Ansell believes that several things need to occur to advance equity in the fields of health care. First, research and data must be collected. Second, policy changes must be developed in concert with community-based organizations. Leaders from affected communities must not only be at the table but should be respected as leaders in the development of viable health care policy alternatives. Third, strategic steps to remedy the lack of access to quality health care must be taken to ensure that meaningful goals are achieved.
Fourth, resources must be allocated to low-income communities to address the root causes of health care inequity. This means supporting community leadership, and funding educational and economic opportunities which lead to greater human flourishing, especially for the most vulnerable and needy among us. The implications for the global world are obvious. The same health care inequities that plague US cites also plague the cities of the developing world. By some measures, the inner cities of Chicago look a lot like Haiti or Bangladesh.
In a society that champions individual liberty, issues of the common good are often cynically rejected. However, if anything, the current health care pandemic has taught us that the public good must transcend private interests, even as those interests are also threatened. If health care is a human right, it cannot be guaranteed by the private market. It must be assessed and funded by public institutions who are invested in the public good.
A few systems have recognized that they will have to tackle the structural and social determinants of health.
But there are signs of hope. Local communities can make a difference too. They can develop their social capital, their internal and external networks, and their social ties. Furthermore, hospital institutions have a role as well, but they must rethink their mission and purpose in the communities that they serve. Hospitals and health systems can use their heft as employers and as purchasers to bring jobs and other resources to the high-mortality, high-poverty neighborhoods in their environs.
Other institutions in civil society have a role to play as well. David Ansell's passionately written The Death Gap presents a powerful case for social inequality as a cause of disease and disparities in health.
The social epidemiologist, physician and public-hospital veteran invokes the concept of 'death gaps' to describe differences in life expectancy by race, ethnicity, class and geography. Ansell uses an approach that is gaining traction in health and medicine, casting health disparities in the United States as arising from the commodification and politicization of health care. He sees the country's health system as another form of structural violence — harm resulting from unjust social systems, such as poor-quality housing and emergency infrastructures.
This architecture, anchored by racism, classism and placeism discrimination on the basis of neighbourhood , fosters ill health in the most marginalized and vulnerable groups, such as poor black people in urban areas and rural working-class white people.
For the most unfortunate, such assaults on health status shave away decades of life. As Ansell shows, there is as much as a year difference in life expectancy between the healthiest and richest US neighbourhoods and the most ill and deprived.
The Death Gap lays out general concepts that inform the complex web of structural violence through case studies and synthetic analyses. Ansell invites us into the heart-wrenching story of one of his long-term patients, whose deprived circumstances led to a disability-inducing stroke — a condition rigged, he argues, by the power and dynamics of public policies that cultivate social inequality.
Citing the case of a survivor of Haiti's catastrophic earthquake, he questions the medical practice of recording cause of death according to the illnesses that precipitate decline, rather than the long-term social conditions that place people at risk of risk. And he looks at 'property politics' in relation to race, seeing it as a key mechanism that perpetuates social, political and economic inequality.
The same exploitative processes, he argues, affect disadvantaged black people in inner cities, rural white people and reservation-bound indigenous Americans. Ansell lays the blame for inequality-related damage to health on ideologies that absolve the wealthy of responsibility and motivation for advocating for an equitable society. He also points the finger at how the US health system and some areas of medical research ignore the interplay between life circumstances and health.
Income inequality and neighbourhood stressors — such as ambient noise, proximity to highways, exposure to violence and low social cohesion — have an impact, he shows, on biological processes that accelerate ageing and break down the body's ability to fight disease. As the basis for these inferences, Ansell cites the growing body of research that links stress to the length of telomeres — caps on chromosomes whose degeneration is associated with shortened lifespan and age-related illnesses.
He also examines how stringent policing policies such as 'stop and frisk', which arose in the post-civil-rights era to control newly empowered black people, adversely affect mental health and family ties that protect well-being. Racism -- Health aspects -- United States. Social medicine -- United States. Local subjects: black. But when detailing the many things that the poor have not, we often overlook the most critical-their health.
The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. This website is available with pay and free online books. Then download it.
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