Chapter  14: Ethnicity , Race and Gender Issues  

SCENARIOS:

For each of the case scenarios you should consider how a person would reach a decision for proving health care if that person were using the basic principles from EACH of the following traditions:

• EGOISM

• UTILITARIANISM

• NATURAL LAW THEORY

• KANT's CATEGORICAL IMPERATIVE

• RAWLS MAXI_MIN PRINCIPLE of JUSTICE as FAIRNESS

• FEMINISM

• VALUE THEORY

=========================================================

CASE: RACE

Case: Racial Disparities in Access to Quality Healthcare

Meet Sarah and Aisha, two women in their early 40s who live in the same urban neighborhood. They both have Type 2 diabetes and require regular medical care to manage their condition. However, despite having similar medical needs, their healthcare experiences are vastly different due to racial disparities.

Sarah's Experience: Sarah is a Caucasian woman with a stable income and private health insurance. She has access to a wide range of healthcare providers, including endocrinologists, nutritionists, and diabetes educators. Her doctors monitor her condition closely, adjusting her treatment plan as needed. Sarah's insurance covers her medication, regular check-ups, and any necessary tests.

Aisha's Experience: Aisha is an African American woman who works multiple part-time jobs to make ends meet. She doesn't have health insurance and can't afford regular visits to a doctor. She relies on a local community clinic for her healthcare needs. However, the clinic is often overcrowded and under-resourced. She struggles to get timely appointments, and when she does, the appointments are rushed due to the high patient load. The clinic doesn't have an endocrinologist, so Aisha's diabetes management isn't as specialized or comprehensive as it should be. She also can't afford some of the necessary tests and medications prescribed by her doctor.

Racial Element: This case illustrates a clear racial element in healthcare disparities. Sarah, who is Caucasian and financially stable, has access to high-quality healthcare with specialized providers and comprehensive treatment plans. On the other hand, Aisha, an African American woman with lower income, faces significant barriers in accessing quality healthcare. The lack of affordable health insurance, limited resources at the community clinic, and the absence of specialized care contribute to poorer health outcomes for Aisha compared to Sarah.

Underlying Factors: Several underlying factors contribute to these disparities:

1. Socioeconomic Status: Aisha's lower socioeconomic status limits her access to private health insurance and quality healthcare providers. Sarah's stable income affords her better healthcare options.
2. Health Insurance Disparities: Racial minorities, particularly African Americans, are disproportionately more likely to be uninsured or underinsured compared to their Caucasian counterparts. This leads to reduced access to essential medical services.
3. Geographic Disparities: Healthcare facilities in low-income neighborhoods, where racial minorities often reside, are often under-resourced and overcrowded, leading to suboptimal care.
4. Implicit Bias: Unconscious biases held by healthcare providers might lead to differences in the quality of care provided to different racial groups.
5. Cultural Competency: Lack of cultural competency in healthcare settings can result in miscommunication and mistrust between patients and providers from different racial backgrounds.
6. Historical Factors: Historical systemic racism, including discriminatory policies, has led to disparities in education, income, and housing, all of which contribute to disparities in healthcare access and outcomes.

In conclusion, this fictional case highlights how racial disparities in healthcare can lead to differential access to quality care and subsequently poorer health outcomes for marginalized racial groups. Addressing these disparities requires systemic changes in healthcare policy, increased access to quality care, and efforts to eliminate implicit biases and ensure cultural competence among healthcare providers.

CASE: GENDER

Case: Gender Disparities in Cardiovascular Health Care

Meet Alex and Taylor, both in their early 50s, who live in the same urban area and lead similar lifestyles. They both experience symptoms that could be indicative of cardiovascular issues, but their healthcare journeys take different paths due to gender disparities.

Alex's Experience: Alex is a male executive in a successful company. He's been experiencing occasional chest discomfort and shortness of breath. Concerned about his symptoms, Alex decides to visit his primary care physician. The doctor promptly orders a series of tests, including an EKG, stress test, and blood work. Based on the results, Alex is referred to a cardiologist. The cardiologist recommends a coronary angiogram to investigate any potential blockages. Within a short time, Alex undergoes the procedure, and a stent is placed to address a significant blockage.

