Chapter  14: Ethnicity , Race and Gender Issues  

“By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place..”—José Escarce, MD, PhD  Health Inequity in the United States | Penn LDI   by JJ Escarce · 2019      https://ldi.upenn.edu/wp-content/uploads/2021/06/Penn-LDI-Health-Inequity-in-the-United-States-Report_5.pdf

On the disparities from CHAT GPT  Philip Pecorino August 2023

The impact of social factors on healthcare delivery is a complex and multifaceted issue. Here's a breakdown of how historical and contemporary social factors like race, gender, class, and sexuality have influenced healthcare delivery:

1. Race:
   • Historical Context: Throughout history, racial discrimination and segregation have significantly affected access to healthcare. In many societies, racial minorities were denied proper medical care, leading to disparities in health outcomes.
   • Contemporary Impact: Racial disparities persist, with minority communities often facing unequal access to quality healthcare, leading to poorer health outcomes. Implicit biases among healthcare providers can lead to misdiagnoses and undertreatment.
2. Gender:
   • Historical Context: Historically, women's health concerns were often marginalized or not taken seriously. Many medical studies focused primarily on male bodies, leading to inadequate understanding and treatment of women's health issues.
   • Contemporary Impact: While progress has been made, gender biases can still influence healthcare delivery. Women's pain is sometimes dismissed or undertreated, and gender-specific health issues may not receive the attention they deserve.
3. Class:
   • Historical Context: Socioeconomic disparities have always played a role in healthcare access. The poor often had limited access to medical care, leading to poorer health outcomes.
   • Contemporary Impact: Socioeconomic status continues to be a major determinant of healthcare access. Those with lower incomes may struggle to afford insurance, medications, and preventive care, leading to disparities in health outcomes.
4. Sexuality:
   • Historical Context: LGBTQ+ individuals have faced discrimination and stigmatization within healthcare systems. This has historically led to a lack of culturally competent care and outright denial of care.
   • Contemporary Impact: LGBTQ+ individuals still face healthcare disparities due to discrimination and lack of understanding from healthcare providers. Many may avoid seeking care due to fear of discrimination, leading to delayed diagnoses and treatment.
5. Intersectionality:
   • Historical Context: Historical inequalities based on a single social factor often intersect, intensifying healthcare disparities. For example, marginalized groups such as Black women or transgender individuals might face compounded discrimination.
   • Contemporary Impact: Intersectionality remains a challenge in healthcare delivery. The experiences of individuals who belong to multiple marginalized groups can be overlooked, leading to unique health needs being unmet.
6. Healthcare Policies and Systems:
   • Historical Context: Historical policies like racially segregated healthcare facilities have had lasting impacts on healthcare disparities.
   • Contemporary Impact: The structure of healthcare systems, insurance coverage, and policies can perpetuate disparities. Limited access to affordable care and insurance coverage can disproportionately affect marginalized groups.
7. Cultural Competency:
   • Historical Context: Historically, healthcare systems often disregarded diverse cultural practices and beliefs, leading to mistrust between marginalized communities and healthcare providers.
   • Contemporary Impact: Culturally competent care is essential for effective healthcare delivery. Healthcare providers need to understand and respect the cultural backgrounds of patients to provide appropriate care.

In summary, historical and contemporary social factors like race, gender, class, and sexuality have had a profound impact on healthcare delivery. While progress has been made, disparities and biases still persist, highlighting the ongoing need for equitable and patient-centered healthcare systems.

Disparities in Health and Health Care: 5 Key Questions and Answers  2023

https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/

Inequality and the health-care system in the USA

Samuel L Dickman  ¹ , David U Himmelstein  ² , Steffie Woolhandler  ³   

https://pubmed.ncbi.nlm.nih.gov/28402825/

The State of Health Disparities in the United States

https://www.ncbi.nlm.nih.gov › books › NBK425844   by A Baciu · 2017 ·

Racism, Inequality, and Health Care for African Americans  

By Jamila Taylor December 19, 2019  https://tcf.org/content/report/racism-inequality-health-care-african-americans/

Inequality and the health-care system in the USA  by SL Dickman · 2017  The Lancet

https://www.thelancet.com › lancet › article › fulltext

Achieving Racial and Ethnic Equity in U.S. Health Care

A Scorecard of State Performance  November 2021 https://www.commonwealthfund.org/publications/scorecard/2021/nov/achieving-racial-ethnic-equity-us-health-care-state-performance

US health care can’t afford health inequities

Inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.  https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html

Health Inequity in the United States | Penn LDI   by JJ Escarce · 2019      https://ldi.upenn.edu/wp-content/uploads/2021/06/Penn-LDI-Health-Inequity-in-the-United-States-Report_5.pdf

How red-state politics are shaving years off American lives  By Lauren Weber, Dan Diamond and  Dan Keating Oct. 3 at 6:00 a.m.

Global Health’s Dirty Secret: Rich Countries Get Good Medicine, and the Poor Sometimes Get Poison Sept. 11, 2023  By Vidya Krishnan

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