disparities in health care: the significance of socioeconomic status

Running head: disparities in health care 1

Disparities in Health Care: The Significance of Socioeconomic Status

Amanda K. Romano-Kwan

California State University of Long Beach

disparities in health care 2

Abstract

This research paper discusses the disparities in the health care system, with a specific focus on

socioeconomic status and how it affects the access and availability of quality care. Global health

is a growing issue that presents itself in the daily lives of people all over the world. While those

who are high standing in socioeconomic status are granted easier access and better quality to

health care, those who are in poorer standings are left to fight for mediocre care at costly prices.

Meanwhile, there is a labor shortage of health care workers in rural areas, leaving those in most

need of care without any form of care at all. The research here will discuss health care disparities

and the meaning of true access to health care. It will also cover the social determinants of health,

poverty and its effects on an individual’s health status, and methods to combat poverty. Finally,

it will review disparity in the health care work force and its effects on rural populations. This

paper will be focusing on these issues and the possible solutions to help improve the health care

system.


Disparities in Health Care: The Significance of Socioeconomic Status

Health care disparities occur when there is a difference in health care between different

population groups. These differences are associated with the inequality of access, health

coverage, and quality of care (The Henry J. Kaiser Family Foundation, 2012). Although health

disparities are typically discussed through views of race and ethnicity, they can also refer to

socioeconomic status and geographical location.

Access to Health Care

Access to basic health care is considered to be a fundamental human right. However,

various factors, such as war and natural disasters, can cause access to health services to become

limited. Access to health is a major economic and political concern in countries all over the

globe. While some countries, such as France and Italy, rank at the top of the list for their health

care system, other countries leave much to be desired. Ideally, a good health system would have

a fair distribution of health, responsiveness, and finance. The World Health Organization

(WHO) has three primary goals of a good health system: the health status of a population must

be good across their life cycle; the responsiveness of their system must meet the expectations of

treatment; and the system must be fair in financing, meaning an even distribution throughout the

population and financial protection for everyone. When comparing countries internationally, the

basis includes the cost, access to health care, the health and well-being of their citizens, their

responsiveness, their attainment and performance, fairness in financing, and overall satisfaction

with the health care system. Every country around the globe aims to have a high standard of


health, but in order to achieve this goal, an increase in the access and tools to health are

necessary.

Evaluating Access

The Universal Declaration of Human Rights was adopted by the United Nations (UN) in 1948. It

was initially drafted as a set of achievements for fundamental human rights to become

universally protected across all nations. Article 25 of the Declaration states that “Everyone has

the right to a standard of living adequate for the health and well-being of himself… including…

medical care” (United Nations, 1948). The human right to a high standard of health includes the

right to access essential medications and health technologies, basic healthcare services, water,

and other foundational resources for health. True access, however, must be defined. According

to the United Nations Committee on Economic, Social, and Cultural Rights, true access can be

evaluated by determining the availability, accessibility, affordability, acceptability, and quality

of the system (Committee on Economic, Social, and Cultural Rights, 2000). In order for a health

care system to have availability and accessibility, it must have a sufficient amount of medical

and public health facilities that are highly functioning, well-staffed, and fully stocked with

necessary medical supplies, and must be geographically and physically accessible to all. A health

care system should be acceptable of all patients, regardless of race, sex, age, culture, or religion.

It should also be affordable, meaning that payment for services should be proportionate with the

ability to pay, or economically accessible. Finally, all health care facilities should be high in

quality, with a skilled staff, a clean environment, and a well-stocked supply.

Determining Access


Gaps and limited access to health care impact people’s ability to liv/////e to their full potential,

which negatively affects the quality of their life. Limited access includes lack of availability,

high costs, and lack of insurance coverage (HealthyPeople.gov, n.d.). There are many types of

factors that affect one’s level of access into the health care system. Individual-level factors

include stigma and fear, limited communication, lack of knowledge about symptoms or services,

and personal beliefs. Practitioner-level factors can include poor attitude towards patients or

inadequate assessments due to limited information about a range of multiple issues, such as

cultural background. System and service-level factors can be identified as a lack of flexibility in

health care systems, and resource-based or practical factors can include transportation issues or

poor appointment systems (National Collaborating Centre for Mental Health, 2011). Because

limited access to health care is still a major issue in every country across the globe, universal

health care, which will be affordable and accessible to all, is still a long ways away. One major

issue that prevents universal health care to become realized is a country’s world view. While

some governments believe that health care is a basic human right, other countries, such as the

United States of America, treat health care as a commodity that can be bought and sold. By

focusing on monetary growth rather than the health of their people, countries who have similar

views tend to rank lower on the standard health of their people, as many of those who live in

poverty cannot access the basic medication they need. These views limit the access granted to

people in various countries and therefore prevent the world from moving forward toward a

universal health care system.


