Presentation is loading. Please wait.

Presentation is loading. Please wait.

Social Injustice and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein.

Similar presentations


Presentation on theme: "Social Injustice and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein."— Presentation transcript:

1 Social Injustice and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein College of Medicine Adjunct Professor of Public Health Weill Medical College of Cornell University University of Kansas Medical Center Kansas City -- October 19, 2009

2

3 Injustice anywhere is a threat to justice everywhere. The Reverend Dr. Martin Luther King, Jr. Letter from Birmingham Jail April 16, 1963

4 Social Injustice Definition #1 The denial or violation of rights of specific populations or groups in society, based on perception of their inferiority by those with more power or influence.

5 Populations or Groups That Suffer Social Injustice May be defined by: Race Socioeconomic position (class) Age Gender Sexual orientation Other perceived characteristics

6 Social Injustice Definition #2 Based on the Institute of Medicine’s definition of public health: “What we, as a society, do collectively to ensure the conditions in which people can be healthy.”

7 Health and Medical Care Rights  “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing and medical care and necessary social services” [Article 25, Part 1 of the Universal Declaration of Human Rights, 1948]  “The attainment of the highest possible level of health is a fundamental human right.” [Preamble to the WHO Constitution, 1946]

8 Role of Medical Care in the Promotion and Protection of Health  The right to health requires assurance of the conditions necessary for health, including adequate levels of housing, nutrition, education, income, public health services and medical care.  The right to medical care requires a medical care system that equitably provides adequate medical care to all who seek it.

9 Role of Medical Care in the Promotion and Protection of Health  Medical care provides diagnosis and treatment of people who are ill and reassurance of people who are concerned they may be ill.  Preventive medicine, a part of medical care, is important in prevention of illness among patients and their families.

10 Addressing Social Injustice in Medical Care Assurance of access to high-quality medical care Support for the equitable organization and financing of medical care Alleviation of related forms of social injustice

11 High-Quality Community Medicine Emphasis on prevention Provision of primary care Cultural sensitivity Effective communication Respect for patient autonomy

12 Barriers to Access to Medical Care Insurance status Immigration status -- Lack of needed documentation -- Fear of detection of status Access to facilities -- Distance or lack of transportation -- Conflicting obligations

13

14 Effects of Un- or Under-insurance People who are uninsured or underinsured: use fewer preventive and screening services; are sicker when diagnosed; receive fewer therapeutic services; have poorer health outcomes; and have lower earnings. SOURCE: Hadley, Jack. “Sicker and Poorer – The Consequences of Being Uninsured: A Review of the Research on the Relationship between Health Insurance, Medical Care Use, Health, Work, and Income,” Medical Care Research and Review (60:2), June 2003.

15 Number of Uninsured Children and Adults, Note: Sums may not equal totals due to rounding. SOURCE: KCMU and Urban Institute estimates based on March Current Population Surveys, M 40.9 M 43.3 M 44.7 M In millions 45.5 M

16 Barriers to Health Care by Insurance Status, 2003 Notes: *Experienced by the respondent or a member of their family. Insured includes those covered by public or private health insurance. SOURCE: Kaiser 2003 Health Insurance Survey. Percent experiencing in past 12 months:*

17 Nonelderly Uninsured by Race, 2004 Risk of Being Uninsured National Average 18% Asian group includes Pacific Islanders; American Indian group includes Aleutian Eskimos. SOURCE: KCMU and Urban Institute analysis of the March 2005 Current Population Survey.

18 Health Insurance Coverage by Poverty Level, 2004 Employer/ Other Private Medicaid/ Other Public Uninsured Notes: The federal poverty level was $19,307 for a family of four in SOURCE: KCMU and Urban Institute analysis of the March 2005 Current Population Survey.

