Healthcare in Underserved Populations

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Healthcare in Underserved Populations

• Elizabeth Bates
• Tinsley Harrison Society
• January 10, 2006

2
Relevance

• 42 of sub-Saharan Africa has access to drinking
  water
• 50 of the worlds population has access to
  adequate sanitation facilities
• Hunger-related causes kill as many people in 2
  days as the atomic bomb killed at Hiroshima

3
Relevance

• 20-25 of children live in poverty
• 4 million Americans fight hunger on a daily basis
• 6 of adult mortality is attributed to
• poverty

4
Attempts at Explanation

• Lifestyle factors often cited as the major
  determinants of premature morbidity and mortality
• When health risk behaviors were considered, the
  risk of dying was still significantly elevated
  for the lowest-income group (95 CI, 1.74-4.42)
  and the middle-income group (95CI, 1.38-3.25).

5
Lantz PM et al. JAMA 1998 279 1703-8
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Other Explanations

• Occupational and environmental health hazards
• Decreased healthcare
• Socioeconomic stratification

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Other Explanations

• Occupational and environmental health hazards
• Blood lead levels higher in inner
• city children
• (27 vs. 2)
• Superfund sites

Friedrich MJ. JAMA 2000 283 3057-8
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Other Explanations

• Decreased healthcare
• Shortage of physicians
• Overcrowding
• Lifestyle factors
• Healthcare for children

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Other Explanations

• Socioeconomic stratification
• Insecurity
• Lack of social trust
• Paucity of associational life

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Income Inequality and Social Trust
Kawachi I et al. American Journal of Public
Health 1997 87 1491-8
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Social Trust and Mortality
Kawachi I et al. American Journal of Public
Health 1997 87 1491-8
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Worsening Situation

• The income gap is widening.
• GM is now larger than Denmark, Thailand, Hong
  Kong, and Turkey.
• Wal-Mart is larger than Israel and Greece.
• ATT is larger than Malaysia and Ireland.
• The combined revenues of GM and Ford exceed the
  combined GDP of all sub-Saharan Africa.
• Intrauterine transmission of poverty

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Solutions

• Robin Hood Index
• 1 rise associated with an excess mortality of
  21.7 deaths per 100,000

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Solutions

• Millennium Declaration
• to make the right to development a reality for
  everyone and to free to entire human race from
  want
• Role of physicians

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Acknowledgements

• Gil Kracke
• Elizabeth H. Wood
• Morgan C. Leverett
• Dr. Max Michael

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Resources

• Chronic Poverty Report 2004-05. Chronic Poverty
  Research Centre.
• Donohoe M. Causes and health consequences of
  environmental degradation and social injustice.
  Social Science Medicine 2003 56 573-87.
• Faulkner LR, McCurdy RL. Teaching medical
  students social responsibility the right thing
  to do. Academic Medicine 2000 75 (4) 346-50.
• Friedrich MJ. Medically underserved children need
  more than insurance card. JAMA 2000 283 3056-7.
• Friedrich MJ. Poor children subject to
  environmental injustice. JAMA 2000 283
  3057-8.
• Greenough PG, Kirsch TD. Public health response
  assessing needs. NEJM 2005 353 1544-6.
• Kaplan GA et al. Inequality in income and
  mortality in the United States analysis of
  mortality and potential pathways. British Medical
  Journal 1996 312 999-1004.
• Kawachi I et al. Social capital, income
  inequality, and mortality. American Journal of
  Public Health 1997 87 1491-8.
• Kawachi I, Kennedy BP. Health and social
  cohesion why care about income inequality?
  British Medical Journal 1997 314 1037-41.

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Resources

• Kennedy BP et al. Income distribution and
  mortality cross sectional ecological study of
  the Robin Hood index in the United States.
  British Medical Journal 1996 312 1004-7.
• Lantz PM et al. Socioeconomic factors, health
  behaviors, and mortality results from a
  nationally representative prospective study of US
  adults. JAMA 1998 279 1703-8.
• McCally M, Cassel CK. Medical responsibility and
  global environmental change. Annals of Internal
  Medicine 1990 113 467-73.
• McCally M, Cassel CK. Medical responsibility and
  global environmental change. Annals of Internal
  Medicine 1990 113 467-73.
• Pappas, G et al. The increasing disparity in
  mortality between socioeconomic groups in the
  United States, 1960 and 1986. NEJM 1993 329
  103-9.
• Poverty Kills in More Ways Than You Think.
  Facts of Life Issue Briefings for Health
  Reporters. Volume 3, No. 1. January 1998.
• Wynd S, Durrheim DN. Health-care provision and
  the path out of poverty. Lancet 2004 364 562-4.

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