What Are the Greatest Challenges to the Healthcare Equity Issue?
by Hugo Amador
The years following 2019 were faced with monumental challenges in structural and systemic inequities rooted in racism and discrimination. The COVID-19 pandemic found communities without access to treatment and vaccinations. The Black Lives Matter Movement, along with the rise in Asian hate crimes, surfaced the historic disparate safety and health of Black and Asian Americans. Within two years the American public has subtly discussed the decades-long issue regarding health and healthcare disparities. A vital discussion; addressing healthcare inequities is key in narrowing the unproportionate impacts of global pandemics, in addition to the overall impacts of chronic diseases endemic to distinct populations. Albeit, a proper discussion on the greatest challenges behind healthcare equity requires acknowledging which populations are affected and what feeds the issue. It may be possible that many are unaware they are a victim of this issue, therefore in a period in time where the health of the American people can seep into the day-to-day life and well being of individuals, tackling these challenges is pivotal in constructing a just and proper system aimed to serve its people. The overall goal of health equity does not apply only to some communities. It applies to all communities that encounter barriers on the journey to improve their health – be it a barrier against age, sex, sexual orientation, race, socioeconomic status, etc. The issue is no longer who and what is affected by these barriers, but rather how we can overcome them.
A young man in his mid-20s reported in a case study by the New York Times was diagnosed with Kaposi’s sarcoma (KS), cancer that forms in the lining of the blood and lymph vessels – often affecting individuals with immune deficiencies such as HIV or AIDS. While undocumented, this individual along with many in the U.S. that are uninsured, face an obstacle of access and fear to the care they need. Frightened by tides of anti-immigrant sentiment, the health of the undocumented patients in the U.S is often disregarded as they are further daunted by the expense of treatment.
Thus as shown, access to care includes more than the out-of-pocket expenses. Despite an effort to mitigate disparities in the U.S, there appears to be a continuous gap in equitable access to care exacerbated by sociological and psychological factors. Health insurance status is an important factor to consider, but more so are the underlying barriers that limit access to health insurance. For instance, insurance coverage, income, and available medical care resources vastly differ by ethnicity. Among Hispanic populations in the U.S, lack of public health insurance is a significant access barrier, but less so for African Americans.
It is often implied that health equity is a natural successor of universal access to healthcare and health insurance. However, a study conducted by the health section of UNICEF found that models from across the globe demonstrate the success and feasibility of equity in the health sector is largely dependent on how universal access/health insurance policies are designed, defined, and implemented.
To assist in the effort of addressing racial/ethnic disparities in healthcare, many federal agencies have advised and at times required providers to collect racial/ethnic information of individuals. Yet, many continue to fail at reporting these demographics completely or accurately, which are vital to understanding how certain groups deviate in overall health trends and accessibility. For instance, missing race/ethnicity data in Veterans ranged from 0% to 48% in certain communities. Meanwhile, 75% of respondents who identify as Hispanic/Latino classify their race as other when asked, a collaborative study at the National Human Genome Research Institute found.
The lack of data to track which populations are, or are not rather, seeking care has aided in placing a toll against methods to make healthcare more equitable to individuals. The statistics that have been collected, however, have demonstrated that people of color, low-income individuals, and those who identify as LGBT continue to be affected by financial and mental health barriers exacerbated by the present pandemic.
The diminishing number of individuals within these demographics that seek care speak to one issue: the lack of workforce diversity within the medical profession. One effort in addressing the diverse healthcare needs within the U.S is training and tasking healthcare professionals within those same demographics. Many medical schools, hospitals, and clinics alike faced the difficulty of treating patients they did not relate to or sympathize with completely, thus adding an additional barrier.
With the recent Biden administration, the president issued a series of executive orders and actions focused on advancing health equity. In March of 2021, the NIH launched the UNITE Initiative to address structural racial inequality along with the CDC’s declaration of racism as a serious threat to the public’s health.
