“Social injustice is killing people on a grand scale.”
(WHO, 2008, p 4)
The graphic above, from the United Nations Department of Economic and Social Affairs, should be both sad and startling. It is shocking that in our modern era the average life expectancy can vary from the 40’s to well into the 80’s. And while global social policy is not the topic of this discussion, the graphic highlights the significant health inequity that exists worldwide. And that perhaps development of sound health policy cannot exist in isolation from good social policy.
Consider the United States. The Centers for Disease Control publish morbidity- adjusted, or healthy life expectancy, statistics for each state. This is an estimate of healthy years left for an individual aged 65. It is interesting to note that a 65 year old resident of Utah may expect greater than 15 more healthy years, while a 65 year old resident of Nevada may expect less than 13 (CDC, 2013).
There is a significant movement to eliminate these tremendous health disparities within the public sector.
I would like to highlight a few of them, particularly the work being done to decrease health disparities for the aging community.
The Commission on Social Determinants of Health (The Commission) was established in 2005 by the World Health Organization (WHO). This Commission calls for governments worldwide to eradicate health inequities within one generation. This appeal is made to all countries, regardless of economic status or developmental position. It is a collaboration of policy on a global level. The Commission calls for societies to address health inequalities through social, economic and health care policy. The executive summary of the Commission highlights three recommendations and action steps. The first of these is to improve daily living conditions. This includes promoting health throughout the lifespan, including the process of aging (WHO, 2008). The Commission asserts that governments should make health a top priority. This may be accomplished by assuring that policies across all disciplines (economic, education, transportation, trade etc.) complement, rather than contradict, the development of health care policy.
The National Institute on Aging (NIA) has created a strategic plan to eliminate health inequality among the elderly. The NIA is specifically addressing disparity among racial and ethnic minority populations. Current population trends anticipate that the number of Hispanic Americans over the age of 65 will increase eleven-fold by the year 2050 (NIA, n.d). This poses unique opportunities for the government to direct its efforts toward specific populations. The NIA contends that to eliminate health disparities among populations research must include not only the physiologic components of aging but the economic, social, genetic and environmental processes.
These health care inequalities persist through the availability of palliative care services. Research has demonstrated persistent barriers to access and utilization of palliative care services among minority groups (Smith & Brawley, 2014). The research further indicates that African Americans are more likely to exhaust their financial resources in end of life care than their Caucasian counterparts (Martin et al, 2011). Advocates of palliative services suggest a multilevel intervention to improve inequalities through policy development. This includes well-funded research, education for providers, an increase in public awareness and improved care delivery models (Smith & Brawley, 2014). A bill has been introduced in Congress to support this multidimensional approach to end of life care. H.R. 1666 was introduced in the House of Representatives in 2013. A similar bill was introduced in the Senate in 2014. It directs leaders of the Centers for Disease Control, the Department of Health and Human Services and the Administrator for the Health Resources and Service Administration to address palliative service needs through funding, education and strategic research collaboration (Congress.gov) Although this bill died in committee it represents great promise in the public approach to palliative care.
We can see that on a grand scale there are initiatives to eliminate health care inequality for the aged. The WHO and the NIA provide a framework for successful policy change. Congressional leaders are building policy initiatives. Next week we will discuss how federal and state reforms are affecting the aging population, addressing health care disparities and influencing the delivery of palliative care.
Centers for Disease Control. (2013). State specific healthy life expectancy at age 65 years. Retrieved from http://www.cdc.gov/about/cdcdirector/life-expectancy.html
Congress.gov. (n.d.) H.R. 1666- Patient centered quality care for life act. Retrieved from https://www.congress.gov/bill/113th-congress/house-bill/1666
Martin, M.Y., Pisu, M., Oster, R. A., Urmie, J. M., Schrag, D., Huskamp, H.A… Fouad, M.N. (2011). Racial variation in willingness to trade financial resources for life-prolonging cancer treatment. Cancer, 117(15), 3476-3484.
National Institute on Aging (n.d.). Health disparities strategic plan: Fiscal years 2009-2013. Retrieved from http://www.nia.nih.gov/about/health-disparities-strategic-plan-fiscal-years-2009-2013/missionvision-statement
Smith, C. and Brawley, O. (2014).Disparities in access to palliative care. Health Affairs Blog. Retrieved from http://healthaffairs.org/blog/2014/07/30/disparities-in-access-to-palliative-care/
United Nations Department of Economic and Social Affairs (UN DESA). (2011). World population prospects: The 2010 Revision.
World Health Organization (WHO). (2008). Closing the gap in a generation. Commission on Social Determinants of Health, Final Report. Retrieved from http://www.who.int/social_determinants/thecommission/finalreport/en/