A report on the comprehensive study conducted on 32 countries by Hero et al. (2017) established that the US was only second to Portugal and Chile in terms of income-based health disparities in the world. A third of the poorest Americans took part in the study and 38.2% reported their health as “fair or poor”, compared to with 12.3% of a third of the richest. The study highlighted the challenges facing the movement for universal health care because social determinants of health remain largely unaddressed. Two thirds of Americans report that a significant proportion of people in the country cannot access health care services they need. County Health Rankings in the US consistently show significant health gaps persist by region, race, and ethnicity. Lincoln County is among the counties ranked the lowest in terms of population health in the state of Oregon. Despite average levels of equity, Lincoln County represents the general trend in the US where social determinants of health influence delays in seeking care, relationship to health, insurance coverage, use of preventative health services, serve as barriers to care, and satisfaction with care services. This report examines social determinants of health and their influence on health disparities in the county of Lincoln, and develops recommendations for improving the situation. The paper is structured into a number of sections each addressing a unique concept about the issues. The introduction highlights and justifies the need for the report. The section on demographic profile paints a clear picture of the scenario that is to be addressed. The paper also highlights existing strategies for mitigating the issues, identifies gaps in the community, suggests ways of providing cultural competent healthcare services, and develops recommendations for actions and partnerships.
Demographic Profile
According to the US Census Bureau 2017 data, Lincoln County had an estimated population of 48,920. The 2010 census established that the county population was distributed across 20,550 households and 12,372 families. Based on race and ethnicity, the county population was primarily whites (87.7%). The remaining proportion comprised of American Indians (3.5%), Asians (1.1%), African Americans (0.4%), Latinos or Hispanics (7.9%), and other races. The census data showed that 21.2% of the households had children under the age of 18 and also differed in terms of average house size. The media age for the county population was 49.6 years. The median income for the household and family were $39,788 and $52,720 respectively. Men had higher median income compared to women. It was also established that 11.7% of families and 16.2% of the population lived below the poverty line, which comprised 21.7% of those below 18 and 8.8% of those aged over 65. The recent data on healthiest communities in Oregon showed that Lincoln County had the lowest rank and also performed dismally in terms of economy. The attributes of the population are major contributors to health disparities in the county.
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The demographics of the county population indicate the potential for health inequalities with some population segments likely to experience adverse health outcomes compared to the general population. It is important to recognize that Lincoln County is racially and ethnically diverse. A report compiled by National Academies of Sciences, Engineering, and Medicine (2017) on the state of health inequalities in the US established race and ethnicity to be critical determinants of health. A 2018 health assessment report by Lincoln, Benton & Linn Counties found out that social determinants of health in the county included income, poverty, and economic challenges. However, the residents of Lincoln County experience less income inequality. However, poverty is a contributing factor with 20% of the county population living below the federal poverty line. Poverty can be attributed to 10.7% of the population under the age of 65 not having health insurance in the county, a trend that reduces access to healthcare services hence contributing to health disparities.
Current Community Efforts
Lincoln County health initiatives borrow from the state health drives such as the 2015-2019 health improvement plan. The state health programs are aligned according to federal data showing areas in which the Oregon lags behind, particularly in relation to the Center for Disease Control and Prevention “Winnable Battles.” Improving the quality of life in the state of Oregon targets key areas including prevention and reduction of tobacco use, mitigating the rise of obesity, improving oral health, reduction in harm from alcohol and drug use, increase immunization rates, and protecting the population from communicable diseases (Oregon Health Authority, 2015). However, the state does not clarify the initiatives it is taking towards addressing health inequalities.
At the county level, the community is served by the Lincoln County Health & Human Services Department. The areas emphasized on by the local government agency are public health, mental counseling, addiction, primary care, school based health centers, environmental health, and public sensitization and education on available health services. While these programs and strategies are intended for all county population segments, they do not recognize the possibility that some areas and groups need specialized strategies because they suffer from health disparities. For instance, in Lincoln county, 33% of children under the age of five were living under poverty, implying they do not grow up with the privileges found in the rest of the population. Such children have been established to face increased risk of poor health outcomes. Therefore, the focus of county initiatives on health outcomes without critically evaluating social determinants of health, can impair allocation of resources to the group that needs help the most.
Gaps in Healthcare for Target Population
The most glaring gap in healthcare in delivery in of health services to the target population experiencing disparities is lack of research evidence. Assessment reports on health status in the county draw on existing empirical evidence. Little primary research has been done to ascertain the implications of social determinants of health to the population of concern. In addition, there is limited information on who falls into the minority groups classified as suffering from health disparities. The Lincoln county health assessment report identifies race and ethnicity, sex and gender, disability status, age, immigration documentation status, veteran status, sexual orientation (GLBT), and income and poverty as some of the important contributors to health disparities. However, the effects of these social determinants of health to the county population are unknown. As a result, addressing the health concerns of specific populations remains a major challenge because it is difficult to develop comprehensive strategies for ensuring equitable health without first addressing the root causes of disparities.
