{"id":906,"date":"2021-02-23T01:53:20","date_gmt":"2021-02-23T01:53:20","guid":{"rendered":"http:\/\/wordpress.thetruthtoledo.com\/?p=906"},"modified":"2021-02-23T01:53:57","modified_gmt":"2021-02-23T01:53:57","slug":"health-care-equity-justice-pillar","status":"publish","type":"post","link":"https:\/\/wordpress.thetruthtoledo.com\/index.php\/2021\/02\/23\/health-care-equity-justice-pillar\/","title":{"rendered":"HEALTH CARE EQUITY & JUSTICE PILLAR"},"content":{"rendered":"

A Look at The Toledo Black Agenda<\/strong><\/p>\n

A wide range of leaders in Toledo\u2019s Black community have joined forces to put together a report on the challenges facing that community in six critical areas.<\/em><\/p>\n

The report, The Toledo Black Agenda, a months-long project in the making, examines historic obstacles and current challenges in the areas of criminal justice, economic development, education, health, housing, workforce development.<\/em><\/p>\n

The community leaders and experts were assembled by Lisa McDuffie, CEO of YWCA of Northwest Ohio and Robin Reese, CEO of Lucas County Children Services.<\/em><\/p>\n

Now Toledo\u2019s Black Agenda will be made available to local government agencies, along with a host of private and public companies and entities in order to gather community-wide support for the demands and suggestions proposed in the report.<\/em><\/p>\n

We are printing excerpts from the report over the next few weeks. The following is an excerpt from the fourth pillar \u2013 the Health Care Equity & Justice Pillar. We will print the recommendations of the Health Care Task Force next week.<\/em><\/p>\n

The entire report, with citations, can be read online at thetruthtoledo.com<\/em><\/p>\n

PART IV:\u00a0 HEALTH CARE EQUITY & JUSTICE PILLAR<\/strong><\/p>\n

INTRODUCTION AND PURPOSE<\/strong><\/p>\n

The issue of equity in healthcare is a complicated one.\u00a0 To improve health for everyone, hard, unflinching questions must be asked, and reasonable, innovative and well-formed solutions designed to directly address the needs of those disenfranchised in our communities must be provided. There can be no fear of confronting history and its fostering of the intentional development of public policies that \u201cghettoized\u201d neighborhoods making them unhealthy places for families to live. We must ask why housing stock is allowed to remain infested with lead, well known to impair the cognitive ability of our children.\u00a0 We must challenge our elected officials to answer the question why, in the most progressive and technologically advanced time in our history, in the richest country in the world, issues of food insecurity, educational process that fail many children in our urban centers and environmental issues that deprive our communities of life sustaining basics like water, still exist?\u00a0 Employment and associated advancements are still unevenly available and the inability or unwillingness to provide equal access to health care, especially specialty care, remains of great concern. Tough questions with no easy solutions, but all necessary inquiries in the movement toward healthcare equity.<\/p>\n

What Is Health Equity?<\/b><\/p>\n

A basic principle of public health is that all people have a right to health care[1]<\/sup><\/a>.\u00a0 When access to care is denied, significant negative differences in the health status between groups occur.\u00a0 These differences most often affect those who are marginalized because of socioeconomic status, race\/ethnicity, sexual orientation, gender, disability status, geographic location, or some combination thereof. People in these groups not only experience worse health but also tend to have less access to those resources which typically form the foundation of healthy communities. Suitable housing, sound education nutritional food and safe neighborhoods are all examples of what are now called the Social Determinants of Health (SDOH) and are considered essential resources in the pursuit of Health Equity.[2]<\/sup><\/a><\/p>\n

The actual definition of Health Equity is complicated by the influences of those elements related to SDOH and its similarity to its counterparts, Health Disparities and Inclusion Health.\u00a0The World Health Organization defines\u00a0health equity<\/em><\/strong>\u00a0as the \u201cabsence of avoidable, unfair or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, geographically or by other means of stratification\u201d in the pursuit of optimal health status.[3]<\/sup><\/a>\u00a0 It is, as defined within the Veterans Health Administration\u2019s Health Equity Plan, \u201cthe understanding of how people\u2019s social characteristics and environments affect health…\u201d\u00a0[4]<\/sup><\/a>\u00a0 These are the definitions of health equity to be used within this document. Health inequities are not naturally made.\u00a0 They arise from racial and class inequities; from decisions that this society has made.\u00a0 The single strongest predictor of our health is our position on the class pyramid.<\/p>\n