Taylor's Experience: Taylor is a female teacher with a busy schedule. She's been experiencing similar chest discomfort and shortness of breath as Alex. Worried about her symptoms, Taylor visits her primary care physician as well. However, the doctor attributes her symptoms to stress and anxiety without ordering any cardiovascular tests. Taylor is advised to practice relaxation techniques and is prescribed anti-anxiety medication. Her symptoms persist, but when she brings up the possibility of heart issues again, her concerns are brushed aside. Frustrated, Taylor seeks a second opinion from another doctor, who eventually orders cardiovascular tests.

Gender Element: This case illustrates a gender element in healthcare disparities. Alex's symptoms were promptly taken seriously, and he received a thorough cardiovascular evaluation. On the other hand, Taylor's symptoms were initially dismissed or attributed to psychological factors, leading to a delay in proper diagnosis and treatment.

Underlying Factors: Several underlying factors contribute to these disparities:

1. Gender Bias: Historically, heart disease has been perceived as a primarily male issue, leading to underdiagnosis and undertreatment of cardiovascular issues in women.
2. Symptom Presentation: Women and men often present different symptoms of heart disease. While men's symptoms might align with the stereotypical "chest pain," women's symptoms can be subtler and may not fit the traditional profile.
3. Research Focus: Clinical research has historically been skewed towards male subjects, leading to a lack of understanding about gender-specific cardiovascular symptoms and treatment responses.
4. Provider Awareness: Healthcare providers might be less familiar with the atypical symptoms of heart disease in women, contributing to diagnostic delays.
5. Communication Challenges: Women's concerns and symptoms might be less likely to be taken seriously, leading to frustration and potential delays in seeking appropriate care.
6. Healthcare Education: Lack of awareness among both patients and healthcare providers about gender differences in heart disease can lead to missed opportunities for early intervention.

Conclusion: Addressing gender disparities in healthcare requires increased awareness among healthcare providers about the unique ways that heart disease can manifest in women, as well as the importance of taking women's cardiovascular health concerns seriously. Research that includes diverse populations and focuses on gender-specific health outcomes is crucial. Empowering patients, regardless of gender, to advocate for their health and seek second opinions when necessary is also vital in ensuring that everyone receives timely and appropriate medical care.

CASE : CLASS

Case: Class Disparities in Mental Health Treatment

Meet Jamie and Alex, both in their early 30s, who live in the same city and work in similar professional fields. They both experience symptoms of anxiety and depression, but their experiences with accessing mental health care differ significantly due to class disparities.

Jamie's Experience: Jamie comes from an affluent background and has a stable job with comprehensive health insurance. Feeling overwhelmed by persistent anxiety, Jamie decides to seek help from a mental health professional. After some research, Jamie finds a well-regarded therapist who specializes in cognitive behavioral therapy. The therapy sessions are covered by the insurance plan, and Jamie is able to attend regular appointments. The therapist also recommends medication, which is covered by the insurance as well. Jamie's mental health gradually improves with proper treatment and support.

Alex's Experience: Alex comes from a working-class background and holds a job that provides limited health benefits. Like Jamie, Alex is struggling with anxiety and depression. However, due to the limited coverage of mental health services, Alex faces significant financial barriers to accessing care. The cost of seeing a therapist who specializes in the required treatment approach is prohibitively expensive, even with insurance. Moreover, the local community mental health center has a long waiting list, and the services offered are generic and not tailored to Alex's specific needs. Unable to afford private care and discouraged by the lack of accessible options, Alex's mental health continues to deteriorate.

Class Element: This case illustrates a class element in healthcare disparities. Jamie, with access to better financial resources and comprehensive health insurance, can readily access specialized mental health care that aligns with their needs. On the other hand, Alex, with limited financial resources and less comprehensive insurance coverage, faces barriers in accessing quality mental health services, which can negatively impact their well-being and quality of life.

