ethics health disparities

Ethics of Health Disparities: 

Ethics of Health Disparities John R. Stone, MD, PhD Center for Health Policy and Ethics Creighton University

Disparities in Health Statusand Healthcare: 

Disparities in Health Status and Healthcare Tragic Horrendous Ethically unacceptable Moral problems of the first order

Universal and Substantial Healthcare: 

Universal and Substantial Healthcare Respect and justice demand such healthcare. BUT To eliminate disparities in health status, much more must be done.

Health Disparities: Ethical Questions: 

Health Disparities: Ethical Questions Given widespread and important disparities (inequalities) in health status and healthcare: What are the ethical problems/issues? What (ethically) should be done? What should be done overall? What should we (each of us) do?

Health professionals’ obligations:: 

Health professionals’ obligations: Regarding their embedded practices. Regarding structures. Institutions Communities Policies

Ethical/Moral Framework*: 

Ethical/Moral Framework* All have equal and significant moral worth. All are due equal and substantial respect and care. Justice must be a guide. All have a right to health and other conditions that promote a “sufficient” level of well-being, given practical constraints. Institutions and professionals must be trustworthy regarding this moral framework. *See Madison Powers, Ruth Faden, Social Justice: The Moral Foundations of Public Health and Social Policy. NY. Oxford, 2006, p. 50.

Health Status: Major Determinants: 

Health Status: Major Determinants Providers Institutions Systems Policies H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J. Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006.

Determinant Influence on Excess Mortality: Poor & Minorities: 

Determinant Influence on Excess Mortality: Poor & Minorities H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J. Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006, p. 265.

Healthcare’s Major Influences: 

Healthcare’s Major Influences Disability Pain Suffering Quality of life H. Jack Geiger. Health Disparities: What do we know? What do we need to know? What should we do?. In Gender, Race, & Health: Intersectional Approaches. Edit by Amy J. Schulz & Leith Mullings. San Francisco. Jossey-Bass, 2006, p. 272.

Model: Ethical/Moral Practice*: 

Model: Ethical/Moral Practice* *Farmer P. Pathologies of power: Health, human rights, and the new war on the poor. Berkeley, Univ. of California, 2003. What should be done? What we should do? Internal to our profession External to our profession Practice Institution/org

Ethical/Moral Practice(Moral Framework Guides): 

Ethical/Moral Practice (Moral Framework Guides) Community Collaboration Partnering Intervene Evaluate Expect Resistance

Ethics, Disparities, Culture: 

Ethics, Disparities, Culture Cross-cultural skills, attitudes, knowledge Diversity at all levels Served community: strong involvement Language and interpretation services Insurgent multiculturalism (Ref: D Wear) Transformation Biomedical model Whiteness

Crucial:Intersectional ApproachesStakeholdersCommunitiesDisciplinesProfessionalsInstitutions & Organizations: 

Crucial: Intersectional Approaches Stakeholders Communities Disciplines Professionals Institutions & Organizations

Other References: 

Other References Crawley, LM. African-American participation in clinical trials: situating trust and trustworthiness. Journal of the National Medical Association 2000;93 (12):14S-16S. Gamble VN. Trust, Medical Care, and Racial and Ethnic Minorities. In: Multicultural Medicine and Health Disparities. Edit by David Satcher & Rubens J. Pamies. NY. McGraw-Hill.2006. Gregg J & Saha S Losing Culture on the Way to Competence: The Use and Misuse of Culture in Medical Education. Acad Med 2006;81:542–547. Taylor J. Confronting culture in medicine’s “culture of non-culture.”Acad Med 2003;78(6): 555-559 Wear D. (2003). "Insurgent multiculturalism: rethinking how and why we teach culture in medical education." Acad Med 78(6): 549-554.