Thoughts on Health Equity

The folks at Health Affairs released a themed issue this month on Pursuing Health Equity, which includes fantastic articles addressing social determinants of health, transitions of care from prison back to the community, challenges to reducing discrimination, and more.  I thought this was an interesting topic that definitely applies to challenges we have in pharmacoeconomics and worth a post today.

Discrimination by Design

I fear that the current system of health care delivery in the United States is doing exactly what it is designed to do: provide excellent care for those able and willing to pay for it and a significantly different level of care and access for those who are not.  Joachim Hero, Alan Zaslavsky, and Robert Blendon from Harvard may have confirmed that with their article on differences in income and perceptions of health and health care, where 67% of US respondents felt that many people do not have access to health care but only 54% felt that the issue was unfair.  Many people benefit from the current US health system, including myself, and there would definitely be winners and losers if any major system reform took place.

The Need for a New Argument

If we consider a health care system that only a few have adequate access to as “fair” then any advocacy efforts for reform in the name of “fairness” or “equity” will likely fall on deaf ears.  For those that pursue better and more efficient care for all individuals, I suggest reframing the message to explain how we all benefit when our most vulnerable people are served well.  I think Dr. Steven Woolf from the Center on Society and Health at VCU makes a great argument to take the focus away from terms such as “equity” and focus on things like “opportunity.”

In my opinion, we do a really bad job of articulating the damage inequity does to everyone – especially the wealthy.  When no care or very poor care is available to disadvantaged groups, our economy suffers and additional resources are pulled to address catastrophes.  Even if you were completely heartless and lacked empathy for any suffering family, there may be enough economic evidence to convince you that it makes sense to improve health care delivery for those that are under-resourced.

A Challenge for Myself

I made an attempt this past spring to make the “good business” argument regarding health equity to my 3rd year PharmD students through a couple of new cases.  In my experience as a pharmacy manager, I know the benefits of great customer service on long term business success and I felt like I could confidently articulate those points.  However, it was met with mixed reviews.  Some of my students felt that it was a political topic and didn’t belong in class, although I worked incredibly hard to keep the politics out of it.  Whether you support a Republican or Democratic ticket shouldn’t change the way you evaluate an issue, but those red and blue lenses are so pervasive.

I’ll be working on revising those cases this summer, so please feel free to send along any thoughts or comments on how you think the issue of health equity could be discussed in the PharmD program.

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Joey Mattingly, PharmD, MBA is an assistant professor at the University of Maryland School of Pharmacy located in Baltimore, Maryland. Joey has managed retail and long-term care pharmacy operations in Kentucky, Illinois and Indiana. Leading Over The Counter is a blog of Joey's views and opinions on the topics of pharmacy leadership and management and do not represent the University of Maryland, Baltimore. Joey can be followed on Twitter @joeymattingly.

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