Addressing these issues with policies is important to improve the underlying social and economic inequities that heighten healthcare inequities. But a broader range of initiatives from within and beyond the healthcare system are crucial in advancing equity. Increasing the availability of data, establishing incentives, accountability for equity, and recognizing discrimination are all instrumental. In addition, communicating to the demographics that are victims is influential; they must understand a key idea: before I am my sex, my gender, my class status, my race, my sexual identity, or citizenship status, I am human. And I deserve the right to my well-being.
Hugo Amador is an undergraduate student at Cornell University currently studying cellular & molecular biology, journalism, and Latin American studies. He is the recipient of prestigious and competitive academic fellowships, such as the Cornell Commitment Fellowship, and is the founder of Hugo’s Movement, a not-for-profit that advocates for the access to equitable healthcare, education, and liberty of victims of war and gang violence, primarily immigrant children and adolescents.
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Do I Really Need to Step on the Scale at the Doctor's Office?
by Julianna Strano
For most patients a visit to the doctor’s office includes having to step on the scale. When we are on the scale, our weight is most often said out loud and saved in file. This step at the doctor’s office is one that causes many patients to feel anxious and sometimes embarrassed and many patients question it’s importance.
Weigh-ins at the doctor's office are a standard part of an appointment, similar to checking your vitals. However, this can be a big stressor for many patients during their visit. In particular, it can be a stressor for those who are affected by or struggle with eating disorders and body image issues.
The question of whether or not body weight and body mass index are relevant in determining health is a debatable topic. BMI or body mass index is calculated from weight and height. Once BMI is calculated, we are able to see if we are at a “healthy weight”.
The Experts Weigh In on the Issue
Mary Anne Cohen, LCSW is a professional psychotherapist and Director of The New York Center for Eating Disorders. According to Cohen, BMI is an outdated concept. She points out that “BMI does not take into account other vital indicators of health such as age, sex, race, genetics, muscle mass, bone density, and previous medical history.”
The number shown on the scale and our BMI should not be the determining factor of health. There are many other factors that play a role.
Cohen continues to explain that “blood pressure, cholesterol, blood sugar, heart rate, inflammation levels, where fat is located on the body, and activity levels are all more accurate indicators of health."
Robyn Goldberg is a registered dietitian nutritionist, certified eating disorder registered dietitian supervisor, certified intuitive eating counselor. She also explains that BMI and the scale do not reflect a person's overall health and wellbeing
“BMI doesn't take into consideration the individual as a whole,” Goldberg states, “It’s not evaluating a person's mental well-being, movement, sleep, and diet.”
Goldberg explains how it’s more effective for patients to talk about other factors in their life like food practices. Communicating about overall well-being is helpful and effective.
“I think it's really asking questions about a person's life, energy, well-being, what do they do to nurture and take care of themselves rather than something arbitrary like a scale,” Goldberg adds
Goldberg also is quick to point out her belief that doctors should be able to respect the patient's decision if they choose to not be weighed.
Really Necessary or Not?
It is true that there are situations where a weight check is necessary. For example, when prescribing a new medication. There are ways to go about this that can make the situation less stressful. One example of this is blind weighing which usually means that the patient will step on the scale backwards and their weight is not said out loud or discussed.
Indeed, BMI and weight can be subjects that cause many patients to feel anxious and stressed, and it's important to understand that weight is just one component that makes us who we are. There are many other ways of determining health. As patients we can choose whether or not we want to know our weight and BMI, or step on the scale at all.
Mary Anne Cohen concludes, “Let’s remember that we, as patients, have the right to refuse being weighed at the doctor’s office, and it is simply a matter of making our choices clear."
Julianna Strano is a senior at The University of Arizona majoring in journalism and sociology. Julianna is passionate about all topics related to health and wellness and has the goal of educating and informing others through her writing. Julianna joined the editorial staff of Today's Patient to have the opportunity to help educate others on patient rights and discuss topics that she is passionate about.
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