Health Inequalities and Health Inequities

a break down of  Health Inequalities and Health Inequities

PART 1 UNIT Vll

Discuss the differences between health care inequities and inequalities. Describe how health care inequities and inequalities have, or have not, affected you or someone you know.

Your journal entry must be at least 200 words in length. No references or citations are necessary

PART 2 UNIT Vlll

Part I: Identify an assignment in this course that had a positive impact on you. How will you be able to apply the skills you learned from it to gain life and/or career success?

Part II: As technology used in medicine changes and advances, how can a health care professional stay up to date while still maintaining the ethics and integrity as they adapt to the changes? How do these new changes affect your feelings as a patient of a health care professional who uses the new technologies?

Your journal entry must be at least 200 words in length. No references or citations are necessary.

HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit VII

Upon completion of this unit, students should be able to:

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.
2.1 Discuss specific health inequality and inequity examples.

3. Evaluate the impact of commonly accepted business principles used to create an equitable health

care system.
3.1 Analyze the factors necessary to create a more equitable health care system.

Course/Unit

Learning Outcomes
Learning Activity

2.1

Unit Lesson

Chapter 12
Unit VII PowerPoint Presentation

3.1
Unit Lesson
Chapter 12
Unit VII PowerPoint Presentation

Required Unit Resources

Chapter 12: Health Inequalities and Health Inequities

Unit Lesson

In this unit, we will discuss health inequalities and health inequities in the United States. Specifically, we will
discuss what the health inequalities and health inequities in the United States are, how they are measured,
possible ways to reduce them, and the ethical issues raised.

Health inequalities and health inequities that exist have an overall negative impact on health outcomes. In the
United States, health disparities exist for various reasons such as socioeconomic status, gender, ethnicity,
race, and geographical region (Morrison & Furlong, 2014). Health disparities are gaps that exist between
different populations who are at a social disadvantage because of social health determinants. However, since
the 1980s, there has been considerable attention to the issue of health inequalities (Murray et al., 1999).

Health Inequalities and Health Inequities

The term health has many definitions. One common definition is the absence of disease. More specifically,
health involves certain indicators such as life expectancy, survival rate, morality, and disease prevalence and
incident. Further, individual health status is often assessed in many different ways by researchers. Various
populations have many drastically different health belief systems and definitions surrounding health (Morrison
& Furlong, 2019).

Health inequality is a descriptive term referring to the total variation in the status of health across a specific
population of individuals or to a difference in health between two or more populations (Morrison & Furlong,
2019). Health inequalities usually include a comparison of population averages and inferences are made
about the results. Health inequalities are variances between groups of individuals and populations.

Health inequity is a normative term that deals with differences that society judges to be morally unacceptable.
A health inequality is not always considered a health inequity, but there is a correlation between the two. For

UNIT VII STUDY GUIDE
Health Inequalities and
Health Inequities

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example, the United States population does not consider elective plastic surgery a necessary health need;
therefore, the population would not consider unequal access to elective plastic surgery to be an inequity
(Morrison & Furlong, 2019). Typically, moral judgment is involved when determining if a health inequality is a
health inequity as well. This can also be determined based off societal perception.

Determining if a specific instance or situation is considered a health inequity requires the comparison and
measurement of at least two populations. A population needs to be defined, and this involves important
ethical and moral decision-making (Morrison & Furlong, 2019). It is important to choose populations that have
distinct differences and different health inequalities. This will allow for more comparison between the
populations chosen.

Measurement of Health Inequalities

There are many different statistical measures of health inequality. The topic of measurements using statistics
is an extremely large topic, and we will just brush the surface of it with a few examples. Health inequities are
measured by rates such as diagnostic rates (Morrison & Furlong, 2014). Health inequality is measured with
simple statistical measurements such as the rate difference (RD) and the rate ratio (RR). The RD is a
subtraction from the numeric measure of group A’s health status from group B (Morrison & Furlong, 2019).
The RR is derived from dividing the numeric measure of group A’s health status from group B’s health status.
The statistical numbers surrounding health inequalities can be used to assess health inequalities over time.
The aggregate numbers, if improved, can simultaneously show an increase in health inequalities in a
population (Morrison & Furlong, 2019).

Reducing Health Inequalities

There are several various ethical issues that play a part in determining possible interventions in hopes of
reducing or eliminating health inequalities. Much consideration needs to be made concerning the relationship
between equality of outcomes and equality of treatment, which are part of the principles of vertical and
horizontal equity (Morrison & Furlong, 2019). To reduce the health disparities in the United States, social
determinants need to be eradicated, and equal distribution of resources across all populations is needed. In
health care, horizontal equity deals with the equal distribution of resources throughout a population. Vertical
equity is the division of various resources for diverse need levels; however, this can be quite complicated
because of the complex interplay of social factors. Another issue that arises when trying to reduce health
inequalities is the relationship of leveling up and down to achieve an equity goal (Morrison & Furlong, 2019).
Finally, there are also many social resources that play an important role in determining the best course of
action to reduce health inequalities.

