Tailoring Healthcare: Understanding and Surpassing Hierarchies

Former UN Secretary-General Ban Ki-moon
[Photo: Flickr user The Official CTBTO Photostream]

United States health outcomes are lagging in comparison to the rest of the developed world: but why is this the case?

It has always been a problem, but is now center stage to the public and global eye: in a time of political supremacy and educational hierarchies, the evidence of poor foundations in healthcare is more evident than ever before. 

Former U.N. Secretary-General Ban Ki-moon allows an outside perspective on U.S. health care systems in an interview with the guardian,  discussing how poor people are lacking support largely due to the failures within the healthcare system and healthcare law. Kin-moon commented on the inability of U.S. officials to move toward universal healthcare, mainly due to inclusion of hierarchies, such as pharmaceutical companies, hospitals, and doctors, in healthcare law and decision-making.

Source: Sara R. Collins et al., “First Look at Health Insurance Coverage in 2018 Finds ACA Gains Beginning to Reverse: Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, Feb.–Mar. 2018,” To the Point (blog), Commonwealth Fund, May 1, 2018.

Since the Trump administration has taken office, healthcare law has weakened, and as a result, around 4 million people within the United States have lost coverage since 2016, increasing total unisured people from 12.7% to 15.5%. This is a problem, especially within the United States, given the fact that we have the highest healthcare costs in comparison to any other industrialized nation, despite education and literacy rates, and innovations in technology.  

If we look at specific health outcomes, the maternal mortality rate within the U.S. is also much higher than any other industrialized nation. Women and maternal death rates show similar patterns; numbers declined during the latter half of the 20th century, but are now seeing the reverse effect--a steady incline since 2000. Maternal deaths associated to chronic disease has increased by alarming numbers.

 Data: Centers for Disease Control

As a recent CDC study supports, this is largely due to systemic errors in the healthcare system. About 12% of U.S. women of child-bearing age (roughly 15 to 44) do not have healthcare. Often, many mothers on Medicaid or living without insurance choose to see a doctor only in the later stages of their pregnancy. By these end stages, it is too difficult to diagnosis and treat any severe medical conditions. Women of child bearing age are dying more frequently from chronic illness, likely due to the discounting of women throughout the healthcare system.

Even when a women is able to choose to see a doctor, there is a fear of the possibilities and the end results. Often, people not only fear the use of medical jargon, but also the degrading and condescending attitude of a doctor. The patient-provider relationship has always been viewed in a paternalistic manner. Ideally, the provider recognizes a health issue, and as a result, directs the patient towards the proper treatment path that they believe is best for the patient. This view stems from the belief that since the doctor has an education and experience that can better mitigate a medical decision. 50% to 70% of the general population voiced concerns in addressing mistakes, confusion, lack of quality of care, or did not want to appear to be a "troublemaker."  A survey done on women in Australia found that nearly 40% of women worried about being perceived as a "hypochondriac" or "drama queen" if they were to speak up if something did not feel right.

Though the U.S. leads in healthcare costs among other industrialized countries, the hierarchies in healthcare exists globally, and are a contributing factor to inferior health outcomes. Not only do these viewpoints foster an environment where patients are uncomfortable to speak, but also an environment where patient safety is not placed as a priority. Power hierarchies in patient-doctor relationships must be diminished and eliminated in order to promote healthcare models that encourages proper moral and value-based patient care. There needs to be a maintained focus on the overall healthcare system, and implemented plans to address individualistic issues in specific areas around the globe.

There is also vital importance in continuing to ask questions; we should be consistently challenging health care and working to break down these hierarchies to provide equal opportunity and outcome to all. Davis explains the ways that Our Body, Ourselves does this. By tailoring different versions of the book to include narratives and questions of women's health specific to areas around the globe, authors allow distinguished analysis. This allows populations to ask the correct questions to direct the attention of healthcare systems toward being more inclusive and diverse, yet specifically tailored to the needs of an individual population.

Equity is crucial to providing quality healthcare and treatments that result in positive health outcomes. By addressing the needs of healthcare systems on a individualistic basis, we will recognize improvements in outcomes and healthcare quality. Surely, these advancements will not happen overnight, but long-lasting change takes time and constant attention.  Despite some steps backwards from current administration, it is time to build awareness, and surpass the implemented hierarchies in healthcare.