People's health is an interesting beast. We often think of health as between one person and their immune system, or some variation of this. There has also long been a correlation between lower income individuals and poor health and, often, shorter lifespans. There are many ideas and studies showing why this latter relationship may exist, but so often it can be oversimplified. This becomes a real struggle when we try to make structural changes to fix things (think healthcare reform) - we know something is broken, but if we are not sure why how can we really fix it? (Before I go on, you should keep in mind that there is neither an explicit nor implicit political point/argument in this blog. Carry on.)
Here are some thoughts from some recent research in the sociology of health and illness. Policy makers and people in general often place a high degree of emphasis on the individual. This usually translates over to things such as focusing on health care and insurance coverage, or even the availability of (affordable) health care. But, even if these problems were fixed, people still may not use the health care available to them because it is not clear that this is the problem (obviously it is a big problem, but it could be subsequent to other issues).
Going back to the 'poor people' and their healthcare. We assume that poor communities have poor health because there is no insurance or the care is hard to access. While this may in part be true, recent research shows that within poor communities, it is not the poor people that are most affected by barriers to health, but middle-class and upper-class individuals living in that location. In other words, the poor health in poor communities is actually not attributed to the poor people within that community, but the middle and upper class individuals within that lower income community. This is usually because poor individuals have social networks in place that allow them to deal with their issues apart from the structural solutions in place - they talk to their friends and family to get help with health and not a doctor. The middle and upper class individuals living within those poorer communities, on the other hand, do not have access to these social networks for solutions and 'suffer' the consequences. Thus, it is possible that if we provided all of these poor people with health care that it may not change community level health outcomes anyways. After all, they are not even the ones pulling down the average level of health.
Additionally, poorer individuals are less trusting of those in positions of authority like a physician and also expect worse outcomes from their interactions with doctors. So, if they did have access and insurance as well as actually use that access, they may still have worse health outcomes than others. This, again, is not so much a structurally caused health problem, but more cultural. They have other ways to deal with health issues in their community and have different expectations when they do seek formal help. Neither of these will be fixed by a shift in the structure of our health care system, but may require something else. Some think a possible road forward is for all doctors to be more engaged with the communities they serve so that when/if people do have access, they will use it and expect something from it. Others find it hard to differentiate solutions to these problems from political activism, and as such think no requirement for 'health advocacy' should be imposed as the activism would necessarily alter the substance of the medicine itself. Either way, it is clear that health requires much more than a mere individual focus and that a structural change is needed in the delivery of health care. It is significantly less clear, however, what that actually means.
Pretty interesting. Sorry if that was a bore. Mostly because there will probably be more.
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