Your reflection should address (a) your self-discovery, including your attitudes and behaviors about health disparities and the individuals that carry the heaviest burdens associated with poor health and disabilities

Your reflection should address (a) your self-discovery, including your attitudes and behaviors about health disparities and the individuals that carry the heaviest burdens associated with poor health and disabilities; (b) insights about health care professionals, consumers (patients), and the health system; (c) additional work that is necessary for you to become a more competent health care provider and demonstrate best practices in an increasingly diverse society; and (d) your next step(s) in addressing health care disparities. should be 3-5 pages double-spaced, Times New Roman 12-point font.

Introduction

The COVID-19 pandemic’s diverse effects, continued instances of police brutality, and a recent surge in Asian hate crimes have raised attention to health and health care inequities in the media and among the general public. Disparities in health and medical care, though, are nothing new. They represent enduring structural and institutional imbalances founded in racism and discrimination and have been well-documented for many years. By addressing these discrepancies, we can lessen the uneven effects of the COVID-19 epidemic and keep health disparities from growing in the future. Additionally, minimizing health inequities is essential for enhancing the general health of our country and lowering needless medical expenses. This overview explains what health and health care disparities are, how they currently stand and how COVID-19 has impacted them, their broader ramifications, and ongoing federal initiatives to promote health equity.

What are health and health care disparities?

Health disparities are discrepancies in health and medical care between populations that result from larger inequities. Health disparities are defined in a number of different ways. Healthy People 2020 defines a health disparity as, “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” and notes that disparities, “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” On other hand, The Centers for Disease Control and Prevention (CDC) defines health disparities as, “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”  Typically, a health care disparity refers to inequalities in health insurance coverage, access to and utilization of care, and quality of care between populations. Inequities are frequently referred to as “health inequality” and “inequity.” Racism causes situations that unfairly favor some and disadvantage others, putting people of color at higher risk for negative health outcomes. The CDC defines racism as the structures, policies, practices, and norms that assign value and determine opportunities based on how people look or the color of their skin.

In general, health equity refers to people obtaining their greatest degree of health by eliminating inequalities in health and healthcare. Health equality is defined by Healthy People 2020 as the achievement of the best possible level of health for all people. It also calls for deliberate and continuing societal efforts to remove preventable inequalities, historical and contemporary injustices, and disparities in health and health care. The CDC states that when everyone has the chance to “attain his or her full health potential,” health equity has been achieved and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.”

Disparities in health and healthcare result from a wide range of internal and external causes (Figure 1). Despite the fact that access to healthcare is crucial for maintaining health, research indicates that underlying genetics, health behaviors, social and environmental variables, and health care utilization all influence health outcomes. Studies indicate that health behaviors and social and economic factors, also known as social determinants of health, are the main drivers of health outcomes and that social and economic factors shape people’s health behaviors, even though there is currently no agreement in the research on the magnitude of the relative contributions of each of these health factors.

Figure 1: Health Disparities are Driven by Social and Economic Inequities

 

Although differences in health and healthcare are frequently seen through the lens of race and ethnicity, they exist across a wide variety of characteristics. For instance, discrepancies exist in terms of financial position, age, region, language, gender, status as a person with a disability, citizenship, and sexual orientation. According to research, discrepancies can be found at any stage of life, including infancy, middle age, and elderly persons. The focus of federal initiatives to eliminate disparities is on designated target populations, such as persons of color, low-income groups, women, children and adolescents, older adults, people with special health care requirements, and people residing in rural and inner-city areas. These groupings frequently interact in significant ways and are not mutually exclusive. Additionally, there are differences among population groupings. For instance, there are variations in the health and medical care of Hispanics depending on their immigrant status, length of stay, and major language. Furthermore, data for Asians frequently conceal hidden discrepancies between different Asian subgroups.

What kind of discrepancies exist?

People of race and other underprivileged groups had long-standing health inequities before the COVID-19 pandemic. With the publication of two Surgeon General studies in the early 2000s that showed differences in tobacco use and access to mental health care by race and ethnicity, the major awareness of health disparities began almost two decades ago. Numerous discrepancies have remained and, in some cases, widened despite the fact that they have been recognized and documented for decades and that population health has generally improved over time.

 

According to data collected before the COVID-19 epidemic, people of color performed worse on a variety of health metrics than their White counterparts, including infant mortality, pregnancy-related deaths, the prevalence of chronic diseases, and the general physical and mental health status (Figure 2). Compared to White people, Black people’s life expectancy was four years lower as of 2018, with Black men having the lowest average. Inequalities in regards to other factors are also documented by research. People with lower incomes, for instance, report having worse health than those with greater incomes, while the lesbians, homosexuals, bisexuals, and transgender (LGBT) people are more likely to have particular health issues.

Figure 2: People of Color Fare Worse than their White Counterparts Across Many Measures of Health Status.

