Academic journal article Journal of Community Positive Practices

The Usefulness of Health Disparity: Stumbling Blocks in the Path to Social Equity

Academic journal article Journal of Community Positive Practices

The Usefulness of Health Disparity: Stumbling Blocks in the Path to Social Equity

Article excerpt

Abstract: Health disparities in the United States have declined little over the past century despite far-reaching technological advances and, especially since the 1980s, heightened consciousness of the problem. Their persistence can be explained in large part by their usefulness to those who hold and seek to consolidate power. Among other things, health disparities help in bolstering master-subservient relationships; shoring up the ideology of rugged individualism; maintaining bureaucratic structures and jobs; providing plausible public enemies; monitoring upstream social ills; and sustaining a flow of research funding. Conditions likely necessary for ameliorating health disparities include open and mutual recognition of several often veiled realities concerning power relations: money equals power; power translates into access to resources; those who hold power are reluctant to part with it; those who lack power serve as convenient scapegoats; and institutions evolve so as to ensure their own survival.

Health disparity will remain exceedingly difficult to eradicate so long as health inequities continue to perform useful functions in ways that seem cost effective for groups and individuals seeking to secure their power. A readiness to work around stumbling blocks in the path to equity-arrived at via frank and equitable discourse among community members and leaders in pursuit of vital community goals-will likely hinge upon heightened awareness not only of the cumulative economic burden imposed by health inequality but also of the extent to which even the most powerful are intrinsically dependent upon other members of the community.

Keywords: health disparities; healthcare reform; minority health; politics; power relations.

1. Introduction

Health disparities between more- and less-privileged groups in the United States have declined little over the past century, despite remarkable strides in overall health-related knowledge and technology and, especially since the 1980s, heightened consciousness of the problem on the part of researchers and policymakers alike (Jones, 1998, 2009; King, Hurd, Hajek, and Jones, 2009). Observations by W. E. B. DuBois (1899, p. 148) regarding racial disparity in Philadelphia at the end of the nineteenth century still ring true today:

". . . [A] much higher death rate at present among Negroes than among whites: this is one measure of the difference in their social advancement. . . . Broadly speaking, the Negroes as a class dwell in the most unhealthful parts of the city and in the worst houses in those parts; . . . the part of the population having a large degree of poverty, ignorance and general social degradation is usually to be found in the worst portions of our great cities."

Granted, every society has some form of stratification that ranks individuals on the basis of characteristics deemed important, and this inevitably results in inequality of some sort. Yet, while inequality per se is unavoidable, some forms of inequality have their roots in present or past injustices and thus can rightly be described as inequities-or, if the differences are between groups, as disparities. For instance, disparities in health can be defined as those differences in outcome that result not entirely from biological differences nor from informed and unconstrained individual choices, but rather from factors over which the individual has little or no control but which systematically reflect the choices, preferences, values, and biases of powerful others, present or past (Hebert, Sisk, and Howell, 2008). In short, health inequity (from the World Health Organization standpoint) implies "differences which are not only unnecessary and avoidable but, in addition, are considered unfair and unjust" (Whitehead, 1990, p. 5).

In today's climate of fiscal austerity, health disparities figure prominently (whether openly or covertly) in U.S. political discourse surrounding healthcare spending and entitlements. …

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