Socioeconomic Status

There are many factors that have an impact on a person’s health status, but by far the most

important is ones socioeconomic status or position. “Socioeconomic status indicates an

individual’s standing in society based on social, economic, and educational characteristics”

(Jacobsen, Introduction to Global Health, 2014). These social determinants of health are

conditions that directly influence a person’s access to health services, and therefore their health

status. For example, a person who is well educated, or with a high educational status, is more

likely to get a better paying job, or occupational status, and therefore have a higher wage, or

economic status. Other social determinants can include a person’s social class, sex, geographical

location, ethnicity, or religion. Those with greater economic, social, or political power tend to

have greater access to health services, and in turn, those with power can limit the access of

others. Furthermore, a person’s culture can also influence their health status. Culture is a way of

life that is shared by other members of a social unit, and can include a group’s norms, morals,

values, beliefs, customs, rules, behavior, and communication. An individual’s culture influences

the way they interpret illnesses and seek help. While some countries like the United States use

modern medicine, other cultures, such as the Chinese, use more traditional methods of healing,

such as acupuncture. Having a clear understanding of global diversity and how health, disease,

and medicine is perceived across different cultures is vital to ensuring that access to health care

can become socioeconomically available to all.

Poverty


Because socioeconomic status is such a huge factor on a person’s access to health care, we can

clearly see the affects that poverty can have on one’s health status. “Even in countries that

provide universal coverage, persons with less income and education do not use health services in

the same way that their wealthier, better-educated peers do” (Adler & Newman, 2002). Those

who are poor simply do not have the ability to access even the minimum level of health care that

they need in order for them live healthily and productively, especially those who are born into

poverty. People in poverty live in less sanitary conditions, therefore becoming exposed to more

diseases. They lack the money to pay the steep prices of proper medicine. The Millennium

Development Goals (MDGs), which were adopted in the year 2000 by the United Nations, has

set out eight major goals to significantly reduce global poverty by 2015. These goals are to:

eradicate extreme poverty and hunger; achieve universal primary education; promote general

equality and empower women; reduce child mortality; improve maternal health; combat

HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a

global partnership for development (Jacobsen, Introduction to Global Health, 2014). These eight

goals provide a definite plan toward international development. Another plan to combat poverty

and its effects is the UNs Sustainable Development Goals (SDGs), whose main priority is to end

poverty by the year of 2030, and achieve a future that can sustain itself from reverting back to

poverty (Jacobsen, Introduction to Global Health, 2014). These seventeen goals include ending

world hunger and achieving food security, ensuring inclusive and equitable quality education,

finding affordable and clean energy, making clean water accessible to all and maintaining

sanitation, conserving nature, and promoting peace and justice, amongst others (United Nations


Department of Economic and Social Affairs, n.d.). The Sustainable Development Goals provide

a framework that will make leaps in the right direction toward a better future for the earth. By

ending poverty, hunger and disease also follows; no poverty means no poor living conditions,

creating cleaner environments and eradicating many opportunities for disease. By ensuring that

these goals are sustainable, that is to say that they can provide for current human needs without

compromising the ability of future generations to meet their own needs, we eliminate any further

problems with poverty, hunger, or disease. Sustainable health programs will create long-term

health benefits that can endure even after specific projects are over. Many current insurance

plans do not properly cover what people actually require, instead only covering broad areas and

offering benefits that aren’t being put to use. This is a huge waste of money that can be utilized

elsewhere. Unfortunately, the health care system is primarily monetary based; by creating a

system that paid by focusing on actually improving the health of the patients, the health care

system could change overnight. Those who were in the profession solely for monetary gain

would be filtered out, and those who truly cared about the well-being of their patients would

remain. This should be the focus of healthcare. The socioeconomic status or wealth of a person

or their family should not be the determining factor of their access to quality health care.

Disparities in the Health Care Workforce

Studies show that the distribution of health care providers in rural and urban communities is

unequal, with more shortages in rural areas. This is primarily due to the increase in population

and the Health Care Labor shortage. Rural communities tend to suffer from low physician supply


even though they depend on primary care providers as their leading source of health care.

Despite this, rural residents are more likely than urban residents to have a usual source of health

care, particularly in the rural versus the urban uninsured (Rural Health Information Hub, 2015).