Long-standing inequities in health care are also present. Large improvements in coverage across categories were made as a result of the Affordable Care Act’s health coverage expansions. Despite these advancements, however, low-income and people of color continue to face larger barriers to obtaining health care due to their increased likelihood of going without insurance (Figure 3). Additionally, beginning in 2017, coverage gains stalled and then started to reverse, as a result of a number of actions taken by the Trump administration, including cuts to outreach and enrollment assistance funding, approval of state waivers to impose new Medicaid eligibility restrictions, and changes to immigration law that raised concerns among immigrant families about enrolling in Medicaid and CHIP. Some of the prior coverage increases made under the ACA were reduced by these coverage losses, notably among Hispanics.

As people have lost their employment and suffered reduced income, coverage losses have probably continued as a result of the COVID-19 epidemic. Beyond coverage gaps, folks with lower incomes and people of color also receive care that is of lesser quality. According to recently released KFF/The Undefeated survey results, Black adults are more likely than White adults to describe specific unfavorable health care experiences, such as a provider not believing them and declining a test, treatment, or painkiller they believed they needed.

Figure 3: People of color face longstanding disparities in health coverage.

 

What impact has the COVID-19 pandemic had on inequalities?

Data repeatedly demonstrate that COVID-19 has caused disproportionate numbers of illnesses and deaths among Black, Hispanic, American Indian and Alaska Native (AIAN), and other persons of color (Figure 4). According to subsequent analysis, the rate of premature excess deaths per 100,000 people among AIAN, Black, Native Hawaiian and Other Pacific Islander (NHOPI), and Hispanic persons in the US was more than three times higher in 2020 than it was for White or Asian people. People of color have higher rates of illness and death because of factors such as higher rates of underlying health conditions, increased risk of exposure to the virus due to living, working, and transportation conditions, and increased barriers to testing and treatment due to already-existing disparities in access to healthcare.

Figure 4: People of color have had higher rates of infection, hospitalization, and death due to COVID-19.

 

Beyond the virus’s direct health effects, the pandemic has had a disproportionately negative impact on people of color, low-income individuals, LGBT people, and other underserved groups’ financial security, mental health, and well-being. For instance, according to KFF survey data from February 2021, almost half of Black and six in ten Hispanic individuals (59%) said that their household lost a job or income as a result of the pandemic, compared to roughly four in ten White adults (39%). Additionally, persons with household incomes under $40,000 were three times more likely than those with households earning $90,000 or more to report struggling to pay for necessities in the previous three months.

By the end of March 2021, Black and Hispanic people were more likely than White adults to express food scarcity and a lack of confidence in their ability to make their next housing payment.

Black and Hispanic people were less likely than White people to have received a COVID-19 vaccine as of April 2021, despite being disproportionately afflicted by the epidemic. Data from many states reveal a recurring pattern whereby Black and Hispanic persons have lower vaccination rates than their White counterparts while having lesser shares of illnesses, fatalities, and the total population. Despite the fact that vaccination rates are rising for all races, the gaps between the immunization rates for Black and Hispanic people continue to exist (Figure 5). These vaccination gaps are a reflection of enduring injustices that place more restrictions on access to health care for people of color and other underprivileged groups. They also raise the danger of infection and sickness for persons of color and obstruct efforts to boost community immunity.

Figure 5: Although vaccination rates are increasing across groups, Black and Hispanic people face persistent gaps.

 

What are the broader implications of disparities?

Besides promoting social justice and equity, addressing health disparities will also help the country’s economy and general well-being. The overall health of the country is hampered by the greater rates of disease and death among underserved populations, particularly people of color. Health inequities are expensive, according to another research. According to analysis, discrepancies result in annual lost productivity of $42 billion, an extra $93 billion in medical care costs, and further economic losses owing to premature deaths. People of color are expected to make up more than half of the population by 2050 (Figure 5), as the population becomes more diversified.

Figure 6: People of color are projected to make up over half of the U.S. population as of 2050.

 

The COVID-19 pandemic has made it more critical than ever to address underlying health and healthcare inequities. If some groups continue to be more at risk from COVID-19 due to lower vaccination rates and/or increased risk of exposure to the virus, this disparate impact of the COVID-19 pandemic on people of color and other underserved groups may lead to even further widening of health disparities and greater health risks for the community as a whole. As a result, putting equity first in COVID-19 response activities is crucial for preventing future health disparities from becoming even larger as well as for reducing the unequal effects of the pandemic itself.

 

What steps has the federal government taken to alleviate health disparities?

Racial equity, especially health equity, has been prioritized by the Biden administration, and recent agency actions reflect this. President Biden initiated a number of executive orders and initiatives aimed at increasing health fairness as soon as he took office. Among these were decrees outlining fairness as a general federal government priority and a component of the pandemic response and recovery. The National Institutes of Health (NIH) announced the UNITE Initiative to combat systemic racism and racial disparities in biomedical research in March 2021, reflecting the priority placed on health equity. The Centers for Disease Control and Prevention (CDC) declared racism a serious threat to the public’s health in early April 2021 and stated that it would take the lead in efforts to address the systems and policies that have led to the generational injustice that has resulted in racial and ethnic health disparities. Supporting states, territories, and tribes in identifying and sustaining health equity-promoting policies, programs, and practices is one of the three overarching programmatic priorities for the Office of Minority Health (OMH) of the Department of Health and Human Services (HHS) for FY2020 and 2021. Another is increasing the use of community health workers to address health disparities.

