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Excerpted from: Peggye Dilworth-Anderson, Geraldine Pierre, Tandrea S. Hilliard, Social Justice, Health Disparities, and Culture in the Care of the Elderly, 40 Journal of Law, Medicine & Ethics 26 (Spring, 2012)(44 footnotes omitted)


This paper addresses two interconnected concepts -- health disparities and social justice -- as they pertain to screening, diagnosis of disease, and health care access among minority elders in the American society. Health disparities are defined as differences in treatment provided to members of different racial or ethnic groups that are not justified by the underlying health conditions or treatment preferences of patients. Disparities currently exist in many aspects of American health care. For example, when compared to whites, the infant mortality rate is higher for African Americans; health insurance coverage is lower for Latinos and African Americans; and ethnic minorities experience poorer care and survival rates for HIV, even after controlling for other confounding factors including income, insurance, health status, and severity of disease. Among older Americans, health status varies by race, income, and gender. Older minority Americans have consistently been shown to have worse health than whites of the same age group across measures of disease, disability, and self-assessed health. When compared to whites, elderly Latinos have higher rates of diabetes and disabilities, and older African Americans have more chronic conditions.

According to Barry Levy and Victor Sidel (2005), social justice encompasses two distinct ideas based on the underlying themes of justice, fairness, and equity. The first is that individuals should not be denied of economic, socio-cultural, political, civil, or human rights based on the perception of their inferiority by those with more power or influence. This can be exhibited through forms of stigmatization or stereotyping particular groups. The second idea is that society -- as a collective -- must act to ensure the conditions under which people can be healthy, in the form of policies and actions that affect societal conditions. The idea of social justice can be applied directly to all areas of health care, particularly access, diagnosis, and provision.

In the context of health disparities, social justice refers to the minimization of social and economic conditions that adversely affect the health of individuals and communities. Several factors related to social injustice may lead to increased rates of disease, injury, disability, and death. These factors include poverty, inadequate education, lack of health insurance coverage, and limited availability of medical care. Advocates of social justice have long established the need to provide comprehensive health care services that would aid every individual, regardless of income, geographic location, and racial identification. This mission is even more urgent for America's elderly minority population, as reflected by the nation's primary policies in health care. The Healthy People Report of 2010 identifies eliminating health disparities and improving quality and years of life as the two central goals of the nation's health care agenda. These issues remain of critical importance in the Healthy People 2020 initiative. Research has revealed that inequity in the provision of medical needs is more common among older African Americans, older women, as well as those with incomes below the poverty line. The implications of this from a social justice perspective are numerous, as the injustices of health care are reflected through the inability of the most vulnerable minority elders to access quality and equitable care when they need it the most.

The interaction of health disparities, justice, and cultural interpretation of disease is presented as a complex problem that researchers and providers must unravel in order to reduce inequalities in health care, while being aware of cultural differences and promoting equality for all older Americans.

With this concern in mind, in this paper, we use a case study on Alzheimer's disease as an example of the profound disparities and social injustices faced by older minority Americans.

We discuss what we call the conundrum of health disparities -- the intricate and difficult problem of distinguishing between disparities in diagnosis and treatment based on need -- and the role that cultural perception and normalization of disease (in this instance Alzheimer's disease) plays in racial and ethnic minorities being less likely than whites to receive and utilize health care services.

The conundrum takes into account. . . the relationship between disparities, cultural beliefs and perceptions, and lack of social justice in differences in diagnoses, access to care, and screening.