Restructuring the American Health Care System
Have a bias toward action--let's see something happen now. You can break that big plan into small steps and take the first step right away.
The American health care system is a highly competitive, complex environment. Restructuring it will require incremental changes and will demand the joint efforts of federal, state, and local governments and various stakeholders in the private sectors. Community-based interventions to alleviate health disparities should be coupled with refinancing strategies at the state and federal level to be effective. Genuine partnerships and networks that leverage resources, share information and collectively make decision can link resources to community demographics and ultimately improve health status through equal access, quality, financing, and the delivery of health care services. From a theoretical perspective, developing networks for community-based participatory research (CBPR) is a prominent alternative to improving health and reducing health disparities. This research approach allows all stakeholders to sit at the table and conjunctively formulate heath policies that will improve our current health conditions.
Interventions to Alleviate Health Disparities
Although the Agency for Healthcare Research and Quality (AHRQ) reported progress in reducing health care disparities, research findings warrant the need to accelerate progress towards achieving higher qualities and more equitable access to quality health care. Our current president is motivated and working diligently to discuss policy options associated with inequalities in our present health system. Failure to warn against inceptions of political evils that sabotage reform efforts will result in status quo.
Policy options should avoid narrow thoughts of health insurance deficiencies and consider broader factors (i.e., inequalities in health results from forms of social injustice and racial discrimination) that have been major determinants on access to quality health care. Our national goal is to eliminate unequal access to quality health care and to build stronger healthier communities. In efforts to achieve this goal there must be a balance between ethical commitment and pragmatic flexibility. Community-based initiatives are essential in reducing health disparities. Initial steps to equality should begin with tracing the occurrence of inequitable behavior, education, and empowering the community to stimulate change.
Improve Data Collection
The current availability of standardized, coordinated data across public and private sectors pertaining to race, ethnicity, and socioeconomic status is insufficient. The initial step towards social justice in health care is to implement laws and regulations guiding data collection activities by clinical information systems--hospitals and ambulatory care, health plans, and government agencies in order to create a national health care database. Movement of improved data collection is crucial to track the occurrence and target improvement initiatives to reduce disparities. Health care needs differ amongst individuals, populations, and geographic locations. These elements are considered when formulating health care costs and local tax revenue sources. Since place (geographic location) is indirectly linked to income and directly linked to access and quality of health care and its delivery; it should be tracked to guide policy-makers in their efforts to provide equality in health care.
Cultural Competency, Capacity, and Empowerment
Racism and discrimination are cognitive behaviors that are the most difficult to change because they are subconsciously embedded in the minds and spirits of the masses and have acquired a certain threshold of acceptance. Mechanisms for changing these behaviors must be structural, cultural, and process and cognitive oriented. In a system that rewards compliance and ostracizes resistance, medical professionals or conservers operate like sardines in a can. We need enthusiastic advocates that push cultural competence, capacity, and empowerment.
In terms of health care, cultural competency is knowing and respecting cultural differences within the population served and using built knowledge in cross-cultural situations.Techniques to enhance cultural competency include interpreter services for language barriers, recruitment, and retention, a more representative diverse health care workforce, cultural and subculture training, and culturally competent health promotion to educate and encourage good health practices. Understanding the diverse needs of the population assist in articulating values to policy makers.
Community capacity and empowerment are two broad perspectives of social protective factors. Community capacity builds on social networking, active participation, leadership, understanding one's history, articulating values, and accessing power. Building consensus is a critical part of community empowerment. Community empowerment is defined as a social action process by which individuals, communities, and organizations gain mastery over their lives in the context of changing their social and political environment to improve equity and quality of life. Community engagement is essential in building capacity and empowerment. If community engagement is not enhanced, community empowerment will not work as a strategy to reduce health disparities.