Underlying Factors: Several underlying factors contribute to these disparities:

1. Healthcare Access: Limited access to mental health services for individuals with lower income and less comprehensive insurance coverage can lead to delayed or inadequate treatment.
2. Financial Barriers: High out-of-pocket costs, even with insurance, can prevent individuals from seeking the care they need, especially for specialized services.
3. Provider Availability: Well-regarded mental health professionals may not accept certain insurance plans or may not be accessible in lower-income areas.
4. Stigma and Perception: There might be a perception that mental health services are a luxury or not a priority, leading to limited investment in expanding affordable mental healthcare options.
5. Resource Allocation: Public mental health services, which are often more accessible for those with limited means, may be underfunded, leading to long waiting lists and generic treatment approaches.

Conclusion: Addressing class disparities in healthcare requires systemic changes in how mental health services are funded, provided, and perceived. Efforts to expand insurance coverage for mental health services, increase funding for public mental health centers, and provide financial assistance to those in need are crucial. Additionally, reducing the stigma surrounding mental health and advocating for policies that prioritize accessible and affordable mental health care can contribute to better outcomes for individuals across different socioeconomic classes.

CASE: SEXUALITY

Case: Sexuality Disparities in Reproductive Health Care

Meet Jordan and Morgan, a same-sex couple in their late 20s who have been together for several years and are considering starting a family. They both face distinct challenges in accessing reproductive health care due to their sexual orientation.

Jordan's Experience: Jordan identifies as a transgender man and is in a relationship with Morgan. Jordan decides to pursue parenthood through assisted reproductive technologies, specifically intrauterine insemination (IUI) with donor sperm. Jordan's journey begins with finding a fertility clinic that is LGBTQ+-friendly and has experience working with transgender individuals. Although they eventually find a clinic, they face judgmental attitudes from some staff members who are uncomfortable with their unconventional family structure. The fertility treatments are expensive and often not covered by insurance. Jordan also has to navigate the emotional toll of the process, particularly the potential misgendering and insensitivity from healthcare professionals.

Morgan's Experience: Morgan identifies as a cisgender woman and is in a same-sex relationship with Jordan. She also wishes to become a parent through assisted reproductive technologies. Morgan's experience is a bit different from Jordan's, as she does not have to navigate the same gender-related challenges. However, she faces societal and legal barriers, including the lack of recognition of her parental rights in some jurisdictions and the difficulties of obtaining legal protections for both partners.

Sexuality Element: This case illustrates a sexuality element in healthcare disparities. Jordan and Morgan, a same-sex couple, face a range of challenges in accessing reproductive health care and starting a family. Their experiences are shaped by societal biases, lack of legal protections, and the limited availability of LGBTQ+-friendly healthcare providers and services.

Underlying Factors: Several underlying factors contribute to these disparities:

1. Lack of Inclusive Care: Many healthcare facilities and providers are not adequately trained or experienced in providing care to LGBTQ+ individuals and couples, leading to misunderstandings and insensitivity.
2. Legal Barriers: In many places, LGBTQ+ individuals and same-sex couples face legal challenges when it comes to parental rights, adoption, and surrogacy.
3. Financial Challenges: Assisted reproductive technologies are often expensive and may not be covered by insurance, making them inaccessible for some LGBTQ+ individuals and couples.
4. Societal Biases: Stereotypes, stigma, and discriminatory attitudes towards LGBTQ+ individuals can create barriers to accessing quality healthcare.
5. Cultural Competency: Healthcare providers might lack the cultural competency to provide LGBTQ+-affirming care, leading to discomfort and mistrust.

CASE:  RACE

Four Tops singer sues hospital, says he was put in restraint jacket after sharing celebrity status

Alexander Morris alleges the hospital thought he was mentally ill and didn't believe he was part of the Motown group, famous for "I Can't Help Myself (Sugar Pie, Honey Bunch)" and other hits.

https://www.scrippsnews.com/entertainment/celebrity/four-tops-singer-sues-hospital-says-he-was-put-in-restraint-jacket-after-sharing-celebrity-status

Proceed to the next section of the chapter by clicking here> next section.

© Copyright Philip A. Pecorino 2002. All Rights reserved.

Web Surfer's Caveat: These are class notes, intended to comment on readings and amplify class discussion. They should be read as such. They are not intended for publication or general distribution.