Disparities in Healthcare in the United States: Identity-based Disparities and Income-based Disparities
Identity-based Disparitiesin healthcare
In the United States, disparities and inequities within healthcare happen for a multitude of reasons, including race, ethnicity, income level, immigration status, and more. Identity based disparities is a concerning issue in the United States, as demonstrated by the history of American medicine, Dr. Angela Anderson, and testimonies of healthcare workers. The nature of structural inequality in the United States also tends to create a vicious cycle of dehumanization, more frequent healthcare needed, and poor treatment by practitioners, as proven by Dr. Jay Pearson's life and work.
Income-based disparities in Healthcare
Healthcare in the United States is expensive: the average per-person spending on healthcare for people 65 and older was $22,365. For people below a certain income threshold, this impacts almost every facet of life. Dr. Rebecca Whitaker has dedicated her life to researching such disparities and how to make a difference and help lower-income people afford healthcare through Medicaid, especially in North Carolina, where such initiatives are becoming a more crucial part of the conversation surrounding healthcare equity.
Sources: https://usafacts.org/articles/how-much-is-spent-on-personal-healthcare/
Dr. Angela Anderson's Story
A harrowing anecdote of the dangers of racism in healthcare
Dr. Angela Anderson, a diversity and inclusion expert whose husband is an MD, exemplifies the struggle to receive care that many Black people in the United States, especially women, face. Despite extreme pain in her chest, Dr. Anderson was turned away or her pain was minimized at several facilities. Eventually, it was discovered that she had a pulmonary embolism in her right lung, pneumonia, and an infarction in her right lung, even though multiple doctors had told her it was nothing or "just congestion." If it weren't for her and her husband's advocacy, Dr. Anderson's struggle could have resulted in her losing her life because of medical negligence. Unfortunately, her story is only one of many of discrimination against Black people in healthcare.
Source: https://www.forbes.com/sites/janicegassam/2021/07/02/how-one-womans-story-of-medical-neglect-highlights-the-pervasive-issue-of-racism-in-healthcare/
Testimony from Healthcare Workers Across the United States
3,000 healthcare employees across the United States were profiled about their experiences with racism and disparities in healthcare. Of these 3,000, 70% who work in facilities with mainly Black patients have seen discrimination, 60% of Black healthcare workers have faced discrimination themselves, and 48% believed that medical professionals were more likely to listen to White patients who advocated for themselves and their needs than Black patients. Often, according to a Maryland doctor, patients of color are seen as "aggressive or belligerent" when they speak out on their medical needs, while White patients are seen as deserving of the care when they advocate for themselves.
Source: https://capitalbnews.org/health-care-industry-racism/
Interview with Dr. Rebecca Whitaker
Research Director with Duke-Margolis
Dr. Rebecca Whitaker, as the child of doctors, grew up surrounded by the healthcare system. However, although she wanted to make a difference and help people, she didn't want to be a clinician, and she enjoyed working around systems, so she decided to pursue health policy and policy research. She helps lead work on North Carolinian medicaid agencies, specifically through Duke's Margolis Institute for Health Policy. Through her work at Margolis, in pursuing healthcare equity for lower-income people, Dr. Whitaker often partakes in community engagement, such as focus groups and community advisory councils. Another big part of her work is to research storytellers, allowing her to elevate and translate existing research to convey the implications on the affordability of healthcare.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu
Interview with Dr. Jay Pearson
McLain Foundation Associate Professor of Public Policy
Dr. Jay Pearson's life and work demonstrates how life circumstances, specifically institutional barriers to receiving crucial healthcare, play out in the United States. Dr. Pearson grew up in rural North Carolina on a farm without electricity and running water, inspiring him to look at inequalities in receiving services, specifically healthcare. Early in his career, he worked with people from Latin America, and noticed that for underserved communities, there were more health risks, and minorities were often treated as if it were their fault when they needed medical attention. Dr. Pearson's life, work, and research has shown him that both institutional and structural mechanisms leave minorities in vulnerable positions, and dealing with systems that weren't designed to support them could damage their health. Specifically, for those who are descended from enslaved people, American systems weren't created with thoughts of them as human. These structural inequalities and the health issues they cause augment the struggle to get proper treatment that minorities face in the United States.