19 Inadequate Quality of Medical Care Lack of language and cultural skills Lack of good clinical practice Barriers to specialty referrals Lack of preventive medicine

20 Disparities in treatment of cardiovascular disease Cooperative Cardiovascular Project: observational study of 169,079 Medicare beneficiaries hospitalized for acute MI Medical therapies underused in the treatment of black, female and poor patients with acute MI Rathore SS. Berger AK. Weinfurt KP. Feinleib M. Oetgen WJ. Gersh BJ. Schulman KA. Race, sex, poverty and the medical treatment of acute MI in the elderly. Circulation. 2000: 102;

21 Disparities in treatment of cancer Members of minority populations tend to have lower rates of cancer screening and present later in the course of illness Members of minority populations often receive less effective treatment for cancer Members of minority populations often receive less effective care for symptoms, such as pain control

22 Disparities in treatment of people with HIV/AIDS Prevention efforts often culturally incompetent Needle exchange not instituted HIV infection often diagnosed late Drug treatment options often inadequate Members of minority groups rarely included in clinical trials of experimental drugs

23 Addressing Social Injustice in Medical Care Assurance of access to high-quality medical care Support for the equitable organization and financing of medical care Alleviation of related forms of social injustice

24 Percent of Population with Government-Assured Insurance Note: Germany does not require coverage for high-income persons, but virtually all buy coverage Source: OECD, Data are for 2000 or most recent year available 92% 100% 45% 0% 20% 40% 60% 80% 100% U.S.GermanyFranceCanadaAustraliaJapanU.K.

25

26

27

28 Addressing Social Injustice in Medical Care Assurance of access to high-quality medical care Support for the equitable organization and financing of medical care Alleviation of related forms of social injustice

29 Medicine cannot deal with the many factors that cause ill-health

30

31

32

33

34

35 Pharmacies in Minority Neighborhoods Fail to Stock Opioids Source: N Engl J Med 2000; 242:1023    0% 25% 50% 75% 100% <21%21-60%>60% % Minority Residents in Neighborhood % of Pharmacies with »Adequate Opioid Supply

36

37 Incarceration Rates, 2000

38

39 A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death. The Reverend Dr. Martin Luther King, Jr. Beyond Vietnam: A Time to Break Silence Riverside Church, NYC April 4, 1967

40

41 Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed. President Dwight D. Eisenhower American Society of Newspaper Editors April 16, 1953

42

43 World Military Expenditures  After a period of declining military expenditures after the end of the cold war worldwide spending grew to $1.5 trillion in 2008, a 45% increase from  The United States spent $711 billion in 2008, 48% of world spending, distantly followed by the United Kingdom, China, France, Japan, Germany and Russia.

44

45 Military Spending in 2008 CountryDollars (billions)% of totalRank United States China Russia United Kingdom France Japan Germany Source: U.S. Military Spending vs. the World, Center for Arms Control and Non-Proliferation, February 22, 2008

46 Wars in Iraq and Afghanistan  In FY 2010 cost of military operations in Iraq & Afghanistan will be $130 billion  By March 2010, total spending in Iraq & Afghanistan will hit $1 trillion  Monthly cost during 2009 averaged 5 billion, up from 3.5 billion in 2008  The $800 billion spent on the Iraq war alone exceeds the $700 billion spent in Vietnam

47 Trade-Offs  Employment  Education  Housing  Public Health  Medical Care

48

49 Job Creation The 915 billion spent in the wars in Iraq and Afghanistan could have provided:  Salaries for 4 million public safety officers for 5 years  Salaries for 3 million elementary school teachers for 5 years  Construction of 7 million affordable housing units National Priorities Project

50 Overall Employment Effects of Spending $1 billion for Alternative Spending Targets in U.S. Economy, 2005 Spending Targets# of Jobs Created # of Jobs Relative to Military Spending Average Wages and Benefits per Worker 1. Military11,977---$65, Tax cuts for personal consumption 15, %$46, Health care18, %$56, Education24, %$74, Mass transit27, %$44, Construction for home weatherization/ infrastructure 17, %$51,812

51 Medical Care  Nearly 45,000 annual deaths are associated with lack of health insurance  Uninsured have higher death rates form hypertension, and heart disease  62 percent of bankruptcies in 2007 were caused by a medical condition American Journal of Public Health September 17, 2009

52 Trade-Offs With the more than $2.5 billion spent by Missouri taxpayers and more than $1.3 billion spent by Kansas taxpayers on the war in Afghanistan, medical care insurance could have been provided for almost a million Missourians and 400,000 Kansans. National Priorities Project

53

54

55 Doc: Kansas City-SocInj Final


Download ppt "Social Injustice and Public Health Victor W. Sidel, MD Distinguished University Professor of Social Medicine Montefiore Medical Center and Albert Einstein."

Similar presentations


Ads by Google