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Transcript
Equity and Practicality in Health
Disparities Research
John R. Stone, MD, PhD
Center for Health Policy and Ethics
Creighton University School of Medicine
Learning Objectives
• Explain meanings of “health equity” and
“healthcare equity.”
• Understand links to equality, justice, and
respect.
• Explain practical implications for health
disparities research.
Health Disparities
Clarity & Practicality
Clear
Definitions
Braveman et al. (2011) AJPH
Clear Indications
• Healthcare
• Social policy
Respect
• Everyone has equal and substantial moral
worth and their equal worth is recognized,
honored, and ensured.
Health Disparities
• “Health differences that adversely affect
socially disadvantaged groups.”
– “plausibly avoidable”
– Assoc w/ “discrimination or marginalization”
• “Disparities in health and its determinants are
the metric for assessing health equity.”
Braveman et al. (2011) AJPH
Equity & Disparities
Health
Equity
• Core
value
Eliminate
Disparities
Braveman et al. (2011) AJPH
Soc Justice
Health
Health
Rights
Equity
Disparities
Braveman et al. (2011) AJPH
Equity & Practicality
• In health disparities research
– The concept of health equity is practically
important.
• Yes/No (Example)
– The concept of healthcare equity is practically
important.
• Yes/No (Example)
Ethical
Actions
Possible
Actions
Practical = Possible
Ethical
Actions
Practical = Possible &
= “Plausible” =
= Reasonably
Possible? or
=Should do, all moral
factors considered
Equity & Practicality
• Is the concept “health equity” practically
helpful in health disparities research?
– Gives helpful ethical guidance
and/or
– Provides helpful new guidance
and/or
– Facilitates what should be done
Health Disparities Research
• Is the concept of health equity of practical
significance? Is it practically helpful?
• If so, how or why?
Justice
Equity
Equality
Equity, Rights, Health, Healthcare
• Ethical Right to health/healthcare: 1o or 2o
(R1/R2)
• Equitable H/Hcare
– Fair honoring of R1/R2
– Not overridden by other Rs & additional ethical
factors as determined through a fair deliberative
process
Equity (& Equality)
• Feature of justice
• Justice as Fairness
– Likes are treated alike (equality)
– To each (grp, individ) what is due (e.g. equal
opportunity)
– Priority to the worse off, especially worst off
– Outcomes of a decision procedure that employs
appropriate ethical guidelines, including fair
equality of opportunity for participation.
Equity in Health/Healthcare
• Fair opportunity for a sufficient level of health*
– Just distribution of social determinants
– Genuine access to needed healthcare
– Needed healthcare
• Remediation of deficiencies, given no overriding
ethical considerations
*Powers, M., & Faden, R. (2006)
Practicality & Disparities Research
• Healthcare Equity
– Fair & substantial equal opportunity for access
• Sort by challenges: poverty, language, education, etc.
• Structural barriers: agencies, policies
• System facilitators
– Equality after system entry
• Quality improvement outcomes
• System “treatment” (policies, procedures, personnel)
Causality & Practicality
• “It must be plausible, but not necessarily
proven, that policies could reduce the
disparities, including not only policies
affecting medical care but also social policies
addressing important nonmedical
determinants of health and health disparities,
Braveman et al. (2011) AJPH
Health Equity, Social Disadvantage
Health Sciences Centers
• Does health equity, a form of social justice,
require that health sciences centers work to
eliminate unfair inequalities in social
determinants that contribute to health
disparities?
• Why/why not?
• If so, how?
Equity: Health & Healthcare
• Does health equity require that healthcare
institutions/systems assess outcomes by
race/ethnicity, gender, sexual orientation,
language, socioecon status, geographic
location, etc.?
• Why/why not?
• If so, how?
References
• Braveman, P. A., Kumanyika, S., Fielding, J.,
Laveist, T., Borrell, L. N., Manderscheid, R., &
Troutman, A. (2011). Health disparities and
health equity: The issue is justice. American
Journal of Public Health, 101 Suppl 1, S149-55.
• Powers, M., & Faden, R. (2006). Social justice:
The moral foundations of public health and
health policy. New York: Oxford Univ. Press.