing discrimination or racism, individuals with disabilities, individuals in hazardous work environments, or individuals who are undereducated or low-
income. Differences in health outcomes related to the aforementioned disadvantages are health disparities. It is important to note that not all health differences are categorized as health disparities; differences in health outcomes between younger and older populations, for instance, is an expected phenomenon and not based on healthcare inequity. Health equality would mean treating every patient exactly the same, with no regard to their life experience or ethnic/cultural differences. While the goal is for all people to reach the highest possible standard of health, certain groups are more at risk for poor health, have less ability to get treatment, and are more likely to get severely sick or die from a treatable or preventable diseases and these people need more support and opportunity from the healthcare system to reach that same level of health (APHA, 2021). Health equity and health disparities are intertwined, wherein the former can only exist when the latter is eliminated. To focus on improving health equity is to focus on health disparities, by identifying them, researching them, and creating strategies and policies to eradicate them. Health equity represents a public health issue in the United States due to persistent and detrimental health disparities that exist in the healthcare system. These health disparities negatively affect not only disadvantaged individuals but also overall population health and the United States economy. A study by the National Urban League Policy Institute estimated that health disparities caused an economic burden of $126 billion dollars in medical costs and lost
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productivity in 2020 and that number is anticipated to increase to $363 billion by 2050 (Fee & Gonzalez, 2017). Healthcare system and policy changes implemented in the coming decades could help mitigate the impact of health disparity-related medical expenditures. Social policies beyond healthcare such as minimum wage increases, progressive tax plans, and antidiscrimination laws regarding equitable housing and employment statutes could lessen the societal burden on disadvantaged groups and promote overall health and safety (Braveman, 2014). It is a public health responsibility for governments of all levels to advance the causes of health equity and progress toward the elimination of health disparities through community, state, and federal programs and policies.
Local governments can address health disparities at the community level by sponsoring a robust public health services infrastructure, improving education access and quality, and ensuring safe, affordable housing for all citizens (Rosenthal et al., 2022). By addressing the social determinants of health, communities can support and uplift the most at risk members of their society and improve health and the quality of life for everyone. In a powerful example of what community initiatives can achieve, Iton et al. (2022) detailed their involvement with the California Endowment initiative Building Healthy Communities, a group that promotes environmental justice and building community power to improve population health and health equity, as they lobbied for neighborhood parks as community enrichment. At the state level, governments and policymakers can build on the progress of local government in improving public health infrastructure and equitable access to essential and specialty medical care across the state. For example, in July 2021, California added an additional
$300 million to the annual budget for public health agencies (Rosenthal et al., 2022). If other
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states were to follow the standard set by California, tremendous advancement of public health would occur across the nation. One of the most significant actions a state can take to advance health equity is the expansion of their Medicaid and Children’s Health Insurance Program (CHIP) benefits. Since the Affordable Care Act (ACA) increased federal funding for Medicaid and CHIP in 2010, not all states have taken advantage of this opportunity and ensured access to essential healthcare services for their uninsured populations, allowing health disparities to run rampant. In the states that have yet to expand Medicaid and CHIP benefits and lowered eligibility thresholds, the federal government has a responsibility to step in and finish the healthcare reform that they started through the ACA.
The federal government has the most authority over healthcare reform and major healthcare system changes. It is crucial that federal policy and lawmakers align their health equity objectives with those at the state and local levels of government. Access to essential medical care should not be a partisan talking point, it is a bipartisan duty to promote health equity and ensure the highest standard of health for all American citizens. The Supplemental Nutrition Assistance Program (SNAP) is an example of a federally funded program that mitigates health disparities by reducing the negative effects of social determinants of health such as poverty and food insecurity. SNAP provides monthly grocery stipends to more than 37 million
people in the United States (Rosenthal et al., 2022). Proper nutrition and dietary balance are critical to health and wellbeing, and many disadvantaged individuals reside in communities that could be referred to as “food deserts”, where commodities such as fresh fruit and vegetables are not available due to the lack of grocery stores and predominance of unhealthy food sources like
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fast food chains and gas stations. SNAP benefits help to bridge this gap in availability and affordability of nutritious foods in families’ diets.
Numerous laws have been passed to address healthcare disparities in America and mitigate the detrimental social and healthcare outcomes for disadvantaged populations. Public Law 106-525, the Minority Health and Health Disparities Research and Education Act of 2000 established the National Center on Minority Health and Health Disparities (NCMHD) and approved a budget to research health disparities. The goal of the NCMHD was to create a comprehensive research plan to identify and define health disparity populations by working in collaboration with other public health service federal agencies such as the Agency for Healthcare
Research and Quality. The Patient Protection and Affordable Care Act (ACA), passed in 2010, promoted the NCMHD to the designation of the National Institute on Minority Health and Health
Disparities (NIMHD) and granted it the authority to oversee all minority health and health disparity research conducted within the National Institutes of Health (NIH, 2023). The ACA was significant to the promotion of health equity across the United States in a multitude of ways. The expansive and comprehensive healthcare reform law increased access to healthcare by providing health insurance to millions of previously uninsured individuals, through the expansion of Medicaid federal benefits and the creation of an Insurance Marketplace for individuals who did not qualify for public insurance nor afford private employer insurance coverage. Preventative care benefits were expanded and required to be free of charge for all insured individuals, allowing many disadvantaged populations to receive routine medical care for the first time in a long time, or possibly their entire life. Another significant provision of the ACA made it impossible for insurance providers to deny coverage to individuals based on preexisting
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conditions, ensuring the continued healthcare coverage for disabled individuals and those suffering from chronic conditions.
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References
American Public Health Association
. (2018, May 10). Creating The Healthiest Nation: Advancing Health Equity. APHA Brief.
https://www.apha.org/-/media/Files/PDF/factsheets/Advancing_Health_Equity.ashx
APHA. [American Public Health Association]. (2021, December 28).
What is Health Equity?
[Video]. Apha.org. https://www.apha.org/Topics-and-Issues/Health-Equity
Braveman, P. (2014). What Are Health Disparities and Health Equity? We Need to Be Clear. Public Health Reports
, 129
(Suppl 2), 5-8. https://doi.org/10.1177/00333549141291S203
Fee, E., & Gonzalez, A. R. (2017, May 22). The History of Health Equity: Concept and Vision. Diversity and Equity in Health and Care
, 14
(3), 148-152. https://diversityhealthcare.imedpub.com/the-history-of-health-equity-concept-and-
vision.pdf
Iton, A., Ross, R. K., & Tamber, P. S. (2022). Building Community Power To Dismantle Policy-
Based Structural Inequity In Population Health.
Health Affairs,
41
(12), 1763-4. https://doi.org/10.1377/hlthaff.2022.00540
National Institutes of Health (2023, August 17).
National Institute on Minority Health and Health Disparities (NIMHD)
. The NIH Almanac. https://www.nih.gov/about-nih/what-
we-do/nih-almanac/national-institute-minority-health-health-disparities-nimhd
Rosenthal, J., Rapfogel, N., & Johns, M. (2022, April 28).
Top 10 Ways To Improve Health and Health Equity
. CAP20. https://www.americanprogress.org/article/top-10-ways-to-
improve-health-and-health-equity/
Walden University (2023).
What Is Public Health and Why Is It Important?
Waldenu.edu. Retrieved December 10, 2023, from
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https://www.waldenu.edu/programs/health/resource/what-is-public-health-and-why-is-it-
important
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