Author Archives: Monica Kao

About Monica Kao

My name is Monica and I am currently a junior at Saint Louis University studying Public Health.

Health disparities affecting the LGB community

By: Monica Kao

The existence of health disparities in certain vulnerable populations–as identified by race/ethnicity, age, gender, disability status, geography, and socioeconomic status, among others–is well-documented in the United States; however, the health inequities affecting those who identify as being gay, lesbian, or bisexual are often overlooked.  A research study conducted by the UCLA Center for Health Policy Research was recently highlighted in the New York Times [Disparities: Illness More Prevalent Among Older Gay Adults] and places a special emphasis on the aging gay population.  The findings of the study reveal that aging LGB adults exhibit higher rates of chronic physical and mental health conditions than their heterosexual counterparts, of hypertension, diabetes, physical disability, and poor mental health.  They are also more likely to report psychological stress and to assess their own health status as being fair or poor.  And although the people who make up the aging LGB community are more likely to be male, less likely to be members of a racial/ethnic minority, more likely to have received a higher education, and more likely to earn a higher income (in other words, they possess more characteristics that typically have been associated with better health status) than those making up the aging heterosexual population, they are no more likely to be insured.

The research suggests that, as is the case with other minorities, LGB adults face unique challenges that impact their health.  Gay/bisexual men and women are less likely to be married and/or living with a partner than their heterosexual counterparts.  As individuals age, support from biological kin or other family members becomes increasingly important for maintaining independence and health, and without the additional family structure afforded by having a partner and children, gay/bisexual men and women may be more prone to poor health.  Furthermore, same-sex partnerships are generally not recognized by the Medicaid and Social Security programs, disqualifying many LGB adults from receiving full benefits and therefore restricting their access to medical care.  Prior studies have also shown that the lesbian, gay and bisexual populations are subject to greater social stresses, oftentimes rooted in discrimination and social stigma.  This, especially in combination with the differences in family structure, has contributed to higher rates of mental health distress in LGB adults relative to the general population.

The number of aging gay, lesbian and bisexual adults in the United States is expected to continue to rise in the coming years, and it will become increasingly important for policymakers to acknowledge the accompanying surge in chronic conditions and to decide how best to prepare.  What will be the strategy to reduce health disparities in minority populations, even as their numbers increase?  What are the specific factors contributing to poor health in certain populations and how might those be remediated?  What social structures are in place to help close the gap?  How might greater sensitivity and cultural competency be introduced so as to improve the quality of care for LGB adults?  Policymakers would be wise to consider such questions and to anticipate the unique needs of the gay, lesbian and bisexual populations when reflecting upon the future health status of the United STates.

Advertisements

1 Comment

Filed under Uncategorized

Left behind by health reform

For many Americans, the new provisions in health care reform have brought about welcome changes.  The Affordable Care Act has increased coverage for millions of people who previously did not have access to health insurance, with future plans to prevent existing abuses committed by the insurance industry.  One demographic slated to benefit from such changes is families with children–insurance companies may no longer exclude children on the basis of pre-existing conditions, and parents may continue to insure their dependent children up until they reach the age of 26.  However, this recent article in the New York Times [Child-Only Insurance Vanishes, a Health Act Victim] called attention to a group of children who would not stand to benefit from the plan.  Twelve-year-old Aria Green has been raised by her grandparents since she was an infant, but as her aging caretakers approach their 65th birthdays and prepare for the switch from employer-offered coverage to Medicare, Aria will be left without coverage.  In response to the Affordable Care Act and its ban on excluding children under the age of 19 on the basis of pre-existing conditions, insurance companies across the nation have decided not to offer new child-only policies, claiming that doing so would force them to write a new policy for every child.  Her family’s income does not allow her to qualify for the Children’s Health Insurance Program (CHIP), and because she does not have any pre-existing conditions, she cannot apply for a high-risk pool.  For Aria and for other children whose circumstances do not allow them to be covered under employer-based insurance or traditional family plans, the new health care overhaul has left them with few options.

Legislation to provide coverage for these children and their families is currently pending.   However, new legislation often takes several years to be ratified.  What will become of Aria and other children when the clock runs out on their families’ plans?  And what can be done to help in the meantime?

