Fighting Systemic Inequities in Healthcare

Systemic inequalities are pervasive across the United States. Data from the US treasury shows that Black and Hispanic Americans have an average household GDP of under $200,000, while White Americans have a household income of just under $1,000,000.

These economic disparities are largely due to a lack of access to quality education and meaningful career opportunities. The US Treasury explains that while “40 percent of white adults had earned a bachelor’s degree,” just “26, 19, and 17 percent of Black, Hispanic, and American Indian or Alaska Native adults, respectively.”

Similar disparities exist in access to healthcare, too. This is a serious issue, as Black and Hispanic Americans are more likely to experience “child abuse, lead exposure, and obesity in childhood,” according to the same government agency. As adults, those same Americans have reduced access to quality care nationwide.

Guest post by Katie Brenneman

Rural vs Urban Inequity

Folks who live in rural areas typically live further from quality care than their urban peers. While this may seem innocuous at first, it has a significant impact on the health and well-being of those who live out in the country. This sentiment is echoed by recent research, which shows that rural people are typically sicker than those who live in towns or cities. Similarly, data shows that rural patients exhibit a higher risk of health factors like smoking and being overweight.

Unfortunately, millions of rural Americans live in healthcare deserts. Healthcare deserts, which are loosely defined as large areas of land without any access to healthcare, present a serious threat to the health and well-being of people across the United States. Folks who live in underserved “deserts” have to drive many miles to see their nearest provider, and may experience waits when they do arrive for care.

The lack of access to healthcare in rural areas creates a cyclical issue wherein folks cannot receive quality care easily and, therefore, do not try to receive care. This undermines the health of the rural population, who would likely benefit from early intervention when facing cancer or heart disease.

Systemic Racism and Disease

Living in a rural area is not the only determinant of the quality of care you are likely to receive. In the US, Black and Hispanic Americans are less likely to receive access to quality healthcare due to systemic racism. This is a pervasive across-the-nation issue as, according to the CDC, the life expectancy of Black Americans is four years lower than White Americans.

Perhaps more shockingly, Black Americans are also more likely to die from diseases like cancer than their White counterparts. This is largely due to socioeconomic inequity and poor access to care. Black Americans — who, on average, have roughly a quarter of the wealth of White Americans — may face affordability issues when seeking treatment options and may be less able to take time off work.

The healthcare industry also has a history of abusing BIPOC communities. According to research published in Health Expect “systems of oppression and historical maltreatment,” have led to a “culture of mistrust in scientific institutions that contributes to hesitancy toward participating in healthcare research.” This forms a barrier to access to healthcare, as communities who have previously suffered due to unethical acts in the name of healthcare are unlikely to engage with healthcare messaging.

However, those researchers also found that mistrust can be overcome with credible information in the community. This can be done by engaging BIPOC communities and ensuring that folks from all backgrounds are adequately represented in healthcare settings. Researchers also suggest changes, including:

Patients should be treated with greater respect;
Increased compensation for those who engage with trials and messaging programs;
Improved consent documents for folks undergoing treatment;
Offering remote participation opportunities when appropriate.

These changes will begin to regain the community’s trust and bring more BIPOC stakeholders into healthcare settings. Over time, this can fight systemic inequities and reduce the risk of populations becoming disenfranchised.

Fighting Systemic Inequity

Addressing the root causes of systematic inequality is key if we are to resolve healthcare disparities and rebuild trust in traditionally marginalized communities. However, fighting against systemic inequities issues represents a monumental challenge, as healthcare professionals like nurses will need to understand and overcome the social determinants of health, which include:

Social issues and the context of the community;
Access to education to improve healthcare literacy;
Environmental factors that increase the risk of illnesses and disease;
Healthcare access and coverage;
Economic stability, including labour protection and food access;

These are broad issues that impact the overall health and well-being of the population. While healthcare providers cannot directly tackle poverty rates or social issues like violence, they can make efforts to alleviate inequity and provide excellent care to those in need. Recognizing this responsibility is particularly important for recently qualified registered nurses, who can serve traditionally marginalized communities while working in a desirable location and earning a great salary.

Recent graduates passionate about championing social causes can consider taking on roles in areas of cities that are typically underserved. For example, nurses who have recently completed their academic training can consider working in high-paying, in-demand cities for nurses like:

San Jose, CA.
- Annual mean wage: $146,870
- Hourly mean wage: $70.61
- Location Quotient (LQ): 0.72
Washington D.C.
- Hourly mean wage: $40.14
- Annual mean wage: $83,490
- LQ: 0.67
Phoenix, AZ
- Hourly mean wage: $39.13
- Annual mean wage: $81,390
- LQ: 0.96

These cities have an enticing blend of high salaries, and good LQ, and are in need of registered nurses. This makes them the perfect choice for recent graduates who want to serve a social cause while making a great living in a fun, safe city. Taking up a position in an in-demand city is particularly important today, as the pandemic saw an exodus of nurses from the healthcare industry and left many hospitals without adequate staffing.

However, resolving systemic inequities means that we also need to address the urban-rural divide. This is crucial, as millions of rural Americans live without the access to quality healthcare that they deserve. Healthcare professionals who are interested in serving rural communities should consider pursuing residencies in traditionally underserved healthcare deserts. This gives professionals hands-on experience with the challenges that folks who live in the countryside face.

Alternatively, folks who are interested in a career switch can consider partnering with groups like the Association of American Medical Colleges (AAMC), which have specialized approaches to serving rural communities across the country. Working with groups like the AAMC gives healthcare professionals the chance to:

Partner with pre-existing healthcare hospitals;
Run mobile clinics;
Support students interested in entering healthcare.

Funding groups like the AAMC should be a priority for decision-makers looking to fight systemic inequities. The AAMC also advocates for healthcare workers and is working hard to ensure that the predicted shortfall of physicians will not disproportionately impact rural residents.

Additionally, folks who live in rural areas can champion calls to address barriers to access. This approach has worked well in Alabama for folks living with a disability. Disability advocates in the state have successfully campaigned for improved accessibility and have used pre-existing legislation to make their case.

Fighting systematic inequality in healthcare can feel like a monumental challenge. Ultimately, widespread social upheaval is necessary to rally against pervasive issues like poverty, healthcare deserts, and other determinants of health. However, that does not mean that recent graduates and RNs should overlook their responsibility to communities that require additional support.

RNs who are looking to make a difference can consider retraining to better serve folks from marginalized rural backgrounds. This will alleviate the barriers to healthcare access and ensure that folks from across the nation can receive care from informed, well-qualified healthcare professionals. While this will not solve underlying issues, it may break the cycle of poor access to healthcare and poverty in the USA.