Source: Dr. Jay Pearson, jay.pearson@duke.edu
Poverty and Healthcare
When lower-income people pay out of pocket for health expenses, it's likely that they won't receive the full range of treatment that they need. As a result, their treatment will be delayed until their health gets worse and worse and they will need a much higher level of care. This impacts not only health, but every aspect of life: when healthcare costs are high and low-income people pay out of pocket, this prevents them from using their income for other things that they need, like housing and putting money into savings.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu
Facing Healthcare Inequalities
When issues don't specifically affect us or aren't often talked about in the media, such as healthcare disparities based on identity or income, it is easy to forget that they even exist. However, identity and income-based disparities are a huge issue all around the world, including in the United States and in North Carolina. Thousands of people face discrimination in healthcare, the struggle to afford services, and dehumanization that damages their health within systems they commonly interact with. It is crucial that people like Dr. Angela Anderson continue to tell their stories and that experts like Dr. Pearson and Dr. Whitaker continue to research the topic and work with communities to create a more equitable future of healthcare.
History of Racism in Health Care
In 19th century America and Europe, phrenology was used to claim that Black people and White people had differently shaped skulls, affecting their characteristics (which has since been disproven) and justifying the enslavement of Black people. In the 20th century, especially in the United States, Black people were used for medical experiments without their knowledge, such as the Tuskegee study, when 399 Black men were told they were given syphilis treatment when they truly were not. Coming into the modern day, healthcare has begun to be managed by computers and software, which tend to give Black patients lower "risk" scores and therefore harm their chance of receiving a referral for treatment. This manifests extremely dangerously: in 2020, Black and Latino people in the US were twice as likely to die from Covid -19 than White people.
Source: https://www.weforum.org/stories/2020/07/medical-racism-history-covid-19/
Medicaid Expansion in North Carolina
North Carolina was the 40th state to expand Medicaid. Before the expansion, the only way to get Medicaid in the state as an adult was to make less than 40% of the federal poverty line and be a parent or caregiver or an individual with disabilities. The expansion raised this to 138% of the poverty line. While this is a relatively recent update in North Carolina, research from other states shows that Medicaid expansion assists with preventative care, access to services, and improves health outcomes, especially for pregnant people . Unfortunately, states are struggling to afford the increase in costs in healthcare, and there have recently been issues with federal legislation changing Medicaid eligibility. States that have expanded Medcaid must now do an eligibility check every 6 months, and adults on Medicaid must attest to having been employed, volunteering, or being in job training programs. This specifically affects low-income and low wage- workers.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu
Disparities in Healthcare in the United States: Identity-based Disparities and Income-based Disparities
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Transcript
Disparities in Healthcare in the United States: Identity-based Disparities and Income-based Disparities
Identity-based Disparitiesin healthcare
In the United States, disparities and inequities within healthcare happen for a multitude of reasons, including race, ethnicity, income level, immigration status, and more. Identity based disparities is a concerning issue in the United States, as demonstrated by the history of American medicine, Dr. Angela Anderson, and testimonies of healthcare workers. The nature of structural inequality in the United States also tends to create a vicious cycle of dehumanization, more frequent healthcare needed, and poor treatment by practitioners, as proven by Dr. Jay Pearson's life and work.
Income-based disparities in Healthcare
Healthcare in the United States is expensive: the average per-person spending on healthcare for people 65 and older was $22,365. For people below a certain income threshold, this impacts almost every facet of life. Dr. Rebecca Whitaker has dedicated her life to researching such disparities and how to make a difference and help lower-income people afford healthcare through Medicaid, especially in North Carolina, where such initiatives are becoming a more crucial part of the conversation surrounding healthcare equity.
Sources: https://usafacts.org/articles/how-much-is-spent-on-personal-healthcare/
Dr. Angela Anderson's Story
A harrowing anecdote of the dangers of racism in healthcare
Dr. Angela Anderson, a diversity and inclusion expert whose husband is an MD, exemplifies the struggle to receive care that many Black people in the United States, especially women, face. Despite extreme pain in her chest, Dr. Anderson was turned away or her pain was minimized at several facilities. Eventually, it was discovered that she had a pulmonary embolism in her right lung, pneumonia, and an infarction in her right lung, even though multiple doctors had told her it was nothing or "just congestion." If it weren't for her and her husband's advocacy, Dr. Anderson's struggle could have resulted in her losing her life because of medical negligence. Unfortunately, her story is only one of many of discrimination against Black people in healthcare.
Source: https://www.forbes.com/sites/janicegassam/2021/07/02/how-one-womans-story-of-medical-neglect-highlights-the-pervasive-issue-of-racism-in-healthcare/
Testimony from Healthcare Workers Across the United States
3,000 healthcare employees across the United States were profiled about their experiences with racism and disparities in healthcare. Of these 3,000, 70% who work in facilities with mainly Black patients have seen discrimination, 60% of Black healthcare workers have faced discrimination themselves, and 48% believed that medical professionals were more likely to listen to White patients who advocated for themselves and their needs than Black patients. Often, according to a Maryland doctor, patients of color are seen as "aggressive or belligerent" when they speak out on their medical needs, while White patients are seen as deserving of the care when they advocate for themselves.