The U.S. government, lawmakers, health practitioners, and policy makers seek to improve overall population
health and to eliminate or reduce variations in health based on race, socioeconomic factors, geographic
location, ethnicity, and social factors (Arcaya et al., 2015). One example is the Patient Protection and
Affordable Care Act (ACA) that aims to reduce social determinants and move toward a more fair and
equitable health care system.

Conclusion

Health inequalities and health inequities are essential concepts for understanding some ethical problems in
health care. Addressing health inequalities and health inequities requires a deeper awareness and
acknowledgement of the magnitude of social issues. Despite efforts to reduce health inequalities and health
inequities, they persist and unfortunately are even increasing in some instances. The need for changes to
address these health inequalities and health inequities is prevalent because of the existence of health care
gaps and the longevity between least and most advantaged populations (Morrison & Furlong, 2019).

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References

Arcaya, M. C., Arcaya, A. L., & Subramanian, S. V. (2015). Inequalities in health: definitions, concepts, and
theories. Global Health Action, 8(1).

Morrison, E. E., & Furlong, B. (Eds.). (2014). Health care ethics: Critical issues for the 21st century (3rd ed.).

Jones & Bartlett Learning.

Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning.

Murray, C. J. L., Gakidou, E. E., & Frenk, J. (1999). Critical reflection: Health inequalities and social group

differences: What should we measure? Bulletin of the World Health Organization, 77(7), 537–543.
https://www.who.int/bulletin/archives/77(7)537

Course Learning Outcomes for Unit VII

Required Unit Resources

Unit Lesson

Health Inequalities and Health Inequities

Measurement of Health Inequalities

Reducing Health Inequalities

Conclusion

References

HCA 3302, Critical Issues in Health Care 1

Course Learning Outcomes for Unit VIII

Upon completion of this unit, students should be able to:

1. Critique arguments related to the impact of social factors that influence the U.S. health care system.

2. Defend an opinion on critical issues facing the U.S. health care system in the 21st century.

3. Evaluate the impact of commonly accepted business principles used to create an equitable health
care system.

4. Summarize the differences between various health care providers.

5. Explain the impact of technology on the health care industry.

6. Summarize the government’s impact on health care regulations and reform.

7. Discuss common ethical principles applied to critical bioethical issues.

8. Outline common management procedures that affect health care organizations’ strategic goals.

8.1 Discuss ethical models and how they are applied in health care organizations.
8.2 Review new technologies that could be applicable to health care.

Course/Unit

Learning Outcomes
Learning Activity

1 Final Exam
2 Final Exam
3 Final Exam
4 Final Exam
5 Final Exam
6 Final Exam
7 Final Exam

8.1, 8.2

Unit Lesson

Chapter 16
Final Exam

Required Unit Resources

Chapter 16: Looking Toward the Future

Unit Lesson

In this unit, we will learn about the future of health care as new technologies are implemented. We will also
cover the ethics surrounding the use of new health care technologies. Specifically, we will learn about the
ethic of care model and the narrative model of ethics.

Ethics of Care Model

In the 1980s, the ethics of care model grew from moral development research done by feminist Carol Gilligan.
The ethics of care model focuses on the entire picture, specifically the relationships and context in decision-
making (Morrison & Furlong, 2019). The use of this model has been popular with health care providers,

UNIT VIII STUDY GUIDE
Looking Toward Health
Care Ethics in the Future

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specifically women and nurses. The ethics of care model depicts moral agents as interconnected, dependent,
vulnerable, and in asymmetric ways (Pettersen, 2011).

Care is the normative core of the ethics of care model and is a normative value that is related to the ideal of
not inflicting harm and aiming at preventing harm. The ethics of care model can be displayed as the
combining of the ethical principle of non-maleficence and the principle of beneficence. Therefore, the
normative value of care is related to promoting good (Pettersen, 2011).

Narrative Ethics Model

The narrative ethics model was derived from the biopsychosocial medicine and patient-centered medicine
models. The narrative ethics model is a model for health care practice that proposes an ideal of care and then
provides practical and conceptual meaning to strive to that ideal (Charon, 2001). It has gained increased
components in the last two decades (Morrison & Furlong, 2019). Narrative medicine looks specifically at the
personal connections between the patients and the health care providers and incorporates the illness, the
meaning of the health care practice for the providers, the health care providers’ collective profession of their
ideals, and health care’s discourse with society (Charon, 2001). The narrative ethics model helps health care
providers to improve the effectiveness of their medical practices through their work with the public,
colleagues, patients, and themselves.

Narrative knowledge is also applied to the fields of nursing, history, philosophy, law, anthropology, religious
studies, government, and sociology. Narrative knowledge is understanding the true significance and meaning
of stories through symbolic, cognitive, and affective means. In health care, this can be applied by providing a
comprehensive picture of a person (the patient’s) lifestyle and situation. In health care, there are several
narratives that apply: the patient and the health care provider, the health care provider and colleagues, the
health care provider and society, and the health care provider and him or herself (Charon, 2001).