Leave a comment

Filed under Uncategorized

Investment in social infrastructure and disaster preparedness

By: Monica Kao

With the world’s eyes riveted on the aftermath of Japan’s historic 9.0-magnitude earthquake and resulting tsunami on March 11th, a number of comparisons have been drawn between this natural disaster and others preceding it, particularly the January 12, 2010 earthquake that rocked Haiti and the one-two earthquake-tsunami combination that ravaged Indonesia and other Indian Ocean nations on December 26, 2004.  Seismologists point out that the earthquakes responsible for triggering the two tsunamis were geologically similar, with epicenters that were a roughly equivalent distance offshore.  And in terms of its natural force, there is nothing particularly special about the Sendai earthquake/tsunami that sets it apart from its predecessors.  Having recently been upgraded from 8.8 to 9.0 on the Richter scale, the earthquake in Japan ranks above the 2010 Haiti quake (7.0) but below the 2004 Sumatra-Andaman earthquake (9.2) in magnitude.  Knowing this, it could reasonably be inferred that a natural disaster of comparable magnitude would also have a comparable impact on social infrastructure and on human health.  In fact, physicians and public health officials anticipate that they will face many of the same health crises as those experienced in Indonesia, Sri Lanka, India, Thailand, and Haiti, with many of casualties being blunt trauma injuries (crush wounds, head injuries, fractures, and cuts) inflicted by floating or falling debris.  After the initial trauma, health workers must rise to meet the challenge of food and water shortages, aspiration-related illnesses, foul-smelling infections, elevated risks of heart attack or stroke, and the threat of disease from contaminated water sources.  Yet, even with the current death toll in Japan having just surpassed the 2000-mark, thousands of Japanese still missing, and the death toll predicted to reach the tens of thousands, the level of devastation is still not expected to come close to the staggering death tolls of 230,000 and 316,000 seen in Indonesia and Haiti, respectively.  The differences in outcomes may be viewed as a manifestation of systematic disadvantage and the impact of investment in social infrastructure on a grand, macroeconomic scale.

According to 2010 GDP (gross domestic product) estimates made by the International Monetary Fund, Japan, Indonesia and Haiti ranked 3rd, 18th, and 132nd, respectively.  By the World Health Organization’s 2000 rankings of the world’s health systems, Japan, Indonesia, and Haiti ranked 10th, 92nd, and 138th.  By death toll numbers in increasing order—Japan comes in first with the lowest death toll, then Indonesia, then Haiti.  The inverse relationship between wealth and the impact of natural disaster on health (measured in human lives) is no coincidence—engineering experts and public health officials hail Japan’s emergency preparedness system and its support for social infrastructure as what spared it from catastrophic destruction and losses on a more massive level [Japan ‘the Most Prepared Place in the World’ for a Tsunami and Did Engineering Save Lives in the Japanese Earthquake?].

When a 7.4-magnitude earthquake rocked the Japanese city of Kobe and its surrounding cities in 1995, a number of buildings (most built before the 1980’s, when stringent building regulations were developed) collapsed and killed thousands of people within minutes of the initial quake.  Japanese officials were compelled to invest in building infrastructure, providing the funding for engineers to revise building codes, tighten regulations, and outfit buildings with technology that allowed them to absorb seismic energy and to remain standing.  Japan also invested millions of dollars in preventative measures against tsunamis, which included concrete sea walls, levy banks, ports with raised platforms, advanced sensor buoys, and a high-tech detection and warning system.  Lastly, Japanese citizens underwent regular earthquake drills designed to familiarize them with the potential dangers (i.e., tsunami risk) and the safest procedures.

Few would stand to argue against the fact that the death toll of Haiti’s 2004 earthquake would have been significantly reduced if its government had invested a fraction of what Japan had invested in its building infrastructure, to update its regulations and to correct poorly constructed buildings.  Fewer still would deny that thousands of Japanese lives were saved by tsunami warnings that afforded them enough time to escape to higher ground—warnings that came too late for hundreds of thousands of people in Indian Ocean nations.  Many of the people who perished in the 2004 tsunami were not even equipped with the general knowledge that earthquakes often trigger tsunamis, and therefore it cannot be said that they were properly informed about the dangers at hand.  In other words, the natural disasters in Indonesia, Haiti and Japan have made it apparent that wealth is an important social determinant of health, and countless lives could have been spared if national governments had had more funding available to invest in public expenditures.  It is my hope not only for Japan to be able to recover quickly and completely from the humanitarian, economic and nuclear crises that it faces, but also for other nations to learn from the past so that future destruction and loss of life can be avoided to the greatest extent possible.

Leave a comment

Filed under Uncategorized

Empathy: The answer to racism in health care?

