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Why we don't talk enough about health equity in America

In recent years, health equity in the United States has gained attention, but societal-level discussions on this topic have been historically lacking. Presently, health disparities in America encompass various factors, including mortality, life expectancy, burden of disease, homicide, insurance coverage, and lack of access to care. These inequities place a significant burden on both the economy and society, as they are associated with an additional $320 billion in annual healthcare spending, projected to surpass $1 trillion by 2040, according to the Deloitte Health Equity Institute.

The complexity of the U.S. healthcare system, involving multiple stakeholders such as private insurers, government programs, healthcare providers, and pharmaceutical companies, adds nuance to discussions about health equity, making it less accessible to the average person. Furthermore, conflicting interests among stakeholders may impede efforts to address health disparities; certain industries may resist initiatives that affect their profits, leading to challenges in achieving equitable healthcare.

Unfortunately, health equity has become politicized, hindering open and constructive discussions. Framing certain topics as ideological or partisan issues rather than matters of public health and social justice adds fear, guilt, hatred, and dishonesty to the discourse, making genuine dialogue challenging.

When discussions about health equity do occur, they sometimes revolve around bringing disadvantaged communities up to the level of care experienced by white Americans, which raises questions about fairness and whether the focus should be on addressing gaps, causes, and systemic failures within the costly and ineffective health system. The U.S. has a long history of inequality based on race, ethnicity, income, and other factors, and health disparities often reflect these broader societal and economic inequities, which necessitate confronting uncomfortable truths.

Stigma associated with certain health conditions, like mental health issues and substance use disorders, also inhibits open discussions about equity. The role of the media in shaping public discourse is significant, but in some regions, like New Hampshire, health equity discussions may not receive adequate attention compared to other topics, limiting awareness and interest in the subject.

Despite these challenges, progress is being made through the efforts of public health organizations, advocacy groups, healthcare providers, and individuals, who work to address these issues and promote equitable health outcomes. However, the framing of the issue, lack of media interest, and blaming of disadvantaged populations for health problems, all within a society with significant systemic barriers, make this work difficult.

American exceptionalism, the belief that the U.S. is superior to other nations, might contribute to overlooking problems within the healthcare system. Despite higher healthcare spending per capita, the U.S. lags behind other major industrialized countries in overall health outcomes. By recognizing and acknowledging these flaws, we can strive for improvement and acknowledge that the U.S. has the potential to do much better in achieving health equity.


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