Is good health maintained if a person has good genes, goes to the doctor, and follows treatment plans? How is health affected if a person has unstable housing, utilities, income, access to food and transportation? Do isolation and interpersonal violence (on children and elderly) and abuse play a role in health? How do chronic stress, mental health, and cognitive impairments impact health and wellness?
History reflects health and wellness to be solely based on medical diagnosis and compliance. I have previously seen patients being fired from a doctor’s office for not following treatment plans, no-shows to appointments, and non-payment. Patients were not asked what their barriers (social determinants) to health were and the barriers were not addressed.
Thankfully, there is a shift and some medical practices, insurance companies, and non-profits are looking at a person as a whole and are assessing for their social, economic, and physical barriers to care.
To address barriers to equity, it is important to understand what some of the definitions are around health equity.
Health equity: Focuses to ensure all people have full and equal access to opportunities that enable them to lead healthy lives. The goal of health equity is to eliminate avoidable health inequities and health disparities by focusing on social, economic, and environmental conditions (social determinants of health.)
Health disparities: Focuses on the differences in health outcomes among groups of people (for example lower working class vs. upper class.) Health disparities are affected by health inequities.
Health inequities: Focuses on the differences in health that are avoidable, unfair, and unjust, the results from social, economic, and environmental conditions (social determinants of health.)
Social determinants of health are important aspects that influence our overall health. These include where we live, the education we receive, the work we do, the wages we earn, and the opportunity to make decisions that affect our own and our family’s health.
Some of these social determinants are easier to change and improve than others and can either positively or negatively impact the ability of all people to lead healthy, productive lives.
Equity vs. equality: Health equity and health equality do not mean the same thing. Equality means giving everyone the same thing, whereas equity means giving people what they need to reach their best health.
For example, there are 100 people in a room, men, women, children all needing new shoes. Shoes provided under equality; every person would be given a pair of men’s shoes, size 9 (only men with size 9 feet would benefit.) Shoes provided under equity; every person would be given a pair of shoes in the right size.
Addressing a person’s social, economic, and physical barriers while providing medical care is a new concept. The medical field including hospitals, doctors’ offices, mental health, and insurance companies are starting to understand the importance of addressing these barriers.
For example, if people don’t have a steady income, they probably do not have stable housing, transportation, and nutrition. They may be forced to decide whether to feed their kids instead of buying insulin.
Here are some examples of cases I have had over the years. An 80-year-old woman who relies on her family for a ride to the doctor has transportation conflicts because her daughter cannot get off work to take her to the appointment.
A 40-year-old with progressive MS lost their job and insurance and misses doctor’s payments because they need to feed their kids.
A 14-year-old with behavioral issues could not get to mental health services because their parent(s) are unstable due to drug use and domestic violence.
A child (USA citizen) of an immigrant worker did not follow up with medical treatment, because there were language barriers and fear of deportation/separation.
A 30-year-old struggling with substance (alcohol) use who had a strong desire to get sober could not afford an inpatient facility.
The list can go on and on.
It takes a lot of time and effort to address a person’s social determinants of health. I have seen first-hand if the daily physical and socioeconomic needs of a person are addressed, health, and wellness improves for people from birth to death.
The goal for health equity will be achieved when every person no matter their age, gender, economic status, geographic location, and skin color is given the opportunity to reach their full health potential.
Amy Rowan is the care coordinator manager for Tri-County Health Network; 970-614-7311.