Health inequities between U.S. residents of different races, ethnicities, geographical locations and socioeconomic status have been recorded since the mid-1800s. While certain interventions have proven effective at alleviating disparities, these gains could be offset by broader trends that disproportionately benefit privileged groups or harm vulnerable populations, according to a study in the June issue of Health Affairs.
Because it's impossible to empirically investigate future determinants of health disparities, researchers focused on trends that include factors of health disparities, as well as those that affect the distribution of resources, risk and power in society, according to the report. "Thus, threats to equity in health and healthcare include not only hazards that disproportionately threaten vulnerable populations, but also innovations that unevenly benefit privileged groups," the authors wrote.
Here are four trends that have the potential to widen the gaps in health between different groups, according to Health Affairs.
1. Technological progress against diseases. Progress in the development of drugs, diagnostics and devices can increase disparities in the likelihood of survival between patients of high and low socioeconomic status. For example, privileged groups are disproportionately benefited by the emergence of personalized medicine and the breakthroughs in clinical care that it delivers.
The study cites several reasons why: First, ethnic and racial minorities are underrepresented in the studies that anchor translational efforts in personalized medicine. Second, the cost of such treatment prohibits many underprivileged groups from accessing it. Third, excitement over the potential of personalized medicine could threaten health equity by attracting investments that could have been directed toward efforts to address social determinants of health.
2. Efforts to reverse Medicaid expansion. Under Medicaid expansion, which covered 11 million new enrollees under the ACA, uninsurance rates fell by 3 percentage points for whites, but by more than 7 percentage points for Hispanics and 5 percentage points for blacks, according to the report.
President Donald Trump's administration is working to repeal and replace the ACA, which includes reversing Medicaid expansion. If this occurs, access to care will be in jeopardy for the poorest and likely the sickest patients, according to the study. "Medicaid can protect low-income, uninsured people from financial debt, and a complete reversal of the expansion would likely exacerbate disparities in financial security between people of low versus high socioeconomic status," the authors wrote.
3. Possible dissolution of protections for preexisting conditions. As part of their efforts to overhaul the national healthcare system, congressional Republicans have proposed repealing the provision of the ACA that prohibits health insurance companies from pricing plans differently or denying coverage to people with preexisting health conditions. Those with preexisting conditions account for 27 percent of nonelderly adults and are disproportionately members of racial and ethnic groups, according to the report. Repealing this protection would leave many of the nation's sickest without insurance due to cost.
4. Environmental hazards. Vulnerable populations are more likely than privileged groups to face exposure to environmental health hazards, such as through consumption of pollutants. Additionally, the poorest and most socially vulnerable groups are more likely to be most affected by adverse affects of climate change, such as intense storms, flooding, fires, heat waves and droughts, which can cause food insecurity, violence, political conflict, mass displacement, disease and pollution.