Access to quality healthcare is influenced by a number of factors such as the economic, social, and physical environment. However, none of these factors influence the access the quality of healthcare than social status of a patient. Social determinants such as education level, employment, racial group, and type of the family play crucial role in the health of the patient. The difference in social status contributes to a huge disparity in access to quality healthcare services in the USA and the world at large. Patients with strong positive social status such as being white, have a high level of education and are well-off have many protective factors that increase their chances of accessing quality healthcare. On the contrary, a patient with the adverse set of social status like being black, illiterate, and poor and not likely to access quality healthcare services. Patients with low social status are not likely to access the high quality of health when compared to their counterparts with high social status. 1
Williams and Jackson explain in their article that the racial disparity in health has persistent in the USA for centuries due to the difference in social status of people from different racial groups. They explain that death rate from heart diseases among blacks is 30% more than that of their white counterparts. 2 At the same time, the cancer death rates among white patients have been stable while that of blacks is increasing. Black people are more likely to die from cancer than white patients. The disparity in death rates between black and whites is mainly influenced by their ability to access quality healthcare services. In many cases, black people are not able to access high-quality healthcare services because of poverty. The cost of healthcare has been rising in the USA, which means that people with enough money can access quality healthcare services.
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Williams and Jackson also argue that residential segregation also prevents patient with low social status from accessing quality healthcare services. Residential segregation forces low and middle-income black to live in poorer areas compared to whites who have the same social status. According to Williams and Jackson poor white lives in better residential area or neighborhoods than poor black. 3 The poor residential areas are not likely to well-equipped healthcare entities, especially regarding trained healthcare personnel and medical facilities and equipment. Consequently, poor black patients, due to residential segregation, are not likely to access the quality of healthcare services. Residential segregation has a further impact on the poor people. Segregation leads to health-damaging conditions for patients. It restricts education and employment opportunities, causing a high level of poverty among the poor. Unfortunately, blacks are more exposed to segregation that white, making hard for the former to access quality healthcare services.
Race, therefore, is one of the elements of social status that influence access to quality care. As in the case of Williams and Jackson, the report by Fiscella and Sanders also reveals that patients from racial minority groups are less likely to access quality healthcare services compared to those from dominant racial groups. 4 Fiscella and Sanders explain that racial and ethnic disparity is evident in the quality of care for patients suffering from chronic diseases. Minority patients experience worse chronic diseases control and management than white patients. Hence, social status determines the quality of health patients are expected to receive when they visit hospitals.
Social status influence health behavior of patients and how they respond to health needs. Patients with low social status are likely to behave differently compared to their counterparts from high social status. People from low-income and poor households are not likely to initiate health-enhancing practices. 5 For instance, they are not likely to visit well-equipped and staff hospitals for cancer screening and treatment. They are not motivated to invest in their health. As a result, they end up visiting community hospitals that may not adequate staff and medical equipment to offer quality healthcare services. Conversely, patients with high social status such as education and income take their health seriously, and they visit hospitals where they can access quality healthcare services. High income and literacy motivate a patient to seek health-enhancing practices that are associated with quality healthcare services. People who are highly educated have a greater healthy knowledge, and they are more likely to access and embrace new health knowledge while at the same time rich people have enough resources to take advantage and utilize health-enhancing opportunities. 6 As a result, social status influences access to quality healthcare because it determines the health behavior and practices of patients. The health behavior of patients is influenced by their social status, especially regarding education and level of income, which end up affecting access to quality of healthcare.
Friel explains that not everyone has the opportunity to live a healthy and prosperous life. She argues that people living at the bottom of the social hierarchy always have worse health than persons living in the middle and upper social hierarchy. She gives a story of Anna who is 44 years old and lives in a socioeconomically disadvantaged urban area in the country. 7 Even though Anna is overweight, suffer from depression, and smokes a lot, she is not motivated to visit a doctor or hospital to seek proper medication. Like the case of Anna, Friel argues that poor people are not always motivated to seek healthcare services. Also, Anna is not highly educated, and she was brought up in a low-income family. Friel further opines that accessibility to quality health is not only influenced by the amount of wealth a person has, but also the people around a person and how the income is spent. Social status also damages persons' perception of their position in the social hierarchy. As a result, poor people perceive themselves as less worthy, and they are not likely to seek quality healthcare services, even if they have the financial ability to do so. 8
Therefore, social status significantly influences patient’s access to quality healthcare services. Poor people in the society are not able to access quality healthcare because of the inability to pay for expensive medical expenses. They prefer to go for cheaper healthcare services that are always of low quality. Minority patients, on the other hand, are mostly associated with low social hierarchy and they can hardly access quality healthcare because of lack of income and residential segregation. Many minority people live in areas where they cannot access well-equipped and staff hospitals that are associated with quality healthcare services. Social status determines where a person lives and in turn influences the access to quality healthcare. Also, social status influences the health behavior and practices of patients. High social status is associated with health-enhancing behaviors and practices, which is not always the case for people with low social status. Hence, social status plays important role in determining the quality of healthcare services received by patients.
Bibliography
Fiscella, Kevin, and Mechelle R. Sanders. "Racial and ethnic disparities in the quality of health care." Annual review of public health 37 (2016): 375-394.
Friel, Sharon. “Social determinants – how class and wealth affect our health.” August 31, 2016. https://theconversation.com/social-determinants-how-class-and-wealth-affect-our-health- 64442
Swain, Geoffrey R. "How do economic and social disadvantage affect health?" Institute for Research on Poverty 33 (2016): 1-6.
Williams, David R., and Pamela Braboy Jackson. "Social sources of racial disparities in health." Health Affairs 24, no. 2 (2005): 325-334.