Source: https://capitalbnews.org/health-care-industry-racism/
Interview with Dr. Rebecca Whitaker
Research Director with Duke-Margolis
Dr. Rebecca Whitaker, as the child of doctors, grew up surrounded by the healthcare system. However, although she wanted to make a difference and help people, she didn't want to be a clinician, and she enjoyed working around systems, so she decided to pursue health policy and policy research. She helps lead work on North Carolinian medicaid agencies, specifically through Duke's Margolis Institute for Health Policy. Through her work at Margolis, in pursuing healthcare equity for lower-income people, Dr. Whitaker often partakes in community engagement, such as focus groups and community advisory councils. Another big part of her work is to research storytellers, allowing her to elevate and translate existing research to convey the implications on the affordability of healthcare.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu
Interview with Dr. Jay Pearson
McLain Foundation Associate Professor of Public Policy
Dr. Jay Pearson's life and work demonstrates how life circumstances, specifically institutional barriers to receiving crucial healthcare, play out in the United States. Dr. Pearson grew up in rural North Carolina on a farm without electricity and running water, inspiring him to look at inequalities in receiving services, specifically healthcare. Early in his career, he worked with people from Latin America, and noticed that for underserved communities, there were more health risks, and minorities were often treated as if it were their fault when they needed medical attention. Dr. Pearson's life, work, and research has shown him that both institutional and structural mechanisms leave minorities in vulnerable positions, and dealing with systems that weren't designed to support them could damage their health. Specifically, for those who are descended from enslaved people, American systems weren't created with thoughts of them as human. These structural inequalities and the health issues they cause augment the struggle to get proper treatment that minorities face in the United States.
Source: Dr. Jay Pearson, jay.pearson@duke.edu
Poverty and Healthcare
When lower-income people pay out of pocket for health expenses, it's likely that they won't receive the full range of treatment that they need. As a result, their treatment will be delayed until their health gets worse and worse and they will need a much higher level of care. This impacts not only health, but every aspect of life: when healthcare costs are high and low-income people pay out of pocket, this prevents them from using their income for other things that they need, like housing and putting money into savings.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu
Facing Healthcare Inequalities
When issues don't specifically affect us or aren't often talked about in the media, such as healthcare disparities based on identity or income, it is easy to forget that they even exist. However, identity and income-based disparities are a huge issue all around the world, including in the United States and in North Carolina. Thousands of people face discrimination in healthcare, the struggle to afford services, and dehumanization that damages their health within systems they commonly interact with. It is crucial that people like Dr. Angela Anderson continue to tell their stories and that experts like Dr. Pearson and Dr. Whitaker continue to research the topic and work with communities to create a more equitable future of healthcare.
History of Racism in Health Care
In 19th century America and Europe, phrenology was used to claim that Black people and White people had differently shaped skulls, affecting their characteristics (which has since been disproven) and justifying the enslavement of Black people. In the 20th century, especially in the United States, Black people were used for medical experiments without their knowledge, such as the Tuskegee study, when 399 Black men were told they were given syphilis treatment when they truly were not. Coming into the modern day, healthcare has begun to be managed by computers and software, which tend to give Black patients lower "risk" scores and therefore harm their chance of receiving a referral for treatment. This manifests extremely dangerously: in 2020, Black and Latino people in the US were twice as likely to die from Covid -19 than White people.
Source: https://www.weforum.org/stories/2020/07/medical-racism-history-covid-19/
Medicaid Expansion in North Carolina
North Carolina was the 40th state to expand Medicaid. Before the expansion, the only way to get Medicaid in the state as an adult was to make less than 40% of the federal poverty line and be a parent or caregiver or an individual with disabilities. The expansion raised this to 138% of the poverty line. While this is a relatively recent update in North Carolina, research from other states shows that Medicaid expansion assists with preventative care, access to services, and improves health outcomes, especially for pregnant people . Unfortunately, states are struggling to afford the increase in costs in healthcare, and there have recently been issues with federal legislation changing Medicaid eligibility. States that have expanded Medcaid must now do an eligibility check every 6 months, and adults on Medicaid must attest to having been employed, volunteering, or being in job training programs. This specifically affects low-income and low wage- workers.
Source: Dr. Rebecca Whitaker, rebecca.whitaker@duke.edu