Ethics and HD

ETHICS AND HEALTH DISPARITIES SOCIAL DETERMINANTS OF HEALTH
 Globalization has heightened the awareness Carter-Pokras and Baquet (2002) define health
of health inequities across population disparity as a “chain of events signified by a
groups in local, national, and global difference in:
contexts
(1) environment,
 The terms used to refer to these differential
health statuses, health outcomes, an access (2) access to, utilization of and quality of care, and
to quality health services in population
groups vary across the globe. (3) health status or a particular health outcome”
 European countries and the World Health
 Environment incorporates both physical
Organization (WHO) have adopted the
and social aspects that impact health status.
notion of social inequality and injustice as
the explanation for differences in morbidity  Exposure to pollutants, overcrowded
and mortality in populations. residential areas, and neighborhoods with
absent or marginal resources are associated
WHO (2013) defines social determinants as
with poor health.
 the conditions in which people are born,
 The higher their social position, the better
grow, live, work and age that are shaped by
their health. The social gradient was
the distribution of money, power and
evident in mortality from coronary heart
resources at global, national and local levels
diseases and other causes of death. Marmot
which are mostly responsible for health
labeled this phenomenon the status
inequities. Health inequities refer to the
syndrome.
unfair and avoidable differences in health
status seen within and between countries.
 The lower individuals are in the social
Health disparity is defined as: hierarchy, the less likely they are able to
meet their needs for autonomy, social
 A type of difference in health that is closely integration, and participation (Marmot,
linked with social or economic 2006).
disadvantage. Health disparities negatively
affect groups of people who have  In the United States, income, education, and
systematically experienced greater social or occupation have all been shown to predict
economic obstacles to health. These morbidity and mortality (Miranda, Messer,
obstacles stem from characteristics & Kroeger, 2012; Seith & Kalof, 2011;
historically linked to discrimination or Williams, John, Oyserman, Sonnega,
exclusion such as race or ethnicity, religion, Mohammed, & Jackson, 2012).
socioeconomic status, gender, mental
health, sexual orientation, or geographic  According to the Centers for Disease
location. Other characteristics include Control and Prevention (2011), despite
cognitive, sensory, or physical disability. (U. progress over the past 20 years,
S. Department of Health and Human racial/ethnic, economic, and other social
Services, 2009) disparities in health persist.
 Krieger (2012) has suggested that societal
patterns of disease are the biologic
consequences of life conditions produced
by a society’s economic and political requiring most people to have or purchase
structure. health insurance
 Studies of racial residential isolation  produces a new kind of nonprofit health

concentrating poor blacks in insurer, Consumer Operated and Oriented
neighborhoods with overcrowd housing, Plan (COOP), which offers consumer-
low quality health services and schools, friendly, affordable health insurance
violent and polluted environments, and options to individuals and small businesses
limited availability of affordable healthy through the Affordable Insurance Exchange
foods create cumulative health risks and  provides free access to most preventive
limited opportunities for economic services and drug coverage for eligible
mobility that perpetuate social and seniors. Individuals can add or keep their
environmental injustices resulting in poor children on their health insurance policy
health. until they reach age 26.
 Studies of chronic stress associated with Hispanic Men Who Have Sex with Other Men
experiences of discrimination,
 Using the snowball recruitment technique,
marginalization, and lack of control over
20 foreign-born Hispanic bisexual or
one’s life circumstances create a “wear and
homosexual men between 26 to 54years of
tear” effect on the body, or allostatic load.
age who were residing in South Florida
participated in three focus groups to gather
 Poor intrauterine conditions such as
their perceptions and concerns regarding
increased levels of maternal stress
how risky sexual behaviors, substance
hormones and malnutrition have been
abuse, and violence affected the Hispanic
correlated with coronary disease in
men who have sex with other men (MSM)
adulthood.
community.
 Stressed the importance of addressing  Participants identified the “roots of risks”
social determinants as more significant in for risky sexual behavior, substance abuse,
improving health than physical pathologies and violence in the following factors: (a)
alone. Understanding the fundamental stressors from immigration, acculturation,
causes of poor health facilitates accurate discrimination, and economic situation, (b)
assignment of responsibility and peer pressure, (c) Hispanic value of
identification of measures to rectify the machismo, (d) inability to maintain stable
problem. intimate relationships, and (e) lack of
psychosocial support
The Patient Protection and Affordable Care Act  Participants identified risky sexual
or the Affordable Care Act (ACA) behaviors as a result of negation of risks
and substance abuse to buffer negative
 was signed into law by President Obama on
events and emotions. Lack of psychosocial
March 23, 2010
support and acceptance breeds the threat of
 to provide access to health coverage to violence from individual partners and the
more than 40 million Americans. community.
 expands health care coverage to most US CULTURALLY COMPETENT ETHICAL DECISION