Provision of Culturally Competent Care Services and Programs
Weech-Maldonado et al. (2012) highlighted the need for a paradigm shift towards culturally competent health systems. The US ha an increasingly diverse population, a trend reflected at lower state and county levels. Majority of the population in Lincoln County comprises of whites, which may premeditate the delivery of healthcare services to other racial and ethnic groups. Ingleby (2012) observed that the predicament of immigrant families of different ethnic groups in relation to health disparities, is due to their small number, implying few contributions to health inequalities. This perception is highly misconstrued because immigrants have been consistently shown to be the victims of discriminative practices that contribute to health disparities. According to Weech-Maldonado et al. (2012), cultural competency is perceived as an organizational strategy with the potential to address racial and ethnic disparities in the health system. The county health assessment reports show that populations affected negatively by social determinants are at a higher risk of unequal access, treatment, and outcomes in healthcare. Therefore, culturally competent healthcare programs must address the factors identified as barriers to access to healthcare by minority racial and ethnic groups. There is need to create awareness about cultural diversity among healthcare providers and educate the public on where and how they can get healthcare services that they need.
Analysis and Recommendations
Recommended Actions
Existing health initiatives by the Lincoln County are a cascade of federal and state policies that may not address the real issues faced by the populace at the grassroots. It is not logical to develop strategic plans for the local community based on federal or state data because of the variation in social determinants of health. Lincoln County has its own unique challenges that must be addressed internally. Therefore, as a responsible agency, it is imperative to:
Invest in research to determine the populations that are affected most by health inequalities.
Conduct assessments on the extent of the impacts of social determinants of health on these populations.
Develop targeted culturally competent strategies to address the challenges faced by the identified population segments.
Strategized on resource sourcing and allocation to ensure healthcare measures for solving inequalities.
Undertake comprehensive review of socioeconomic factors and mechanisms for improving overall economic wellbeing of the residents as the primary goal for solving disparities.
Recommended Partnerships
Development and implementation of the healthcare initiative for the target population is currently the mandate of Oregon Health Authority and the Lincoln County Health & Human Services Department. Collaborative efforts between the two agencies, if they exist, are not clearly highlighted. Therefore, onus is on the two organizations to diversify their engagement and demonstrate the willingness to work with both local and external stakeholders. Federal agencies offer relevant support in terms of systems, infrastructure, and finance, but special emphasis needs to be placed local and non-governmental agencies. Successful implementation of culturally competent health systems at the local level require involvement of religious groups and community based organizations that can be used to reach out to the affected population segments. The logical behind use of these groups is that they have better understanding of the people and their socioeconomic and cultural backgrounds, and have their trust, hence they can be listened to. There is need to engage other partners who may not be from the health sector such as local banks and credit organizations that can assist in acquisition of funding. Business coaching organizations can also be approached to help the target population acquire entrepreneurship skills necessary to boost household and individual income, hence alleviating poverty, which is the main contributor to health disparities.
Conclusion
The quest for universal healthcare is a global phenomenon that has trickled down to the grassroots. The US is known to have the most glaring health disparities in the world, and has taken the initiative to lead by example. However, the country efforts face significant hurdles because of the increasingly culturally diverse population. Lincoln County is a local example of the challenges faced at the federal level. This reports highlights that despite understanding of the social determinants of health, they have not been addressed in respect to the population that are affected most. Consequently, health care initiatives fail to yield the required outcome because segments of the population are not factored into the health agenda. Therefore, comprehensive review of strategies is mandatory with a bias towards the development of culturally competent health system for the vulnerable populations.
References
Hero, J. O., Zaslavsky, A. M., & Blendon, R. J. (2017). The United States leads other nations in differences by income in perceptions of health and health care. Health Affairs , 36 (6), 1032-1040.
Ingleby, D. (2012). Ethnicity, migration and the ‘social determinants of health’ agenda. Psychosocial Intervention , 21 (3), 331-341.
Lincoln, Benton & Linn Counties. (2018). Lincoln County Community Health Assessment 2018. Retrieved from https://www.co.lincoln.or.us/sites/default/files/fileattachments/health_amp_human_services/page/4316/8_2_lincoln_cha_draft.pdf.
National Academies of Sciences, Engineering, and Medicine. (2017). Communities in Action: Pathways to Health Equity . National Academies Press.
Oregon Health Authority. (2015). State health: Improvement plan. Retrieved from https://www.oregon.gov/oha/ph/About/Documents/ship/oregon-state-health-improvement-plan.pdf.
Weech-Maldonado, R., Elliott, M. N., Pradhan, R., Schiller, C., Dreachslin, J., & Hays, R. D. (2012). Moving towards culturally competent health systems: organizational and market factors. Social Science & Medicine , 75 (5), 815-822.