Nevertheless, “rural residents have difficulty accessing after hours care and traveling to see their

usual provider” (Muskie School of Public Service, 2011). Insured or uninsured, the health care

work force and its distribution shortage in rural America is still a major issue. This disparity is

caused by various factors. One factor is education. “The current rate of training of new health

professionals is falling well below current and projected demand, which will make it hard in the

coming years for people to get the essential services” (Brooks, 2013). There is a lack or limit of

proper health care education in rural areas. They tend to lack providers, and the education

provided does not properly prepare providers for working in rural areas. Furthermore, some

medical professions require even more extensive and in-depth education, making it extremely

difficult for students living in rural areas to afford. “There must be continual investment in the

education and funding of the public sector workforce to maintain quality and ensure equity”

(World Health Organization, 2014).There are also fewer role models for potential students in

rural communities. Those who are studying health care tend to move to urban areas to learn, and

those who come from a rural area might not want to move back. This is because the competition

from urban facilities lure providers away for better benefits, salaries, and working conditions.

This migration of health care professionals trained in low-income countries to higher paying jobs

in high-income countries is called the brain drain (Jacobsen, Introduction to Global Health,

2014). The demographics and health status of rural areas are also a major factor, as there is a


higher burden of disease. They also tend to have more elderly citizens, who require more service

care than can be provided. This creates more demand than there is supply of health care

providers. “The National Rural Health Association (NHRA) believes that it is essential for rural

areas to have an adequate and able workforce to deliver needed health care services” (Burrows,

Suh, & Hamann, 2003). It is important that the disparity of health workers is addressed to better

the health status of cities across the globe.

Policies and Programs to Help Shortages

Although the health care labor shortage is expected to last for some time, there are different

policies and programs that can help implement a change. Allowing new or alternative provider

types to provide their services in rural communities will bring in more supply of physicians.

There can also be policy changes to remove barriers to practice health care. Another potential

solution is telemedicine. Telemedicine, or telehealth, is “the use of medical information

exchanged from one site to another via electronic communications to improve a patient’s clinical

health status” (American Telemedicine Association, n.d.). It allows physicians to more easily

connect with and monitor their patients. Services provided include primary care and specialist

referral services, remote patient monitoring, consumer medical and health information, and

medical education. According to Forbes, telemedicine is already “well-established in rural areas

for specialty consultations, and has been widely used in many primary care practices like

pediatrics as a practical matter” (Frist, 2015). It allows non-physician providers to practice in

multiple areas while still being advised by physicians. This increases the availability of

specialists, which is sorely needed in rural communities. It also helps prevent physicians from


transferring patients from rural to urban areas, since telemedicine gives them access to specialists

through their technology, along with helping to support the newly graduated providers that have

been recruited to rural areas. Telemedicine gives patients improved access and quality, and is

more cost efficient. Unfortunately, telehealth has yet to be adopted in many rural areas. Policy

changes in the area of education can also make a big impact. Developing distance-education

programs and offering a rural-centric curriculum and training in the health care education

program will help prepare physicians for working in rural areas. Supporting these training

opportunities, including various residency programs, can also encourage providers to stay and

work in rural communities. Additionally, using admissions criteria that are more likely to

produce individuals that are interested in rural practice—for example, admitting students from

rural communities—and giving out grants, loans, and scholarships can help promote people in

rural areas to pursue an education and career in rural health care. By assisting the recruitment

and retention of health care providers for rural communities and supporting the development and

growth of health care education programs, the number of graduates in rural communities will

increase.

Conclusion

Disparities in health care are a pressing issue and influence the daily lives of people all across the

globe, especially in rural communities. Though there are many factors that contribute to the

imbalance in the global health care system, it is possible for it to change. By redefining and

reevaluating what true access in the health care system means, we can ensure that universal

health care is available to everyone—not just for those who can afford it, but for those who truly


need it. By striving to end poverty and ensure sustainability through the Millennium

Development Goals and the Sustainable Development Goals provided by the United Nations, the

world takes one step closer to ending world hunger and disease. The social determinants of

health majorly influence the accessibility of health care for many individuals, but by focusing on

a system that bases its economic growth on improving the health status of their patients, the

social determinants would have less of a compromising factor. Poverty should not be the

defining factor of a person’s health. Finally, the disparities in the health care workforce can be

improved by different policies and programs. Better implementations of policies and programs

regarding rural community health care, including the educational programs, will bring in more

physicians to the rural work force. This will balance the shortage of health care workers and

properly prepare them for working in a rural area. Telehealth saves time and money for both the

patient and the physician, and allows those in rural areas to remain where they are to receive

care, instead of traveling far distances to get the treatment they need.