citizens and permanent residents by MAKING
 Globalization has heightened the need for through social justice and protection of
health professionals to have a worldwide human rights.
perspective and assume an ethical-moral
obligation to enter and function in a  Culturally competent care is not merely at
worldwide community. the level of doing no harm
(nonmaleficence), but more immortality. It
 World citizenship involves a genuine
creates a positive difference in people’s
concern and commitment to the welfare of
lives (beneficence).
all persons and to see the world from the
lens of others. TRADITIONAL BIRTH ATTENDANTS IN SIERRA
 Understanding and feeling the distress of LEONE
another provides the impetus fot the desire
to help.  Sierra Leone, a country in Sub-Saharan
West Africa, has suffered more than a
decade of civil war that destroyed its health
infrastructure and impoverished its people.
 The country is plagued with high illiteracy
and has the highest maternal mortality rate
(MMR) in the world.
 In Sierra Leone, a traditional birth
attendant (TBAs) is mostly untrained,
illiterate woman who perform deliveries as
their main occupation.
 Culturally competent ethical decision  In 2010, the government introduced free
making is proposed as the pathway to health care for all pregnant women,
promote health equity. lactating mothers, and children less than 5
years of age.
 The goal in this model is the achievement
of social justice and protection of human Human rights aim to protect the inherent dignity
rights through culturally competent and equal and inalienable rights of all people.
collaboration, partnership, and advocacy
particularly with vulnerable individuals and  According to John Rawls (1999), justice,
communities. and especially distributive justice, is a form
of fairness or an impartial distribution of
 It is built on compassion as the critical goods.
motivation that compels people to act on
behalf of others, which emerges from an  Rawls proposes two principles of justice:
effective and cognitive understanding and 1) each person is to have an equal right
identification with others experiences. to the most extensive total system
 Vulnerable populations are people who of equal basic liberties compatible
experience a higher risk of poverty and with a similar system of liberty for
social exclusion than does the general all and
population. 2) social and economic inequalities are
to be arranged so
 Culturally competent care promotes that they are both to the
health equity for vulnerable and greatest benefit of the least
disadvantaged individuals and population advantaged.
 Social justice is the ability of people to 3. Cultural repatterning means attempting to
realize their potential in the society where help individuals and groups change their
they live. It implies fairness and mutual way of life to achieve a healthy, safe, and
obligation in society or the mutual meaningful existence.
responsibility for one another, to ensure
that all have equal chances to succeed in
life.
 Advocacy for social justice and human

rights requires collaborative partnerships
with;
- individuals
- families
- communities
The Gawad Kalinga (GK) project has
 It requires multisectoral collaboration
established homes for the poor in 2,000
that attends to the whole spectrum of
communities in the Philippines through global and
keeping people healthy by improving their
local partnerships among individuals,
lie and work conditions, going beyond
governmental and private organizations, and local
access to health care services and disease-
communities to eradicate poverty.
based care.
 Community partnership for social justice

and human rights protection can be GROUP 3
achieved at so many levels. Group Members:
 Nurses can also participate in influencing  Domesa, Aivy Mae V.

health and social policies impacting the  Deposoy, Jorinda T.
community through their professional  Gallemit, Catherine Faith
organizations, churches, parent-teacher  Guiret, Mystyca Styx Angel A.
organizations, and municipal boards.
 Maglangit, Marilou P.
According to Leininger (2002), Culturally

Congruent Action Modes are the following:
1. Cultural preservation means maintaining

the core values, beliefs, and practices
significant to the individual or group.
2. Cultural accommodation involves

negotiating with existing cultural
differences in order to find a meaningful
existence of one’s cultural lifeways with
those of others.

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ETHICS AND HEALTH DISPARITIES SOCIAL DETERMINANTS OF HEALTH

 Studies of racial residential isolation  produces a new kind of nonprofit health

 expands health care coverage to most US CULTURALLY COMPETENT ETHICAL DECISION

 Advocacy for social justice and human

 Community partnership for social justice

 Nurses can also participate in influencing  Domesa, Aivy Mae V.

According to Leininger (2002), Culturally

1. Cultural preservation means maintaining

2. Cultural accommodation involves

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