The issue of Health Equity is both massive in scope and complex when considering a pathway toward its attainment.\u00a0\u00a0 And while there are a significant number of health issues that should be addressed by this community, this document will identify those health issues in our community that require immediate consideration.\u00a0 One thing is without question; the data and research evidence are clear that racism is a systemic and ongoing public health crisis with serious consequences for the health of Black Ohioans. It is also clear that racism has a profound and pervasive impact across\u00a0all the factors\u00a0that shape our health. This includes our healthcare delivery systems, education, housing, food, economic, environmental, criminal justice and political systems, among others.[5]<\/sup><\/a><\/p>\n

\u00a0Health disparities<\/em><\/strong>\u00a0on the other hand, are the health-related outcomes present in\u00a0marginalized communities<\/em><\/strong>, which are directly attributable to the systematic and\u00a0unjust distribution<\/em><\/strong>\u00a0of those critical resources mentioned above.\u00a0 Equally important is the somewhat derivative definition of\u00a0Inclusion Health<\/em><\/strong>.\u00a0 This term\u00a0\u00a0is used to define a number of groups of people who are not usually well provided for by healthcare systems, have poorer, access to healthcare , experiences and health outcomes than even the most vulnerable of our population.[6]<\/sup><\/a>\u00a0This definition covers people who are\u00a0homeless, vulnerable migrants (refugees, those undocumented, asylum seekers) and sex workers to name a few.\u00a0The conceptual differences between these terms are subtle but significant. It is important however, that they and their differences be understood as each is important in this discussion.<\/p>\n

The Cumulative Impact of Healthcare Inequity<\/strong><\/p>\n

Racism and the inequities it creates are well documented as drivers of health disparities and overall poor health in the Black community. While these are avoidable differences in health outcomes among groups, the ongoing trauma of systemic or institutional racism, results in an unequal\u00a0allocation of social resources that shape health status.\u00a0 Resulting imbalances can be seen in conditions that shape and define Social Determinants of Health.\u00a0[7]<\/sup><\/a>\u00a0\u00a0But beyond these things, evidence suggests that the stress of the experience of racism may have its own physical impact. \u201cIt’s about access and unequal treatment, but it’s also about much more than that\u2019 states April Thames, PhD, Associate Professor of Psychology and Director of the Social Neuroscience in Health Psychology lab at the University of Southern California.<\/p>\n

\u00a0The fact that individuals live with these stressors their entire lives produces adverse health consequences. Discrimination has a directly toxic impact on health in general and neurologic health in particular. Several studies have shown clear biological links for poor health outcomes associated with racism, even after controlling for other factors that might serve as a proxy, such as access to care. In fact,\u00a0the persistent stress of these environmental influencers causes changes to the neurological, endocrine and immune systems. These changes contribute to a great number of health maladies including high rates of infant mortality and co-morbidities such as hypertension and heart disease. Comorbidities render Black people more vulnerable to illnesses like COVID-19, shortens lifespans and increases medical complications and death from otherwise survivable diseases.<\/p>\n

There are also real differences in how people are treated when they obtain care. The examples are many and range from providing significant misinformation (telling a patient with suspected Multiple Sclerosis that \u201cBlack people don\u2019t get MS\u201d) to disparities in the way illnesses are managed. For example, Black patients experiencing a stroke are one quarter less likely to be given thrombolysis, the treatment which is known to be most effective, than White patients. In her book CASTE, Isabelle Wilkerson discusses that\u00a0 empirical studies show physicians often disregard the reports of pain from Black patients, wrongly believing that Blacks in particular have higher pain thresholds.\u00a0 This, according to Wilkerson, has led physicians to undertreat or deny pain medication to Black patients-even those with metastatic cancer-while readily prescribing medication to White patients reporting equivalent levels of pain.\u00a0 The disparity is so severe that Blacks as a group receive pain medication at levels beneath the threshold established by the World Health Organization.<\/p>\n

California Surgeon General Dr. Nadine Burke Harris is a pediatrician who has studied the profound health effects of childhood trauma and stress.\u00a0 In pointing out the higher COVID-19 rates among Black and Brown people, she identified their long term environmental and racially tinged experiences to be \u201cseverely flawed and systematically different than others, resulting in negative health outcomes. We (this country) have created these differences\u2014 and they are literally leading Black and Brown people to die in far greater numbers, than others\u201d she said.<\/p>\n

Ohio by The Numbers<\/strong><\/p>\n

When it comes to developing a health system rooted in the principles of health equity and justice, the numbers below will show that Ohio and Lucas county face significant challenges.<\/p>\n