The federal government’s COVID-19 reaction has prioritized equity. To address the unequal and serious effects of COVID-19 on communities of color and vulnerable populations, President Biden issued an Executive Order on Ensuring an Equitable Pandemic Response and Recovery in January 2021. The order creates a COVID-19 Health Equity Task Force, orders agencies to improve equity data gathering and reporting, ensure that response plans and policies provide for equitable resource allocation, and orders HHS to launch an outreach campaign aimed at increasing vaccine confidence among communities of color and other underserved populations.

The COVID-19 alleviation American Rescue Plan Act, passed in March 2021, provides additional financing to promote COVID-19 immunization and other public health initiatives, with a focus on improving access to vaccines and services for preventing and treating COVID-19 among underprivileged groups. Through a portion of this money, HHS will put approximately $10 billion into improving the health of underrepresented communities like communities of color, rural areas, and low-income people. This includes $6 billion that will be given to community health clinics, which according to data have been immunizing greater percentages of people of color than overall vaccination campaigns.

To increase access to and enrollment in health coverage, the administration and Congress have taken a number of steps. As previously mentioned, improvements in health coverage stagnated and then started to reverse themselves starting in 2017. Due of people losing their jobs and having their money drop, the COVID-19 epidemic has probably caused even more coverage losses. An Executive Order on Strengthening Medicaid and the Affordable Care Act was issued by President Biden in January 2021. It established a Special Open Enrollment Period for the Health Insurance Marketplaces and instructed federal organizations to review their policies and procedures to make sure they support access to healthcare. The American Rescue Plan Act also includes provisions that aim to broaden access to healthcare and lower the cost of that coverage. These include Medicaid provisions that offer incentives to encourage states that have not yet adopted the ACA Medicaid expansion to do so and provide a new option for states to extend the length of Medicaid coverage for postpartum women. These also include increases and expansions in eligibility for subsidies to buy health insurance through the Marketplaces. Additionally, the administration intensified outreach efforts and restored funds for navigators who assist eligible individuals in signing up for health insurance. People of color and those with low incomes, who are more likely to be uninsured, will particularly benefit from these initiatives. Six out of ten uninsured persons who would be eligible for Medicaid if all remaining states extended it are people of color, and more than seven out of ten are adults who fall within the poverty line. Overall, evidence indicates that Medicaid expansion is linked to lessening racial/ethnic disparities in health coverage and health outcomes for Black and Hispanic people, notably for indicators of maternal and infant health.

The administration has undone Trump administration actions that led to immigrant families having less access to health care and other programs. An Executive Order on Restoring Faith in Our Legal Immigration Systems and Strengthening Integration and Inclusion Efforts for New Americans, signed by President Biden in February 2021, mandated that the federal government create welcoming policies that encourage integration, inclusion, and citizenship. The order instructed federal agencies to examine ongoing initiatives to make sure they are in line with the policy, remove obstacles to receiving immigration benefits, and examine changes to public charge policies made under the Trump Administration that affected immigrant families’ access to health care and other programs. The administration then moved to undo these public charge policy modifications. The Department of Homeland Security also released a statement to explain that everyone, regardless of immigration status, should take the COVID-19 vaccine and that, unless in the most unusual circumstances, it will not conduct enforcement activities at or near healthcare institutions.

The administration has started a number of programs to reduce maternal health disparities. In order to address the high rates of Black maternal death and morbidity, President Biden issued a proclamation in April 2021. Additionally, the American Rescue Plan Act will make the Medicaid postpartum coverage period a state option starting in 2022, and the Centers for Medicare and Medicaid Services (CMS) has accepted seven state waivers to implement this change. The Rural Maternal and Obstetrics Management Strategies Program, which aims to create models and put strategies in place to promote maternal health in rural communities, has also received $12 million in grants from the Human Resources and Services Administration.

 

Looking Forward

In conclusion, there are long-standing issues with health and medical inequities for people of color and underserved groups. The COVID-19 pandemic has made these inequities worse and made it even more crucial to solve them. Racism-based social and economic inequality are what underlie health disparities. In addition to being necessary for social fairness, addressing gaps is also crucial for the economic and general well-being of our country. In response to COVID-19 and more generally, the federal government has prioritized equity and started a number of programs to address disparities. Efforts to lessen health disparities are being made by states, local communities, private organizations, and clinicians. In order to advance equity, a wide range of initiatives both inside and outside the health care system will be necessary. These initiatives include: giving equity a high priority across sectors; allocating resources to support equity initiatives; expanding data accessibility; promoting and building on the strengths and resources already available in the community; establishing incentives, accountability, and oversight for equity; and identifying and addressing racism as a primary driver of disparities.