By: Monica Kao

As public health students, we are often called to give special consideration to those health inequities that stem from racism.  In general, racial minorities are reported to have shorter life expectancies and to experience poorer health outcomes, which are most often attributed to a variety of social determinants of health–unequal distribution of income, poor education, substandard housing, and exposure to violence, as well as differential access to employment opportunities, nutritious (and affordable) foods, and quality healthcare, among others.  Since social institutions are inextricably linked with and often reflect societal norms, much of the blame for racial inequities in health has been ascribed to institutional racism, the effects of which are known to be both pervasive and persistent.  And because individuals respond to and are heavily influenced by societal norms, institutionalized racism is also thought to have a significant role in fostering internalized and personally-mediated racism.  However, new findings in a recent study at the University of Wisconsin-Madison are beginning to shed a different light on racism in health care, and they raise some interesting questions about how personally-mediated racism might come about–as well as how it might be combated [New perspective diminishes racial bias in pain treatment].

The study centered on varying degrees of racial bias in pain treatment and found that caregivers tended to go to greater lengths to ease the pain of patients who were of the same race as themselves.  This racial bias was seen in white caregivers as well as in their black counterparts.  Brian Drwecki, who headed the study, commented, “I want to be very clear about this: We’re not saying health care professionals are racist.  This is not racism. Racism is a conscious act of hate. We find it very unlikely that health care professionals are aware that they are making these biases, let alone trying to actively hurt black patients.”  The findings of the study suggest that personally-mediated racism may occur not only as a result of institutionalized racism, but also naturally or as an unconscious act, as a person may simply find it easier to relate to someone of the same race.

In certain aspects, the outlook appears bleak–in addition to throwing off the pervasive influence of institutionalized racism, caregivers and health professionals must also fight a natural inclination towards racial bias.  However, the study went on to find that the pain-treatment gap was reduced significantly when caregivers were asked to take a few moments to think about how the patient felt about his or her pain and how it might be affecting his/her life.  The implications of such findings are that personally-mediated racism might be resolved with nothing more than a little empathy.  Skeptics might argue that the solution to health disparities lies not in combating personally-mediated racism, but in ending institutionalized racism, as its effects are more far-reaching.  The population impact of institutionalized racism is undeniable, and initially, it may be difficult to see how changing one’s perspective could equalize the social determinants of health and reduce disparities that occur across all dimensions of health–in types of care, representation in clinical studies, access and quality of care.  After all, what can empathy do about economic opportunity for minorities, or housing?  What about insurance coverage?  The answer is, “more than we might think.”    The sweeping issues that face today’s society and disproportionately contribute to poor health outcomes in minority populations will require strategic planning and concerted efforts to effect change; however, such change begins with collaboration among health professionals and civic leaders at the local and community levels.  A little empathy can go a long ways, particularly when the moral considerations that accompany it are brought into discussions of social issues, and so the potential impact that could be had with just a change in perspective should not be underestimated by any means.

Leave a comment

Filed under Uncategorized

Sharing the responsibility for health

By: Monica Kao

The Obama administration has been characterized, in part, by its novel approaches to improving the future of the country, not all of which have gained widespread acceptance.  The $814 billion-dollar economic stimulus package has been no exception–hundreds of millions of dollars have been allocated for Communities Putting Prevention to Work (CPPW) grants and new health campaigns discouraging tobacco use and the consumption of sugary beverages–and its implications are currently the subject of intense debate [Stimulus funds aim to help kick cigarettes].  Opponents have raised objections to using federal dollars to discourage consumers from spending money on such products, which they claim runs counter to the objective of the stimulus package itself.  They also express increasing discomfort at the government’s attempts to shape consumer choices, claiming that they are intrusive and place limits on self-determination.  But perhaps the greatest point of contention is the campaign’s emphasis on personal accountability for health–the advertisements (which promote tobacco-free environments, better nutrition, and exercise programs) reflect a paradigm shift towards the belief that one can engage in specific health-promoting behaviors and actively take control of one’s own health.

In my view, the health campaigns initiated by the economic stimulus package might be exactly what the United States needs, and many of the objections can be addressed with relatively little argument.  While it is easy enough to understand how discouraging the purchase and consumption of products harmful to one’s health could be perceived as being counterproductive to the goal of the stimulus package, many health experts argue that such efforts will save taxpayer dollars in other areas.  Obesity-related illnesses, for example, cost state and federal governments billions of dollars per year–if prevention efforts are successful in curbing obesity, the economic losses suffered through diminished soda and cigarette sales will soon pay for themselves in the form of reduced health expenditures and a healthier population.  And for those critics who fear that the campaigns are the government’s attempts to exert control over consumer choices and to limit self-determination, the campaigns currently do not include any efforts to restrict or to place taxes upon available products.  Rather, the goal has been to make information more widely available so that consumers can be fully informed about the choices that they are making [to view an example, click here].

