Wendy Wolfson
Newswire21.org
When it comes to your health, your tax bracket and zip code may play a bigger role than your genetic makeup.
Healthcare experts in recent years have started to look at why people's health depends so much more on their income than anything else.
"The debate on health care reform, hate to say it, is not going to improve the nation's health." said Dr. Brian Smedley, researcher at the Health Policy Institute at the Joint Center for Political and Economic Studies, in one of the seminars at the recent California Endowment Health Journalism fellowship in Los Angeles. "It is downstream, but doesn't address the causes of why you get sick."
Researchers like Smedley are looking at living conditions within communities, and social and economic opportunities.
"A lot of people have conflated health care with health status," said Smedley. "We sometimes think if we just had that silver bullet - the magic shot that would cure cancer - we would all be healthy. But these are not as cost effective as looking at the conditions that make people sick in the first place."
In thinking about your health as a series of interacting factors, zip code is shorthand for a lot of things. According to Smedley, the illnesses you get and care you receive are a function of where you live and how much money you make.
Smedley and his colleagues have analyzed health care bills before Congress to see how effectively they address health care inequities particularly for people of color.
"Access to care is limited for racial and ethnic minority groups," said Smedley. "They get a lower quality of health care, according to an Institute of Medicine report. Or they get more treatments that you don't want, like amputations because of uncontrolled diabetes."
Weak Legislation
According to Smedley, current health care bills lack in community-based
prevention: "This is where we get the biggest bang for our buck in
addressing population based inequities."
The moral argument for healthcare just isn't working any more, Smedley noted; the arguments to sway people, need to be economic. While legislatures are rightly concerned of the implications of cost, what are the consequences of allowing racial and ethnic disparities to exist? What are the indirect costs?
The Joint Center commissioned a couple of health economists to look at the federal data set of health care expenditure survey. According to the report, more than 30 percent of direct medical costs faced by African-Americans, Hispanics and Asian-Americans were excess costs due to health inequities – more than $230 billion over a three-year period. And when you add the indirect costs of these inequities over the same period, the tab comes to $1.24 trillion.
Beyond Health
Smedley projects that, according to current trends, inequality in health
care access will worsen, subtly but importantly because of economic downturn.
"Despite the historic 2008 election, the US is not post-racial. The individual determinist attitude remains predominant in US," he said, calling for systemic preventive health and improvement of overall neighborhood conditions.
"Racial segregation is one of the most fundamental drivers of health disparities," said Smedley. "While fewer US families live in great poverty since 1960, the US remains highly segregated. Factors that contribute to structural inequality include your socioeconomic position, occupation risks, and degree of residential segregation."
Segregation concentrates poverty and excludes communities from mainstream resources. It also restricts socio-economic opportunity by channeling non-whites into neighborhoods with poorer public schools. Real estate is worth less, resulting in a lower tax base, resulting in less money for schools.
African-Americans are five times more likely than whites to live in tracts without supermarkets, but with fast food outlets, liquor stores and convenience stores. They also are less likelier to live with safe places to walk, recreational centers or swimming pools. Poor neighborhoods are more likely to be exposed to environmental hazards.
Poverty Tax
There is also the "poverty tax", noted by Delores Acevedo-Garcia,
researcher at the Harvard School of Public Health in a 2008 paper where
residents of poor communities pay more for same consumer products.
The relative risk of living in concentrated poverty is greater if you are of color. "It is better to be poor if you are white." said Smedley.
Black and Hispanic children live in families that disproportionately experienced disadvantage. What is striking is that those children tend to be concentrated in poor neighborhoods with high degrees of poverty, but poor white kids are spread out in more middle class and affluent neighborhoods.
On each step up the socio-economic ladder, your health tends to be better.
"Health risks and health-seeking behaviors arise out of an ecological context," said Smedley. "All this added up to differences in access to health care. The differences in quality of care are just not as important as the prior factors."
