Posts Tagged 'equity'

Health Equity in New Orleans

There is an awesome post by Dr. Aaron Fox at the Social Medicine Portal highlighting how the two-tiered medical system in place in New Orleans before Katrina completely failed the poor of New Orleans, particularly those with chronic diseases.

In an early study of Katrina survivors, the impact of this impaired access to care is readily seen. 74% of the surveyed population reported a chronic health condition that preceded the disaster. Of this group, 21% needed to disrupt treatment due to barriers to care.

With more uninsured, and fewer sources of care for those without insurance, there was undoubtedly much avoidable suffering.

He continues his analysis,

The reason for health disparities by socioeconomic status or race in New Orleans is not limited to lack of health insuance, and insurance coverage alone without a strong primary care infrastructure would not have increased access to care, however, the two tiered health system that exists in Louisiana, and all across the United States, one that treats patients differently based on ability to pay, leaves a large percentage of the population at increased risk…

If we are going to build a healthy society in New Orleans, and across America, access to high quality affordable health care needs to be considered a right – not just charity.

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Public health needs the private sector?

In response to the news of the Bill and Melinda Gates Foundations massive investment in the eradication of polio this week, Terry Kosdrosky at the University of Michigan Ross School of Business wrote an interesting piece about the important role that private corporations can have in investing in health as a public good. Kosdrosky quotes Dr. Tachi Yamada, the president of the Bill and Melinda Gates Foundation Global Health Program:

“If we can’t think of this problem in terms of a moral tragedy, we can think of self-interest,” Yamada said. “From a commercial standpoint, the emerging world is the emerging market. Real opportunity for industries, stable industries throughout the world, is in the developing world — south Asia, Africa.”

Kosdrosky goes on:

“From an economic perspective, not solving these problems will deprive businesses of a huge market, now and in the future, as mature markets see slower growth.

…there are limits to what even well-funded government programs can do. For example, Yamada recently visited a clinic in a remote part of Ghana. It was well-staffed, the professionals were well-educated, and it was fully equipped with medicine. The county has a national health insurance plan. But the clinic was only seeing about 150 people a month, or five a day.

A visit to a nearby village showed him why. The people there said very few of them went to the clinic for several reasons. For one, it took a long time to be seen because of red tape associated with the national health insurance program. If you pay cash, you can be seen right away, but the cost is prohibitive. Second, a medicine seller came by the village every so often. People would report their symptoms and he’d sell them medicine at low prices.

It tells you the public sector by itself can’t do it,” Yamada said. “It’s necessary, but not sufficient, to deliver care… The delivery channels for care are there for the private sector in a way they’re not available to the public sector.”

Of course, coming from a business school,  Terry Kosdrosky emphasizes using market forces to drive the creation of efficient health systems. I have no doubt that engaging the private sector and leveraging massive corporate resources will be essential to building true global health equity. But, I think that the fundamental position that patient = customer, or that we are all consumers of health care as a product, is fundamentally flawed. In my mind it conflicts directly with the notion that health is a fundamental human right.

How can we use market forces to drive the efficiency and quality of health systems without erroding our ultimate goal of equity?


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Welcome to the Students for Global Health Equity (SGHE) blog. Published by university students, the SGHE blog seeks to explore news and issues related to global health.

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