The Economics of Health Equities October 6, 2021

The Economics of Health Equities October 6, 2021
Darrell J. Gaskin, PhD MS William C. and Nancy F. Richardson Professor in Health Policy
Director, Center for Health Disparities Solutions Johns Hopkins Bloomberg School of Public Health
Johns Hopkins Bloomberg School of Public Health

Outline for the 1st Session
• Achieving Health Equity for African Americans - Darrell J. Gaskin, PhD MS – Richardson Professor in Health Policy and Director Center for Health Disparities Solutions, Johns Hopkins University
• Achieving Health Equity for Asians and Pacific Islanders - Ninez A. Ponce, MPP PhD – Professor in the UCLA Fielding School of Public Health's Department of Health Policy and Management)
• Achieving Health Equity for Hispanics - Monica I. García-Pérez, PhD – Professor in the Department of Economics, St. Cloud State University, Past President of the American Society of Hispanic Economists
• Q&A from participants in the chat.
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Outline
1. The Difference between Health Equity and Health Disparities? 2. How can economics inform efforts to achieve health equity. 3. NIMHD Conceptual Framework of Health Disparities 4. Explaining an Eliminating Health Inequities instead of Eliminating
Health Disparities 5. Examples of Research Differences between Health Equity compared to
Health Disparities
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Health Equity versus Health Disparities
Health Equity – Everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences including powerless ness and lack of access to good jobs with fair pay, quality education and housing, safe environments and health care. Pursuing health equity striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health based on social condition.
Health Disparity – A particular type of health difference that is closely linked with economic, social or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status gender, age or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location or other characteristics historically linked to discrimination or exclusion. (Healthy People 2020)
Braveman P. What are health disparities and health equity? We need to be clear. Public Health Rep. 2014;129 Suppl 2(Suppl 2):5-8. doi:10.1177/00333549141291S203 Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN, Manderscheid R, et al. Health disparities and health equity: the issue is justice. Am J Public Health. 2011;101(Suppl 1):S149–55. Braveman P, Arkin E, Orleans T, Proctor D, Plough A. What is Health Equity? And What Difference Does a Definition Make? RWJF May 2017
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Health Economics is about Arrow-like Observations.
We study how the complexity of the health production, demand for health, healthcare production and the organization of the healthcare marketplace. For the most part, we assume that people are acting in their best interests based on the information they have and the choice architecture they are presented. (With the exception of the behavioral economics which is a deviation for optimization because of short cuts we systematically make in decision making. The question is how does the factors that underlie health inequities influence decisions by patient, providers and organizations that impact health and healthcare outcomes.
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IOM DEFINITION OF HEALTHCARE DISPARITIES

Quality of Health Care Non-Minority
Minority

Difference

Clinical Appropriateness and Need
Patient Preferences
The Operation of Healthcare Systems and the Legal and Regulatory Climate
Discrimination: Biases and Prejudice, Stereotyping, and Uncertainty

Disparity

Populations with Equal Access to Health Care Source: Unequal Treatment, IOM 2003

Definition of Health Inequity versus Health Disparities
Coronary Heart Disease Death Rates by Race/Ethnicity and the Healthy People 2030 Target
120

Target of 71.1 from Healthy People 2030

H10e0 alth Disparity
80
60

40

Health Inequity

Health Inequity

20

0 Target Rate

Whites

Blacks

Asians

Hispanics

CHD Deaths per 100,000

American Indians/ Alaska
Native

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Achieving Health Equity instead of Eliminating Health Disparities - Why?
• Absolute targets based on societal goals instead of relative ones • (Example – Optimize vaccine distribution so if we strive to hit the target across all of our demographic groups, instead of focusing on making sure rates do not vary across groups.)
• Moves us away from minority pathology solutions – No broken people just broken systems. • (Example – it is not the case the minority populations are always worse off than non-Hispanic White population)
• Moves us towards understanding the resiliency within disparity populations and learning from within group heterogeneity.
• Disparities can be eliminated by declining health in the advantage population which is not really a societal win. Health equity promotes win-wins.
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Achieving Health Equity for Racial and Ethnic Minority: The Role of
Economics
Johns Hopkins Bloomberg School of Public Health