What is health justice?
Health justice means dismantling the effects of racism and working towards sustainable policies and innovations that end up lasting through generations.
Who does health justice impact?
People with systematically more barriers to health due to their:
Marginalized individuals, both racial and socioeconomic, who suffer from inaccessibility to healthcare as well as chronic medical conditions and shorter life expectancies.
Why is health justice important?
2020 marked the first year that Californians were required by state law to have health insurance, with the goal of healthier outcomes for all in the state. Ideally, healthcare should be guaranteed socially in a way that reduces disparities caused by inadequate healthcare and not in terms of equality in healthcare delivery (equal amounts or types) no matter what the health consequences may be.
How COVID widened the gap.
Due to the spread of COVID-19 across countries, vulnerable and marginalized populations have been adversely impacted, including specific ethnic minorities and migrant groups, as well as those with low income and socioeconomic status. Health disparities exist between these groups and have been exacerbated by the pandemic, which was triggered by complex socioeconomic factors and long-standing structural inequalities.
As part of its commitment to reduce health inequities, the state has launched a Health Equity Dashboard on California's COVID-19 site that tracks California’s health equity measure and data by race and ethnicity, sexual orientation, and gender identity.
How can we shrink the gap?
To achieve health equity, law and policy must be integrated within the pursuit of access to justice. It is impossible for those without equal opportunities to attain health and well-being to receive justice. Access to justice strategies should facilitate enforcement of existing laws, empower affected populations, and reform structural law and policy as a pathway to health equity.
Racial and Gender Bias in Healthcare
According to the CDC, Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. 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.
Racial/ethnic groups that are adversely affected by health inequality in the United States include:
American Indians/Alaska Natives
Asian Americans, Native Hawaiians and other Pacific Islanders
African Americans and Hispanics/Latinos are more likely to report experiencing discrimination and racial health inequality in the United States.
Many systems contribute to racial health inequality within these various populations such as:
Lack of healthcare access
Segregated healthcare workforce
Distrust of physicians
Racial stereotypes and biases
Culturally sensitive health care providers
Racial health inequality has created challenges with ethical, public health, economic implications.
By increasing awareness of racial and ethnic disparities in healthcare among the general public, strengthening patient-provider relationships in publicly funded health plans, and applying the same level of healthcare to publicly funded HMO participants that apply to private HMO participants, racial health disparities can be eliminated. In addition, healthcare professionals must be educated on healthcare inequalities and acknowledge that systemic racism and unconscious biases factor into healthcare.
Gender is another marker for social and economic vulnerability that manifests in inequality in access to healthcare.
Gender inequality is defined as discrimination based on gender or sex, causing one sex or gender to be privileged or prioritized over another. It has a profound effect on mental health worldwide, with psychological effects including anxiety, depression, higher levels of stress, and post-traumatic stress disorder (PTSD) in women and people of marginalized genders. Also contributing to women's health inequality are social and structural factors like fewer neighborhood health services, decreased access to educational and economic attainment, less insurance coverage, and even practitioner-level factors such as racial bias and stereotyping.
The areas of health that are mostly affected in women’s health inequality consists of:
Sexually transmitted infection care,
Human papillomavirus vaccination among younger women aged 18-25 years
Low birth weight neonates
Maternal morbidity and mortality.
In order to eliminate women’s health inequality, it is important to create systemic change. Women, especially those in underserved racial and low-income areas, must have access to healthcare services without clinician bias or other obstacles.
Higher mortality in people that experience health inequality has contributed to the lack of early detection of several medical conditions. The main goal to eradicate racial and women’s health inequality starts with identifying the inequality and specific variables that have a direct impact on the health inequality. Also, it is important to develop a plan that addresses the specific variable and identifies government, professional societies and state, local, community based initiatives and private entities to partner with for significant impact.
Beyond the clinical interface, it is important that there is a development of opportunities that foster engagement of minorities and women. There should be a promotion of information in relation to access to healthcare for all individuals which facilitates communication, trust and impact in the community. These information provided by the community should focus on state and community offered services, access to healthcare, healthcare screenings and care to aid in improving health equality.
A local lens
The American healthcare system has long been impacted by racial and socioeconomic disparities. Lower income communities especially have more health risks, less access to safe and affordable healthcare, and worse health outcomes.
In California, about 1 in 10 people are uninsured. Lack of healthcare results in people being less likely to have a primary health care provider and the ability to pay for necessary services and medicine. While the implementation of the Affordable Care Act (ACA) in 2010 has since helped people receive necessary healthcare, there’s more work that needs to be done for people that face additional barriers such as lack of transportation to facilities, inability to travel, and lack of resources in lower income areas. Additionally, undocumented Californians have the highest uninsured rate in the state, with nearly 1.3 million uninsured under the age of 65. Disparities in health insurance are more prevalent across racial/ethnic and socioeconomic lines. Even with subsidies provided by the ACA, many Californians struggle to afford healthcare premiums for themselves or their families.
An important piece of the healthcare puzzle is accessibility. Because of the aforementioned barriers to healthcare, there are large racial and socioeconomic discrepancies in mortality rates; the lack of early detection of several medical conditions, for example, is a direct effect of health inequality. Access to healthcare, healthcare screenings, and healthcare quality all play a role in health outcomes for Californians. In order to help insure more Californians, the UC Berkeley Labor Center recommends that the state expand Medi-Cal coverage regardless of immigration status; if Medi-Cal expanded to low-income adults of all ages, the number of uninsured Californians would be reduced by nearly 25%.
In Los Angeles County, barriers to healthcare access remain. Among other things, rising housing costs and a lack of reliable public transportation provide challenges to get Angelenos the healthcare they deserve. Even after the ACA was implemented, communities of color and women still face healthcare disparities and struggle with access to competent care. Black, Hispanic/Latinx, and Indigenous communities especially continue to experience disparities at higher rates than other groups.
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Check out these local non-profit organizations working towards Health Justice in their communities: