The USA – Does wealthy really mean healthy ?

 

We often tend to have this misconception that by increasing a nation’s GDP, we increase the quality of health within it. While there is an element of truth to this, it must be considered that inequities across a range of  areas prevent attaining the highest level of health for all individuals and groups in a population.

The USA has the highest GDP in the world and ranks 5th on the United Nations Human Development index. However despite this overall bright picture for this nation , health outcomes within the country and across population subgroups are far from ideal !

Despite being what the layman would consider a ‘wealthy’ or ‘developed’ nation , here are some facts that suggest that “wealth does not necessarily mean health”, and that disparities and inequities within a population can have significant impacts on its health status.

  • The American healthcare system is ranked at 37th in the world.
  • According to the William Johnson & Joseph Hickey Academic Class model, 14-20% of the American population would be classified as being “Lower Class”.
  • McMichael reported mortality rates to respiratory diseases and digestive diseases to be four times higher in the lower class than for the highest class.
    • Therefore we can estimate the mortality rates of 14-20% of the American population to be around 4 times higher for respiratory diseases and digestive diseases.
  • America has a growing divergence between the upper and lower class in terms of healthy eating. This means the upper class are becoming healthier while the lower class are become less healthy.
Growing class divergence in healthy eating

Growing class divergence in healthy eating

  • Income inequality (measured by Gini Coefficient, where a coefficient of 0 means perfect income equality) has been steadily growing.
Increasing Gini coefficient indicates rising levels of inequality

Increasing Gini coefficient indicates rising levels of inequality

  • Neglected tropical diseases such as Chagas (normally considered to be a disease of poverty in developing tropical countries) are becoming a problem, concentrating in the poorest parts of the cities. It is thought that poor housing due to low income, environmental destruction, and poor access to healthcare are important factors attributing to the rise of this disease.

When we begin to look at subgroups rather than a nation as a whole it becomes quite clear what crippling effects inequity has. In the USA , health outcomes vary across a range of areas.

  • Strong associations between Race/Ethnicity and health outcomes
    • Native Americans , African Americans , Latinos are more likely to rate their health status as ‘poor’ compared to White Americans and Asians.
    • For women in similar socioeconomic backgrounds , African Americans and Native Americans.
    • Native Americans and African Americans experience higher levels of mortality than Whites or Asians across each age groups.
  • Women of colour are at greater risk of adverse outcomes
    • African American women were around  twice as likely to be diagnosed with hypertension than white women.
    • African American and Latina women experience higher prevalence of diabetes than White women.
    • African American women were more likely to delay or forego medical care compared to White women. This could be for a range of reasons such as cost, lack of insurance, inadequate access to services , or family/work commitments.

In the US, public health benefit schemes are far less comprehensive than ones such as   Australia’s ‘Medicare’. Whereas many developed nations have a universal healthcare scheme, health services are predominantly provided by the private sector. Thus , access to basic healthcare is quite heavily dependent on having private health insurance. Lack of insurance could thus have adverse effects on a person’s health as they are less likely to seek medical treatment for preventable ailments and thus more likely to experience more severe illness.

Income and ethnicity tend to be the greatest determinants of  whether or not an individual is covered by health insurance. For many , the high cost of health insurance prices them out of being able to access health services in all but the most severe circumstances. Very often it is those in the greatest need of medical treatment who are unable to access it.

Ethnic minorities* now make up approximately a third of the US population however they make up around half of those who are uninsured. This is again linked to the fact that many people of ethnic minority groups also fall into those with socioeconomic disadvantage.

Despite the powerhouse of an economy that the US has, its health and healthcare fall short, with a myriad of social, economic, and health inequalities plaguing the country, there is a lot that should be done. It is easy to see what should be done, however the difficulty lies in applying a solution. Most countries reduce income inequalities with high taxation and transfer strategies, however with the rich of the US having so much power over the government, it would be highly unlikely to be able to enforce such policies. It is also likely that poorly made policies would in fact hurt the lower class more should the upper class transfer their losses to the lower class through increasing price of goods to make up for taxes. Nonetheless, something must be done! How do you think US policy makers should act to reduce inequality in the USA?

Leave a comment if you agree or disagree with what has been said, as feedback and debate on the matter are encouraged and appreciated!

From the ‘Mind the Gap’ team

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