I think there are many reasons why different populations experience differences in care. There is the obvious answer of bias and discrimination. Some of it obvious, some of it has been inherent in the way that social disparities have grown and worsened over time. Another reason is insurance coverage and what they can afford. Location is another reason. Some medical treatments or medications are not covered by insurance or have high premiums with insurances and only people with higher levels of income can afford those treatments or medications. Another reason is that health care facilities that are located in less desirable areas are harder to staff by experienced providers. I think that when most health care providers are going through school, they do desire to help everyone and be the one that confronts health care disparities, but that is hard work. After awhile, people move on to “easier” jobs that pay better, in more desirable areas. Health care options available in rural communities are different than you would see in an urban medical center. Many times, people in rural areas don’t have the transportation or options to travel to get these premium treatments.
Unconscious bias, discrimination, and structural racism are very much present in health care throughout the United States. Unconscious bias is seen as an unsupported judgement in favor of or against a person or group. It can shadow the way a person treats another person, or doesn’t treat another person. It may be assuming that someone who elicits certain behaviors is not capable of change, or basing health care decisions off of someone’s demographic or socioeconomic status. An example of this can be seen in substance abuse patients. A group of doctors that are working in a rural area, or reservation may treat substance abuse patients with a certain type of penalizing behavior, where as valet doctors that work in a place like Martha’s Vineyard may treat their patients with substance abuse behaviors with a “gloved hand”. Discrimination can affect health care delivery in many ways. It affects with patient provider relationship. It can affect the way people living in certain areas, or that have certain insurance, or lack of insurance, or people with certain health care problems get medical care or treatment. Structural racism is seen in how neighborhoods are segregated and how economically disproportionate the health care delivery is in these areas. In the book, TheColor of Law,it shows how the government is responsible for creating these segregated areas within our communities which has in turn created and perpetuated inequalities in social, economic, and educational opportunities. Minorities that live in these poorer neighborhoods attend low quality schools, and receive their health care at lower quality hospitals (Beck, Edwards, Horbar, Howell, McCormick, & Pursley, 2019).
In the United States, people that can afford better care, get better care. It is hard to say that better medical centers are located in good areas, because some of the best trauma centers are located in less desirable areas for living. However, in and around more upscale neighborhoods are health care facilities that cater to specific economic classes and are located in very desirable areas. People that are fortunate, can base where they want to live on the quality of health care facilities and schools that are in the neighborhoods. Social determinants of health contribute to the health of all demographics, and contribute to the management of their healthcare and predisposition for illness. Political, social, and economic factors all contribute to the well-being of a person and their community in which they live.
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