So, what exactly is a narrative? In the health care setting, it is the story or state of affairs that a person has to
tell. The patient recounts (narrates) his or her acts, set of events, etc. to the health care provider. As the
health care provider listens to the patient’s narrative, he or she is often entered into and moved by the
narrative of the patient (Charon, 2001). Stories are an important part of the narrative ethics model.

Seen daily in the health care profession through research, teaching, academia, and patient care are the works
of narratives. Having health care providers who are aware of the narrative aspects of their health care
practices and ethical practices ultimately makes for a better care team (Jones, 1999).

Emergent Technologies and Ethics

Health care providers need to follow medical ethics, but sometimes advances in technologies make it difficult.
The University of Notre Dame’s John J. Reilly Center for Science, Technology, and Values announced a list
of emerging ethical dilemmas in science and technology on a yearly basis until 2018. It is now published by
Dr. Jessica Baron, formerly of the John J. Reilly Center for Science, Technology, and Values (Tech Top 10,
2018). The published list from 2019 contains a few items related to health care.

• Insect allies is creating genetically modified insects to deliver viruses to plants. This is ethically
questionable as it brings about a new biotechnology regarding sticking new genes into things to make
changes in the way that a person wants. Viruses are used frequently in this process.

• Seeding trials are clinical trials that are not to find the efficacy of a pharmaceutical drug but to suggest
new uses to health care providers so there is scientific data to support off-label usage. This is
basically a trial designed solely for marketing purposes.

• DIY neurohacking involves an at-home device to zap one’s brain in hopes of improving cognitive
function. This includes obvious dangers.

If you would like to further explore the list of ethical dilemmas and policy issues in science and technology,
take a look at the Tech Top 10 website.

Complementary and Alternative Medicine and Ethics

http://reillytop10.com/

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Complementary therapies have many different names: alternative medicine, complementary and alternative
medicine, integrated health care, or integrative medicine. Over the past couple of decades, alternative
medicine use has grown. Complementary therapies have become an important arena within health care.
Complementary therapies have a high level of acceptance in the overall population, and this can present
challenges to health care professionals as well as raise ethical issues (Ernst et al., 2004).

There are three ethical issues surrounding complementary therapies: safety, scope of practice, and cultural
diversity. Safety, the first ethical issue, refers to the degree of safeness that complementary therapies have or
lack. There are thousands of complementary therapies; many of which lack regulation through the Food and
Drug Administration (Silva & Ludwick, 2001). The second ethical issue surrounds the scope of practice. If a
complementary therapy is to be used within a nursing practice, does the nurse have the competence to
administer the therapy and not violate standards of practice? If scope of practice is not clear to the patient and
the health care provider, then harm is likely to occur. The third ethical issue is cultural diversity. The United
States is becoming more and more culturally diverse. With this growth, health care staff needs to make sure
they are culturally competent and nonjudgmental of a patient’s history in using complementary therapies. The
health care team also needs to be sensitive to the ethical principle of justice (Silva & Ludwick, 2001). Health
care providers are becoming more receptive to complementary therapies, and the therapies have gained
attention in the mainstream media due to patients’ interest in their own health, well-being, and prevention
(Morrison & Furlong, 2019). Health care providers are also now learning more about complementary
therapies in their schooling, and there are research institutions that are actively researching complementary
therapies applied to health care.

References

Charon, R. (2001). Narrative medicine: A model for empathy, reflection, profession, and trust. Journal of the

American Medical Association, 286(15), 1897–1902.
https://jamanetwork.com/journals/jama/fullarticle/194300

Ernst, E., Cohen, M. H., & Stone, J. (2004). Ethical problems arising in evidence based complementary and

alternative medicine. Journal of Medical Ethics, 30(2), 156–159.
https://jme.bmj.com/content/30/2/156.full

Jones, A. H. (1999). Narrative based medicine: narrative in medical ethics. British Medical Journal,

318(7178), 253–256. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1114730/

Morrison, E. E., & Furlong, B. (Eds.). (2019). Health care ethics: Critical issues for the 21st century (4th ed.).

Jones & Bartlett Learning.

Pettersen, T. (2011). The ethics of care: Normative structures and empirical implications. Health Care

Analysis, 19(1), 51–64. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037474/

Silva, M. C., & Ludwick, R. (2001). Ethics: Ethical issues in complementary/alternative therapies. Online

Journal of Issues in Nursing, 7(1).
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Et
hics/EthicalIssues.html

Tech Top 10. (2018). Home. http://reillytop10.com/

Course Learning Outcomes for Unit VIII

Required Unit Resources

Unit Lesson

Ethics of Care Model

Narrative Ethics Model

Emergent Technologies and Ethics

Complementary and Alternative Medicine and Ethics

References