Article Review of Health Disparities Research

ARTICLE ONE (1) REVIEW

Purpose

This paper is a personal subjective review of the article “Perspective: Challenges to Using a Business Case for Addressing Health Disparities“,^[1] further referenced herein as ‘the literature’.

Definition

Health disparity is defined as “the difference in health among different populations”^[2]

Discussion

In our textbook, McKenzie and Pinger describe differential gaps between individuals as the cause for health disparities.  To expand on this, they write^[3]:

“…recognized that some individuals lead longer and healthier lives than others, and that often these differences are closely associated with social characteristics such as race, ethnicity, gender, location, and socioeconomic status…. These gaps between groups have been referred to as health disparities…”

Health Disparity Problem

Whereas our textbook briefly discusses health disparity, it doesn’t delve into causes, nor how long it has existed.  However, the ‘how long’ answer can be found in a paper by Cindy Lawler in which she writes that the problem was recognized “As early as 1899, W.E.B Dubois (1899) observed the existence of Racial and ethnic Health Disparities (REHDs)“, and through “… his social study of Blacks in Philadelphia he interpreted statistical data about their health and drew several conclusions that are similar to today.“  She also touched upon Dubois working with “…flawed health data collection in Philadelphia that sacrificed the accuracy of statistical analysis.”^[4]

80 plus studies, conducted between 1984 and 2004^[5], have repeatedly stated similar, if not the same issues and viewpoint – all point to the health disparity issues in the United States, but not enough data to identify a fix for the causation(s).

So, if this is an age-old problem, why are we still facing this systemic problem after a full century of recommendations have been made?  I believe the authors attempted to address this by writing the literature; but, it is my belief, they fell short as the literature only touches the tip of the ice berg.

Challenges

As written, the literature appears to be solely focused on the many challenges to using a business case for health care organizations. The common challenges that were identified included:

• lag-time in ROI, and
• disconnect between investor and the realized beneficiary.

In discussing ways to tackle the problem, the literature laid out a litany of challenges faced by health care entities through use of a broad view of both business and social cases. Throughout, it outlined what businesses and health care entities must do to achieve a better ROI, while trying to attain equity, with the ultimate goal of achieving a reduction in health care disparity.

The literature also points out that a great many health organizations remain reluctant to help combat the disparity problem. Their reasoning is based on concern for their bottom line–they are unsure about whether they may see a positive ROI return, or not.  And, this is not without merit, especially since there is typically a lag between initiation and seeing the ROI.

To emphasis this point the authors state it doesn’t take much to begin the process.

“…a combination of business and quality improvement principles may still be able to guide health care organizations seeking to reduce disparities.”

As a starting juncture, they suggest use of Pareto charts and application of the 80-20 rule. In doing so, stakeholders could initiate a process to re-focus their efforts, thus allowing them the ability to turn their energies toward redirecting threatened capital items, such as funds, manpower, and equipment more effectively.

To prove their point, the authors referred to an 80/20 rule study which identified a disparity within an unidentified health care setting – specifically, care afforded to African Americans. The study found that “approximately 80 percent of African Americans were cared for by 20 percent of physicians,” in an under-resourced setting, thus subjecting the group to a lessor form of quality care.^[6]

The literature goes on to identify another avenue to further increase effort effectiveness, and reap further rewards in doing so, and that is though collaboration with other interested parties within the community. By doing so, they hopefully will begin the process of reducing the disparities, one small step at a time.

Who is at Risk?

Health disparities commonly affect minority, low-income, and rural-based populations.  One reason for this, in part, is due to location. Regardless of the setting, in town, low income housing projects, or rural environment, many may have little to no access to a quality care facility, or any type care facility, or provider at all. This forces these groups to travel greater distances, and in tight economic times, such as we are in today, these groups many not be able to afford the travel costs. This creates a socio-economic Access to Care disparity, as well as an inequity issue.

Of course, many races and ethnicities are affected by these factors, and the literature explains that the authors believe this is rooted in racial segregation.

Conclusion

Individual health is the culmination of many factors. However, the most important factors are the social, economic, and environmental conditions in which we are born, live, work, study, and play.

Engaging the social elements of health is a critical component of any comprehensive health equality strategy. Successful engagement could ultimately lead to reduced healthcare costs, and improvement in everyone’s overall health outlook. From a business standpoint, health care entities, stakeholders, and investors need to identify and implement the correct business model, ensure proper policies and procedures in place, and have buy in from everyone (community, workers, senior ‘C’ levels, and ultimately clients) before they can begin to realize a faster, positive ROI.

Furthermore, health care entities and business stake holders, in cooperation with community leaders and governmental agencies (regardless of level), need to realize there is a critical need to identify and improve community health environments and health policies. This can only be achieved though cooperative efforts by all; and, by supporting programs and policies that address the myriad of social and economic determinants of health. In doing so, only then can we ensure the root causes of health disparities, and the associated inequities, are adequately, and effectively addressed and eliminated.

[1] Lurie, N., Somers, S. A., Fremont, A., et al., 2008

[2] McKenzie, James F., Pinger, Robert R. 2015. pg. 25, sidebar

[3] McKenzie, James F., Pinger, Robert R. 2015, pg. 25, para 5

[4] Lawler, C. (2011), Introduction, pg. 15

[5] Lawler, C. (2011), Introduction, pg. 15, para. 3.

[6] ^{Lurie, N., Somers, S. A., Fremont, A., et al., 2008, para 12.}