An individual’s socioeconomic status should not have such a lasting impact on their health

status. Because vulnerable populations, such as racial, ethnic, or religious minorities, are not

typically factors that can or should be changed, they should not be the victims of an imbalanced

health care system. People should be mindful of one another’s cultures and traditions. Because

access to health care is so greatly influenced by the amount of economic, social, educational, or

governmental power that one has, we leave millions across the world without the basic human

right to a high standard of health. By focusing on some of these issues and working to eradicate


these health care disparities, we can work toward a universal health care system that benefits

people of all types at a cost efficient price.


References

Adler, N. E., & Newman, K. (2002, March). Socioeconomic Disparities In Health: Pathways

And Policies. Retrieved from Health Affairs:

http://content.healthaffairs.org/content/21/2/60.full

American Telemedicine Association. (n.d.). What is Telemedicine. Retrieved November 26,

2015, from American Telemedicine Association: http://www.americantelemed.org/about-

telemedicine/what-is-telemedicine#.VmEAr7grIgs

Brooks, M. (2013, November 12). Report Warns of Worsening Global Healthcare Worker

Shortage. Retrieved from Medscape: http://www.medscape.com/viewarticle/814221

Burrows, E., Suh, R., & Hamann, D. (2003, March). Health Care Workforce Distribution and

Shortage Issues in Rural America. Retrieved from National Rural Health Association:

http://www.ruralhealthweb.org/index.cfm?objectid=3D776162-3048-651A-

FEA70F1F09670B0D.

Committee on Economic, Social, and Cultural Rights. (2000, August 11). General Comment No.

14. Retrieved from United Nations Human Rights: Office of the High Commissioner:

http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?

enc=4slQ6QSmlBEDzFEovLCuW1AVC1NkPsgUedPlF1vfPMJ2c7ey6PAz2qaojTzDJm

C0y%2b9t%2bsAtGDNzdEqA6SuP2r0w

%2f6sVBGTpvTSCbiOr4XVFTqhQY65auTFbQRPWNDxL

Frist, B. (2015, March 12). Telemedicine is a Game-Changer for Patients, The System.

Retrieved from Forbes: http://www.forbes.com/sites/henrymiller/2015/12/02/how-


organic-agriculture-evolved-from-marketing-tool-to-evil-empire/

HealthyPeople.gov. (n.d.). Access to Health Services. Retrieved November 29, 2015, from

HealthyPeople.gov: http://www.healthypeople.gov/2020/topics-objectives/topic/Access-

to-Health-Services

Jacobsen, K. H. (2014). Introduction to Global Health. (Second, Ed.) Burlington,

Massachusetts: Jones & Bartlett Learning.

Muskie School of Public Service. (2011, November). Health Care Access and Use Among the

Rural Uninsured. Retrieved from Muskie School of Public Service:

https://muskie.usm.maine.edu/Publications/rural/pb/Rural-Healthcare-Access-Use.pdf

National Collaborating Centre for Mental Health. (2011). Common Mental Health Disorders:

Identification and Pathways to Care: Access to Healthcare. Retrieved from National

Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/books/NBK92265/

Rural Health Information Hub. (2015, November 3). Rural Healthcare Workforce. Retrieved

from Rural Health Information Hub: https://www.ruralhealthinfo.org/topics/health-care-

workforce#workforce

The Henry J. Kaiser Family Foundation. (2012, November 30). Disparities in Health and

Health Care: Five Key Questions and Answers. Retrieved November 1, 2015, from The

Henry J. Kaiser Family Foundation:

http://kff.org/disparities-policy/issue-brief/disparities-in-health-and-health-care-five-key-

questions-and-answers/


United Nations. (1948, December 10). The Universal Declaration of Human Rights. Retrieved

from United Nations: http://www.un.org/en/universal-declaration-human-rights/

United Nations Department of Economic and Social Affairs. (n.d.). Sustainable Development

Knowledge Platform. Retrieved November 20, 2015, from Sustainable Development

Goals: https://sustainabledevelopment.un.org/?menu=1300

World Health Organization. (2014). A Universal Truth: No Health Without a Workforce. France:

Design & Layout by Prographics Inc. Retrieved from

http://www.who.int/workforcealliance/knowledge/resources/GHWA-

a_universal_truth_report.pdf?ua=1