The Cost of Inequality on Health

The excerpts below are from the  article,  The costs of inequality: money=quality health care= longer life by Alvin Powell, is from one of a series of articles in the Harvard Gazette exploring inequality in the US.. :

Health inequality is part of American life, so deeply entangled with other social problems — disparities in income, education, housing, race, gender, and even geography — that analysts have trouble saying which factors are cause and which are effect. The confusing result, they say, is a massive chicken-and-egg puzzle, its solution reaching beyond just health care. Because of that, everyday realities often determine whether people live in health or infirmity, to a ripe old age or early death.

“There are huge inequalities in this country that often get overlooked … If you want to observe the problems of poverty and inequality, you don’t need to travel all the way to Malawi. You can go to a rural house in America,” said Ichiro Kawachi, John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology and chair of the Harvard T.H. Chan School of Public Health’s Department of Social and Behavioral Sciences. “If you’re born a black man in, let’s say, New Orleans Parish, your average life expectancy is worse than the male average of countries that are much poorer than America.”

Scholars say that inequality in health is actually three related problems. The first, and most critical, involves disparities in health itself: rates of asthma, diabetes, heart disease, cancer, drug abuse, violence, and other afflictions. The second problem involves disparities in care, including access to hospitals, clinics, doctors’ offices, skilled professionals, medical technology, essential medicine, and proper procedures to deal with illness and disease. The third problem, one that has grabbed national headlines in recent years, is inequality in health insurance, the financial means to pay for the care people get to stay well.

The three problems, scholars say, require interlaced solutions. President Obama’s signature health care law, the Patient Protection and Affordable Care Act (ACA), has taken important strides in narrowing the gap in health insurance coverage, but those gains so far have translated to limited advances in ensuring access to quality medical care and even less progress in making diverse groups equally healthy.

“That’s an area where there’s less progress and more disappointment,” said John McDonough, professor of the practice of public health at the Harvard Chan School. McDonough has worked on health care reform both in Massachusetts, which created the model for national care, and at the federal level.

Disparities are built into the health care landscape, but there has been great progress in recent decades, according to S.V. Subramanian, professor of population health and geography at the Harvard Chan School and the Harvard Center for Population and Development Studies. Life expectancy is increasing for African-Americans and the poor, albeit at a lower rate than for wealthy whites. Although stark disparities remain, the overall health picture in this country is one of improvement, analysts say.

Read the full article from the Harvard Gazette.

Explore the full inequality series from the Harvard Gazette.