Health Care for the Poor
Ethnicity and race are two of the most studied factors in social status and health risk because minorities historically have less access to the social rewards that limit risk levels. Lower-class urban neighborhoods with a high number of minority residents often lack representation in social politics and suffer for it with higher levels of air and water pollution, which increase the level of health risk for all residents. Furthermore, poverty can breed crime, and the stress of living in a high-crime area also negatively affects a person’s health. Stress can manifest physically by presenting as complaints such as headaches. Stress can also increase the likelihood of negative health behaviors, such as cigarette and alcohol use. Limited access to resources, including fresh vegetables and medical care, increases the burden. Low-income areas are commonly populated with fast-food restaurants that serve high-fat foods, whereas more affluent areas often have more grocery stores and farmers’ markets. Additional factors such as migrant status further increase a person’s vulnerability. Risk factors do not stand alone. An elderly minority female has different risk factors than an elderly Caucasian male.
Social capital is the measurement of personal relationships in an individual’s life. The number, type, and reliability of interpersonal relationships greatly influence a person’s vulnerability and health risk. For example, a single mother is less likely to spend a day in bed, resting and recovering from an illness, than a mother who has a partner or someone reliable who can care for the children. Working parents are better able to maintain viable employment if grandparents and other relations are available to help with child care.
A photo of an older woman, younger woman, and little girl smiling at each other while fresh produce sits in front of them.
Courtesy of Hemera/Thinkstock
Health risk depends on several factors, including the quantity and quality of a person’s interpersonal relationships.
The ability to work creates opportunities and other social rewards. An upwardly mobile career path grants access to money and insurance to help pay for doctor visits and medicine. The opportunity to meet people and grow friendships at work adds to a person’s support network. A strong, healthy support network directly influences psychological and physical well-being, lessening a person’s health risk. Hospitals and rehabilitation facilities have found that patients who have reliable support systems enjoy faster recovery times and spend less time recuperating in the medical center in favor of convalescing at home with the assistance of a robust, developed support system. Reducing the length and frequency of hospital stays reduces the risk of secondary and recurrent infections.
Human capital is the amount of investment in a person’s potential. Low-income individuals often have low human capital, while higher-income individuals enjoy investment in their potential in the form of education, opportunities for advancement, and even better access to higher-quality health care. The more investment made in a person’s potential, or future, the more that person will be able to contribute to society in a positive way.
Data on various subjects including education, wage earnings, and health care access indicates gaps in human capital based on gender, age, and ethnicity. Poor-performing schools are more common in low-income neighborhoods, females are sometimes passed over for advanced training and managerial positions, and minorities often suffer a lack of social resource allocation. In all of these examples, failure to invest in people’s potential negatively influences their long-term outcomes. Poorly educated children are less likely to attend college, the disenfranchised female will lose work productivity, and the neighborhood that needs public resources to fix streetlights will see an increase in crime.
Outside influences are not the only way to invest in human capital. Individuals invest in their own potential by working hard at school and work and by organizing communities to create the change they want. Conversely, investment in human capital can be negatively impacted by a collective lifestyle perspective. The collective lifestyle perspective dictates behavior based on social constructs, or ideas, about the way people “like me” should behave (Barnes, Hall, & Taylor, 2010). Middle-class mothers may perceive that smoking is unacceptable among their peers and so give up smoking. Conversely, adolescents in low-income areas may perceive that smoking makes them more accepted among their peers and so take up the unhealthy habit.
Do you have a support network? Can they help with family needs such as child care or transportation? Are they supportive of your education goals?
The World Health Organization (WHO) is an international organization that coordinates health-related efforts around the globe. The WHO definition of health goes beyond the mere absence of illness, proposing that “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization [WHO], 2012).
From this definition of health, we can see where values and resources are directly linked to well-being. The WHO definition indicates that health exists in varying degrees, based on a number of recognized indicators. Indicators of physical health are considered the measurements of the body’s wellness, such as bodily illness and disability. Mental health indicators measure emotional issues such as stress and mental illness. The WHO definition also includes social well-being, based on indicators such as relationships with others. Figure 1.2 illustrates the health continuum.
Figure 1.2: The health continuum
A graph illustrating the Health Continuum via a line with arrows on each end. “Perfect Health” is at one end of the continuum and “Death” is at the other, with “Chronic Illnesses” and “Cold and Flu” in between.
Health is not simply the absence of disease. A person’s degree of health exists on a spectrum, fluctuating throughout life.
Health is measured along a continuum, with great health at one end and death on the opposite end. Minor ailments fall nearer the perfect health end of the continuum, with more severe needs nearer the death end.
The WHO definition of health clearly includes physical, mental, and social components. Physical health deals with the body and bodily functions, mental health includes brain functions such as thought and emotions, and social health includes interpersonal relationships with others. Physical health is measured by patient perception, doctor opinion, and clinical testing. Another way to measure health is based on a patient’s abilities to perform activities of daily living (ADLs). Basic ADLs include personal hygiene and being able to dress oneself, feed oneself, walk with or without assistance, and use the restroom (Weiner, Hanley, Clark, & Van Nostrand, 1990).
Patient perception of well-being cannot be overlooked when measuring health. An important part of patient perception of well-being involves the concept that people alter their behavior when they perceive that they are unwell. Staying in bed and eating chicken soup are two common “sick role” behaviors. Perception is a key tool in measuring both mental health and social health, as people interpret stressors and relationships differently.
Patient perception, doctor opinion, and clinical testing are standard ways of measuring individual health status but do not offer a larger picture of community health status. Community health status is measured with statistics of the rates of occurrence of illness, disease, and death within a recognized group. This data, such as that shown in Figure 1.3, is used to influence public policy and the distribution of public resources.
Figure 1.3: U.S. infant mortality rates per 1,000 live births, by maternal education and race
A bar graph illustrates the U.S. Infant Mortality Rates per 1,000 live births, broken first into columns based on the mother’s education level and then subdivided by the mother’s white or black race. In all five education categories (grades 0-8, 9-11, 12, 13-15, and 16), the infant mortality rate decreases as the mother’s education level increases. In all race-based subcategories, the infant mortality rate was higher for black women than for white women.
Mortality rates for children born to white mothers is much lower overall than for children born to black mothers; however, both races see a significant decrease in infant mortality as the mother’s number of years of completed education rises.
Singh, G. K. & Yu, S. M. (1995). Infant mortality in the United States: Trends, differentials, and projections, 1950 through 2010. American Journal of Public Health, 85(7). Retrieved January 12, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615523/pdf/amjph00445-0063.pdf
Where does your current total health fall on the health continuum? Can you think of a time when your health measured nearer the negative end?
Do you feel that patient perception is a reliable method of measurement for use in global decisions regarding heath issues?
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