Health inequities among African Americans and Hispanics in the U.S. healthcare system

Inequities for Ethnic Minorities in the United States in the National Healthcare System

Introduction
Today, the U.S. spends approximately double the amount of other high-income nations on health care, but the nation still suffers from the lowest life expectancy and the highest infant mortality rates among these countries (Rapaport 2019). Although the demographic composition of the United States has experienced significant increases in the percentages of ethnic minorities, most especially Hispanics and African Americans, in recent years, many members of these groups remain marginalized in terms of their access to high quality and affordable health care services. As defined by the World Health Organization, health inequities are “are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies” (Key concepts, 2019, para. 2). This definition underscores the fact that although health inequities continue to exist in many countries, including the United States, it is possible to mitigate and even eliminate them if the political wherewithal exists. The purpose of this paper is to explicate the current inequitable distribution of health in the United State. A discussion concerning how public health has explained this health inequity in the past is followed by an example of a current public health model to show how this health inequity is produced and understood today. Finally, a summary of the research and important findings concerning the current inequitable distribution of health in the United States are provided in the conclusion.
Review and Discussion
How public health explains health inequities in the past
Today, African Americans account for nearly 13 percent of the population in the United States, meaning that they number about 37.3 million people (United States people 2019). While this minority group has experienced significant gains in terms of gaining equal civil and voting rights as well as improved employment opportunities in recent decades, African Americans as a group continue to suffer from significant inequities in health. For instance, a recent white paper by Cigna (Health disparities 2019, p. 1) found that, “As a group, the African-American or Black population experiences significant disparities with chronic conditions, access to care, preventive screenings, and mental health.”
As a group, African Americans suffer from some of these disparate health care outcomes as a result of various genetic factors, but there are also some profound significant environmental factors such as the communities in which they live that also play a significant role in exacerbating lingering health inequities. In this regard, one industry analyst emphasizes that,”The underlying causes of the health disparities have been linked to genetics, lack of economic resources, limited access to health care, delay in treatment, cultural beliefs, low literacy and health literacy rates, and certain environmental factors” (Health disparities 2019, p. 1).
A breakdown of the current health inequities that are being experienced by African Americans as a demographic group is set forth in Table 1 below.

Table 1. Breakdown of health inequity types among African Americans
Health Inequity Type
Current Statistics

Obesity and childhood obesity 48 percent of adults are obese. High rates of severe childhood obesity. Diabetes

80 percent more likely to be diagnosed with diabetes. 2.4 times more likely to begin treatment for end-stage renal disease. 1.7 times more likely to be hospitalized. 20 percent more likely to have visual impairments. Heart disease

Men are 30 percent and women 60 percent more likely to have high blood pressure. Less likely to keep their blood pressure under control. Men have twice the risk of first time stroke. Cancer

Women are 40 percent more likely to die of breast cancer. Men are 1.3 times more likely to have new cases of colorectal cancer. Maternal and child health

Children are 1.8 times more likely to have ever been told they have asthma. 3.5 times as likely to die as infants due to complications related to low birth weight. 2.2 times higher infant mortality rate. Mental health

