7.3 Health Equity for Families
Elizabeth B. Pearce; Audrey Nomvula Moyo; Jessica N. Hampton; Hannah Morelos; and Amy Huskey
Health in the United States is a complex topic. As one of the wealthiest nations, health equity—equal access to health benefits for all people, regardless of identity—could be within reach. The United States, however, fares well in some health comparisons with the rest of the world and badly in others. For example, postoperative complications are less common in the United States than in comparable countries. And, as figure 7.6 shows, mortality rates for several cancers are lower. First, let’s look at how the United States compares overall to other countries.
The overall comparative picture is more grim. The United States spends a great deal more public, private, and out-of-pocket funds per capita on health care but also lags behind almost every industrialized country in terms of providing basic health and health care to all of its citizens (figures 7.7, 7.8, and 7.9) (Tikkanen & Abrams, 2020).
In 2016, 51% of patients in the United States were able to make a same-day appointment with a provider, compared to 57% of patients in similar countries. In other words, you are more likely to have to stay home, miss work or social activities, and be sick longer in the United States compared to someone in other countries, who also spend less on health care than we do in the United States.
Hospital admission rates in the United States are higher than in comparable countries for congestive heart failure, asthma, and complications due to diabetes. However, the United States has lower rates of hospitalization for hypertension than comparably wealthy countries do on average. Why is it that hypertension receives more attention in the United States than other diseases? In total, across these four disease categories, the United States has a 37% higher rate of hospital admissions than the average of other countries.
For example, a person who dies at age 45 would have a “years of life lost” (YLL) value of 25. The United States and comparable countries have made progress in reducing YLLs over the last 25 years (down 23% and 42%, respectively), although the United States continues to trail comparable countries by a significant margin (12,282 versus 7,764 YLLs in 2017).
But these charts do not tell the entire story. The overall averages of health only compare the rates in the United States to the rates in other countries. Within the United States, groups are affected disproportionately in terms of access to health and health outcomes. These disparities are described next.
Social Determinants of Health and Disparities
Family and individual health is affected by the environments in which people live, work, learn, and play, the non-medical factors that affect health outcomes, or social determinants of health (World Health Organization). Social engagement and access to resources, safety, and security are all impacted by the settings where families spen