Ius Gentium

University of Baltimore School of Law's Center for International and Comparative Law Fellows discuss international and comparative legal issues


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Does Universal Healthcare Fix Racial Disparity in Healthcare? Investigating France

Jasen Lau

Racial disparity still infects the US healthcare system.[1] To counter this disparity, many suggest that an universal healthcare will solve the issue, and to a certain extent, that may be true. If the true issue in the disparity is merely access to physicians, universal coverage will solve the racial disparity. However, disparity is not solely reliant upon access to medical coverage. For if the only issue in racial disparity in healthcare is merely access, then, logically, all nations with universal healthcare should have no racial disparity. Turning to France, touted as having the best healthcare system in the world,[2] studies show that racial disparity still exists in France despite having the best universal healthcare.

Assuming racial disparity in healthcare is purely about access to medical coverage, analyzing France is the first step to finding out if improving access would solve racial disparities in the US. Even now, there are French health institutes that do not have properly implemented protocols to handle what the article calls “migrants.” One primary concern is how to properly administer health when the patient, being foreign and “migrant,” does not speak French. A natural thought process would be to have an interpreter available, but the article indirectly suggests that there is no policy to implement such a service.[3] Granted, the patient may bring their own interpreter, but of course, this assumes the patient has one on hand and ready or can even afford one. Curious, too, is that certain French health institutes are attempting to find a balance between accommodating for cultural differences while making an extra effort to ensure the facility is not associated with any one particular religion or culture.[4] As an example, if a French hospitals treats Islamic patients, that institute must respect certain dietary or religious preferences out of respect for the patient. In that situation, the hospital must be Islamic friendly without being associated with the particular Islamic race. This, too, leads to certain issues.

black-white-hands-shaking-race-racism-friends-700x506

Allegedly, patients discriminating against hospital staff is an ever rising issue.[5] Patients refuse to be treated by certain providers based either the race, gender, or even sexual orientation. This, of course, inhibits the healthcare system if certain providers must be found in order to accommodate a racist, patient request. This extends to other services by the hospital, too: food, routine examinations by technicians, pharmaceutical intervention, and so forth. Quite in fact, one determining factor of those who are most at risk for healthcare disparity is the religious region from where the patient hails.[6] There is clearly racial disparity in France. While access to healthcare may be solved in France, access, in of itself, is not the sole source nor even the primary source of racial disparity in healthcare.

Understanding healthcare requires a broader sense of the word. A truer definition of current healthcare involves socioeconomic factors: poverty, living conditions, and education. In France, there is no study which directly correlates poverty to minorities. However, there is no doubt that migrants and foreigners, who have been historically disadvantaged, are most likely subjected to poverty, unsanitary living conditions, and a lesser likelihood of employment.[7] This historic and systemic disadvantage has left the foreigners and immigrants to a poor self-image, having a lower opinion of their own health despite having adjusted for all socio-economic factors.[8] This leads to further doctor visits of whom, as stated above, will have continued problems treating those patients, and the cycle repeats itself. Similar analysis must be taken into account in the US.

A brief study of the early 20th century reveals that the greatest innovation of healthcare did not involve the practice of medicine. Despite the discovery of penicillin in 1928,[9] above the creation of the polio vaccine in 1952,[10] and more impactful than gene therapy in 1985,[11] clean water and plentiful food have had more impact to general health than any form of medical treatment to date. With the advent of plentiful food and clean water, diseases have decreased in occurrence[12] and have much later dates of onset.[13] Yet, the pervasive fact remains that racial disparity exists, leaving the last key factor in question: socioeconomic factors. There is no contest that the most poor, most uneducated, more residentially unstable are minorities.[14] Perhaps access is not the biggest issue of healthcare today.

racisme

Perhaps, then, racial disparity in healthcare is an issue far beyond just access to the clinic or the pharmacy. Perhaps racial disparity is much more systemic and beyond merely the Department of Health and Mental Hygiene. Perhaps, just perhaps, an unfair system – disfavoring minorities – is a root cause of racial disparity in everything and not just healthcare.

Jasen Lau is a third year law student at the University of Baltimore School of Law. He graduated from the University of Maryland in 2013 with a Bachelor of Arts in English. Jasen took it upon himself to become a certified pharmacy technician and studied several continuing education credits that focus on Medicare Fraud and Abuse prevention, HIPAA privacy and security laws, and ethics in the pharmacy workplace. Jasen has long been in the health care field either working directly with patients or as an assistant to providers. During that time, his obsession with working in health care has grown into policy analysis and counseling. Along with being a CICL fellow, he is also a law clerk for Johns Hopkins Hospital.

[1] http://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr14/2014nhqdr.pdf ; see also http://www.cdc.gov/mmwr/pdf/other/su6203.pdf

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447687/#r5

[3] https://www.ifri.org/fr/publications/editoriaux/diversite-lhopital-identites-sociales-discriminations

[4] Id.

[5] http://faceaface.revues.org/344

[6]http://www.sherpa-recherche.com/wp-content/uploads/2015/01/FS-Racisme-et-discriminations-contexte-SSS.pdf

[7] https://remi.revues.org/5611

[8] Id.

[9] http://www.ars.usda.gov/Research/docs.htm?docid=12764

[10] http://www.cdc.gov/vaccines/vpd-vac/polio/default.htm

[11] https://history.nih.gov/exhibits/genetics/sect4.htm

[12] David M. Cutler & Grant Miller, The Role of Public Health Improvements in Health Advances: The Twentieth-Century United States, 42 Demography 1, 6 (2005); the amount of diseases both water-borne or otherwise significantly decreased as the 20th century progressed with the implementation of water treatment

[13] Robert W. Fogel, Secular Trends in Physiological Capital: implications for equity in healthcare, 46 Perspectives in Biology and Med. S24, S33 (2003); many diseases were much less prominent in younger people. For example, arthritis started occurring in those above 60 years of age instead of mid-50’s

[14] Robert J. Sampson, The Neighborhood Context of Well-Being, 46 Perspectives in Biology and Med. S53, S54 (2003).

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