20 percent more likely to report psychological distress. 50 percent less likely to receive counseling or mental health treatment Source: Health Disparities: White Paper (2019, p. 2)
These glaring inequities in health among African Americans are the legacy of racial segregation that still remains a significant problem in many American communities, creating large pockets of impoverished individuals, most especially in the nation’s inner cities. Following the passage of the Civil Rights Act of 1964 and the Voting Rights Act of 1965, the United States experienced what has been termed “white flight” as tens of millions of white Americans moved to the suburbs to escape the increasingly turbulent inner cities, leaving behind millions of African Americans who could not afford to relocate. As a result, many African Americans remain mired in inner-city neighborhoods that lack reasonable access to health care services. In this regard, Baum (2003, p. 397) emphasizes that, “In the United States of America, segregated minorities are concentrated in central cities, which are typically the oldest, most dilapidated and most socioeconomically deprived part of the metropolitan area.”
Although every African American community is unique and differs in various ways, the overall severe adverse effects that result from living in impoverished neighborhoods on health has been carefully studied and is well documented. For example, Baum (2003, p. 397) notes that, “The effect of neighborhood characteristics on mortality indicates a moderate (statistically significant relative risk between 1.1 and 1.8) association between neighborhood environment and health, controlling for individual socioeconomic and other characteristics.” Moreover, in far too many cases, the needs of inner-city African Americans with respect to access to health care services have outpaced the ability of local communities to respond, creating a downward health spiral that may have lasting effects over the next several generations.
The problem is well documented, but there has been little political impetus to make substantive changes in the current health care delivery system to address these inequities, a tendency that is also the ugly legacy of longstanding negative views about minorities among many elderly white male lawmakers today. This is not to say, of course, that the houses of the U.S. Congress and the current chief of the executive branch are blatantly racist in their views and deliberations, but it is to say that the recent efforts by many states to all-but-outlaw abortions indicate that many legislators in the United States today are highly conservative and these views can translate in the maintenance of longstanding inequities in health. Likewise, many black people consider themselves stigmatized “as a negatively stereotyped minority community within the larger society” (Coreil, Mayard, Simpson et al. 2010, p. 1409). Indeed, a growing body of scholarship has evaluated the adverse effects of stigmatization on minority groups and health care outcomes (Hatzenbuehler, Phelan and Link 2013, p. 813).
Therefore, in order to effect meaningful changes that directly address these health inequities, it is vitally important to develop a better understanding of how these social forces have operated to marginalize tens of millions of African Americans and what effects these forces have had on health care outcomes. For example, according to Baum (2003, p. 17), Understanding the place and role of public health in our society requires an understanding of health and its manifestations.” Better understanding the place and role of public health in U.S. society clearly involves the function of lawmakers in formulating and implementing health care policies for all Americans, as well as the role played by the health care community in achieving its mission to deliver the highest quality medical services to all Americans.
It is reasonable to posit that the current health inequities that are being experienced by the African American demographic group are the direct and indirect result of the above-mentioned conservative lawmakers. For instance, according to Baum, Lawless, Delany et al. (2014, p. 130), The impact of social, political and economic determinants on health has long been recognized. Policy has also been seen as a means of making the impact of these determinants healthier since at least the nineteenth century.” Given that regions of the country that are at the highest risk of failing to provide equitable access to health care services are well known and that the United States spends more on health care services per capita than any other, it is perplexing to understand how these inequities persist unless the problem is considered in terms of the lengthy historic marginalization of African Americans.
In this context, the problem becomes easier to understand but identifying optimal strategies for addressing it remains a profound challenge for policymakers and social scientists alike. As Baum, Lawless, Delany et al. (2014, p. 131) point out, “Implementing policies that address the social determinants of health has proven to be difficult, partly because of the complexity of devising effective policies.” Notwithstanding the challenges and difficulties that are involved in directly addressing the lingering health inequities in the United States, there are some models available to help guide the process and these issues are discussed further below.
Description of public health model to show how this health inequity is produced and understood today
In general, public health models focus on the overall health of the American public, rather than specific demographic groups. There are some public health models available, however, that manage to take all health care consumers and their unique needs into account at the macro level. In this regard, Baum et al. (2014, p. 131) report that one such model is the, “Health in All Policies (HiAP) [which] has developed as a mechanism to promote action on the social determinants of health (SDH) by facilitating action in sectors where health is not a primary consideration.” The HiAP model operates at the macro level on American society. For example, according to one authority, “Briefly, the macro level, sometimes called a primary intervention strategy, may be referred to as a whole-population approach. It is a strategy of helping that aims to impact the quality of life of groups as largely as possible” (An Advanced Generalist/Public Health Model n.d., p. 109).
As noted throughout, the vast sums of money that are being spent on health care services in the United States exceed all other affluent nations, and the per capita amount is staggering. For example, according to the U.S. Centers for Medicare and Medicaid Services (Historical 2019, p.2), “U.S. health care spending grew 3.9 percent in 2017, reaching $3.5 trillion or $10,739 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.9 percent.”
The argument could easily be made that it would be far more productive to simply give each American health care consumers $11,000 a year and allow them to arrange for their own health care needs, but this approach would still not solve the fundamental problem of health inequities in the United States today. Rather, what is needed is a public health model that recognizes the needs of all health care consumers such as the HiAP model. In this regard, Baum et al. (2014, p. 1132), “HiAP is an approach to generating public policies across sectors which systematically takes into account the health implications of decisions, seeks synergies and avoids harmful health impacts in order to improve population health and health equity.”
Perhaps the most innovative aspect of the HiAP model is its reliance upon the health care community to participate in the process of providing appropriate levels of health care to all demographic groups. For example, according to Krech and Valentine (2010, p. 730), the HiAP model “starts by stressing the need to examine the management of policies and goals across government. Further, it calls upon the health sector to be involved in the development of policies in other sectors to ensure health equity.” The basic difference between the HiAP model and the current health care model in place in the United States is its focus on overcoming longstanding inequities in health in every aspect of policymaking. In this regard, Krech and Valentine (2016, p. 730) add that, “This does not necessarily mean a departure from the health sector's main functions, but rather a broadening of its scope and role within public policy-making.”
In sum, by making equitable access to health care a priority in all policymaking, the HiAP model provides a useful framework in which to ensure that the health care needs of all citizens are taken into account by lawmakers acting in collaboration with the health care community. It is important to note, however, that overcoming longstanding inequities in health also involves improving other socioeconomic factors and the process does not occur overnight but is rather the end result of a focused effort.
In fact, the HiAP model requires a sea change in thinking on the part of legislators and health care leaders alike that acknowledges their shared responsibility of developing, implementing and administering policies that are specifically designed to ensure that access to high quality health care services is not regarded as a luxury but rather as a basic human right. As Krech and Valentine (2010, p. 731) conclude, “For the health sector to play a broader role, new accountability arrangements must also be created across government that recognize that health and well-being issues are in everyone's interest.” In sum, the HiAP model represents a valuable resource that can be used to address a broad range of health inequities in the United States today.

Conclusion
The research showed that today, the United States spends more on health care than any other country in the world. Indeed, the United States spends nearly $11,000 per person, but the nation still suffers from some of the worst health indicators among the industrialized world. This troubling trend also means that on average, some health care consumers are receiving far more than their fair share of this $11,000 per person per year figure indicates, while many others, most especially already marginalized ethnic minority members, receive far less. This is by definition a major health inequity. Moreover, simply throwing more money at this problem, though, will not solve it because the issues involved are not only complex, many of them date back more than three centuries when African Americans were first brought to the United States as slaves. In the final analysis, it is reasonable to conclude that the current inequities in health that characterize the African American demographic group will not improve unless and until an appropriate public health model such as Health in All Policies is embraced and consistently applied to the provision of health care services for all citizens in the United States.

References
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