It is troubling to many people to see any person suffering in our society. It is even more troubling to see inequality extend to whole ethnic and racial groups within our society. We certainly do not want to be an unjust society, and we certainly want every member of our society to benefit from the technological gains made in the last century.
One of the more troublesome areas that many view as unjust is health and health care. It is unfortunate that some members of our society suffer from disparities in health. For instance, immunizations and vaccines for most of the common deadly pathogens are readily available, yet many people fail to immunize themselves or their family.
Immunization and vaccination programs have eradicated smallpox and polio and have all but eliminated the threat of measles in the United States (U. S. Department of Health and Human Services [DHHS], 2000). With influenza and pneumonia causing 30,000 to 41,000 deaths in the U. S., annually, the importance of vaccinating against these diseases is quite evident. Obviously, lacking immunity to a deadly pathogen is a disparate condition of health status, and Hispanic and African American populations are vaccinated with less frequency than Whites. How are these issues being addressed?
On the international level, the United Nations (2009) is addressing health disparities by attempting to eradicate poverty on a global scale. Unfortunately, many of these global initiatives have created an environment rife with economic turmoil that we are just now starting to see and understand. Though the premise of helping people out of poverty is very noble, the reality seems to be that we can only offer means for people to help themselves. Otherwise, we risk thrusting whole populations into a world they know nothing about, setting them up for failure. Poverty is based on local economy, and I believe that these interrelated problems are best addressed on the local levels with assistance from states, nations, and global endeavors. The people must direct their own path for a successful transition. They must take responsibility for their own successes and failures.
The United States addresses these concerns on a federal level, offering guidance to states and municipalities in ways to address them. One of these methods is a report from the U. S. Department of Health and Human Services. Healthy People 2010 (DHHS, 2000) has two stated major goals: 1) to increase quality and years of healthy life, and 2) to eliminate major health disparities. There are also 467 objectives in 28 focus areas designed to further these two major goals. Immunization is one of these focus areas.
According to the CDC’s National Center for Disease Statistics (2010), the goal of achieving a 90% immunization rate for children 19-35 months of age is close to being reached. The combination diphtheria, tetanus, and pertussis (DTP) vaccine (85%) and pneumococcal conjugate vaccine (75%) are the only two recommended childhood vaccines that are not being administered at least 90% of the time. According to DHHS (2000), the goal for DTP vaccination was 80% in 2000. It appears that this goal has been reached and exceeded.
Conversely, older adults, age 65 and greater, are at an increased risk of contracting illnesses that could be prevented by vaccination. “In 1999 approximately 90 percent of all influenza and pneumonia-related deaths occurred in individuals aged 65 and older” (Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities, 2007, para. 2). DHHS (2000) does not state a quantitative goal for vaccinating noninstitutionalized older adults, though it does mention a need to “increase the proportion of noninstitutionalized adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease” (p. 42). In 2000, 46% of the population in the U. S. were vaccinated against pneumococcal disease, and 64% were vaccinated against influenza (DHHS, 2000). In 2009, pneumococcal disease vaccinations increased by 15%, whereas influenza vaccinations increased by only 3% (Centers for Disease Control and Prevention, National Center for Health Statistics, 2010).
Striving to eliminating health disparities is a noble endeavor; however, the mere fact of attaining this goal contributes to the increase of health care disparity. By increasing the health care delivery model for one at-risk population, we must accept negative gains in the delivery of health care for all other populations. This is an example of the law of conservation describing the divisional nature of finite resources: when an isolated system undergoes change, its change in entropy will be zero or greater than zero (Negi & Anand, 1985). This concept is better stated as it applies to the zero-sum game of our economics today. Kathleen Madigan (2010), in a Wall Street Journal blog post, stated, “More spending in one area has to be financed by less purchases elsewhere” (para. 5).
Two conclusions can be drawn from observing this phenomena in health care. First, if people are spending their health care dollars on other staples, such as food, clothing, and shelter, then we should see a decline in the health of individuals that are making these choices. Second, within health care, in order to increase a focus on one population, an equal negative effect will be seen in all other population groups.
In all aspects of health care delivery, care should be taken to ensure just and equitable delivery of care regardless of socioeconomic factors, race, gender, religion, or creed. All people should have access to the minimum required care in order to maintain a healthy and productive life. We can counsel and educate our patients and clients to best health practices, but we cannot, however, force people to choose health over other facets of their lives.
Centers for Disease Control and Prevention, National Center for Health Statistics. (2010). Immunization. FastStats. Retrieved from http://www.cdc.gov/nchs/fastats/immunize.htm
Centers for Disease Control and Prevention, Office of Minority Health and Health Disparities. (2007). Eliminate disparities in adult & child immunization rates. Retrieved from http://www.cdc.gov/omhd/AMH/factsheets/immunization.htm
Madigan, K. (2010, August 3). With wallets thin, consumers face zero-sum game. Real time economics: Economic insight and analysis from the Wall Street Journal. Retrieved from http://blogs.wsj.com/economics/2010/08/03/with-wallets-thin-consumers-face-zero-sum-game/
Negi, A. S. & Anand, S. C. (1985). The second law of thermodynamics. A textbook of physical chemistry (pp. 241-289). Retrieved from http://books.google.com/
United Nations. (2009). The millenium development goals report: 2009. Retrieved from http://www.un.org/millenniumgoals/pdf/MDG_Report_2009_ENG.pdf
U.S. Department of Health and Human Services. (2000, November). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U. S. Government Printing Office.