Depending on where a person lives, or if he or she is white, black or another race or ethnicity, or if they are impoverished – their health reflects who they are.
People who spend an hour commuting to work may not have time to eat healthy food or may suffer from stress. People who live near factories may breath toxins or particulates. People who have fewer opportunities have fewer connections to preventative health care.
Eliminating disparities in health care is a major focus of policymakers, advocates and health care providers who seek to ensure that all people – regardless of race, ethnicity, gender, socio-economic status, etc. – have access to quality health care.
The only way disparities in health care can be eliminated, Dr. David Satcher said, is for the country’s health care system to become committed to the health of every citizen, regardless of their race, ethnicity and socio-economic status.
Satcher, who will be giving the keynote address at the National Health Care for the Homeless Council’s annual conference later this month, served as the country’s 16th Surgeon General during the Clinton and George W. Bush administrations. He has also served in high-level positions at the Centers for Disease Control and Prevention, the Kaiser Family Foundation and the Morehouse School of Medicine.
In 2006, he founded the Satcher Health Leadership Institute at the Morehouse School of Medicine. The institute’s mission is to promote policy and practices that will eliminate disparities in health.
Satcher said the major factors are what are known as the social determinants of health: a person’s access to transportation, their education, work and income, where they live, etc. The thing that people within health care can most easily change, he said, is the health care system.
Amanda Waldroupe: How is changing the health system easy?
David Satcher: We spend more money than any other country on health care. And we don’t have a system that’s universal. We invest enough money in it that we can provide access to quality care to everybody, if we did it the right way. That means we’re going to be focusing on preventive care, like preventing obesity and diabetes. That means we’re going to invest in our schools, and physical education, and good nutrition. It means we’re going to provide the kind of environments where every child can be physically active. It’s what we as a country must do to eliminate disparities in health.
A.W.: What do you think that comes down to? Is it the lack of political will at the federal level? The power of insurance companies?
D.S.: It’s a combination of things. Surely, when it comes to the politics, it has not, unfortunately, been supportive enough of everybody being able to access health care. The Affordable Care Act was passed by one party, and not a single Republican voted for it. I often say that we need to declare health and health care a political no-fly zone. The way we deal with health care is too political.
A.W.: There are more efforts to use Medicaid funding flexibly – like paying for a patient’s short-term rent assistance if getting them into stable housing could affect their health, or pay for an air conditioner for a person with congestive heart failure. Do you think that is a part of the solution?
D.S.: That’s one way to look at it. The other way is to make sure that everyone has adequate income and adequate housing. You could argue that health care dollars should be spent for health care. The health care budget is not the only way to get money for those things. Should we invest other monies in seeing everybody has good working conditions and safe housing? The answer is yes. Should there be no children in this country who are exposed to lead in the water? Is that the responsibility of health care? Or the social determinant responsibilities of government? The whole point of the social determinants of health is what we used to call “health in all policy.”
I think that when you develop budgets for housing, for example, one thing you’ve got to consider is how it will impact the health of the person.
So, the answer is not just in the health care budget. You’ve got to look at health as a component of all policy. Whenever you are making policy, you ought to ask yourself: How will this impact health?