The primary message communicated by the campaigns is that consumers are able to exercise some degree of control in the preservation of their own health through the choices that they make, which raises new questions regarding accountability and the balance of individual and social responsibility for health.  The campaigns do not impose or enforce any rules requiring healthy choices, nor do they introduce taxes or require that potential risk takers pay elevated insurance fees for added risk, reflecting a belief in shared responsibility.  Rather, the Obama administration and state health departments have shouldered the responsibility of informing individuals about risk factors for disease and creating a social and physical environment that promotes health and well being.  In doing so, the federally-funded health initiatives have also left room for individual liberty–individuals are free to use that information however they may choose, whether they should decide to disregard the information given or to use it to maintain health and to avoid disease.  The shared accountability then reduces the risks associated with pinning sole responsibility on individuals and the wrongful blame that may arise if or when individuals fall ill.  There is much more that can and should be done in terms of building health equities and creating social and physical environments that promote health, and so these health initiatives cannot be viewed as a panacea for issues of public health.  However, they do seem to be a commendable start in promoting both personal and social responsibility for health and I hope to see this shared belief reflected in future funding initiatives.

1 Comment

Filed under Uncategorized

Paying the price of injustice

Recently, oil giant Chevron (formerly Texaco) made international headlines when it was ordered to pay nearly $9 billion in damages (a ruling that saddled Chevron with the burden of paying one of the largest environmental awards in history) on the grounds that it contributed to pollution and environmental degradation in Ecuador [Ecuador Judge Orders Chevron to Pay $9 Billion].  Five billion dollars–the majority of the $8.6 billion awarded–has been designated for soil restoration and conservation efforts, with two billion dollars allocated for healthcare.  But despite their victory, the plaintiffs claim that the amount still fails to reflect the injustice done.  The ruling claimed that Chevron deliberately made operational decisions that were in violation of existing environmental laws and industry standards, which included using substandard technology in order to cut costs.  Billions of gallons of toxic crude were systematically dumped during drilling operations over the span of nearly 30 years, leading to the  contamination of lakes, rivers and soil, and even more importantly, the subsequent disruption of health and life.  The Amazon Defense Coalition, representing villagers and members of indigenous tribes hailing from northern Ecuador, is seeking over $113 billion for oil pollution that it claims is causing disease in the affected populations.  The sheer amount raises new questions regarding the moral importance of health and how victims should be compensated for their losses–is $9 billion too much or too little?  What about $113 billion?  The amounts awarded and demanded seem almost arbitrary–perhaps the appropriate amount for compensation can be better understood by framing the situation according to the dimensions of well-being set forth by Powers and Faden.  Prior to Chevron’s presence of the area, many of the indigenous cultures had been untouched by modern civilization and had little knowledge of the potential effects it could have upon the preservation of their way of life.  However, the systematic pollution of the rainforest region led to the contamination of vital lakes, rivers and other bodies of water, which the indigenous people depended upon for fishing, bathing, drinking and cooking purposes.  The victims’ health complaints range from constant headaches (due in part to the lingering smell of petroleum in the air) to higher incidence of skin disease, birth defects and cancer.  An elevated rate of pregnancies terminating in miscarriages has also been attributed to the oil contamination in the area.  In summary, it can reasonably be inferred that the affected populations would not choose such a fate for themselves; rather, it seems clear that the indigenous natives had little to no say over the decision to drill for oil in the area.  The Ecuadorian government had had little experience with the oil industry; yet, it entrusted Chevron with its development and expected the oil giant to employ modern techniques and technology that were already common practice in other countries.  However, Chevron’s practices clearly reflected that it valued the reduction of costs over the trust and health of the Ecuadorian people, which could be perceived as a lack of respect and a clear violation of personal security.  And although the Ecuadorian government had little knowledge of the damaging effects that Chevron would inflict upon the entire country, the government’s decision to allow drilling in the rainforest was perceived by many as a betrayal of its people.  How much money will it take to restore health in these rainforest communities?  To restore a sense of trust in one’s government?  To prove that the voices of the indigenous people can be heard?

Leave a comment

Filed under Uncategorized