This research paper discusses the disparities in the health care system, with a specific focus on socioeconomic status and how it affects the access and availability of quality care.

1. Running head: DISPARITIES IN HEALTH CARE 1
Disparities in Health Care: The Significance of Socioeconomic Status
Amanda K. Romano-Kwan
California State University of Long Beach

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Abstract
This research paper discusses the disparities in the health care system, with a specific focus on
socioeconomic status and how it affects the access and availability of quality care. Global health
is a growing issue that presents itself in the daily lives of people all over the world. While those
who are high standing in socioeconomic status are granted easier access and better quality to
health care, those who are in poorer standings are left to fight for mediocre care at costly prices.
Meanwhile, there is a labor shortage of health care workers in rural areas, leaving those in most
need of care without any form of care at all. The research here will discuss health care disparities
and the meaning of true access to health care. It will also cover the social determinants of health,
poverty and its effects on an individual’s health status, and methods to combat poverty. Finally,
it will review disparity in the health care work force and its effects on rural populations. This
paper will be focusing on these issues and the possible solutions to help improve the health care
system.

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Disparities in Health Care: The Significance of Socioeconomic Status
Health care disparities occur when there is a difference in health care between different
population groups. These differences are associated with the inequality of access, health
coverage, and quality of care (The Henry J. Kaiser Family Foundation, 2012). Although health
disparities are typically discussed through views of race and ethnicity, they can also refer to
socioeconomic status and geographical location.
Access to Health Care
Access to basic health care is considered to be a fundamental human right. However,
various factors, such as war and natural disasters, can cause access to health services to become
limited. Access to health is a major economic and political concern in countries all over the
globe. While some countries, such as France and Italy, rank at the top of the list for their health
care system, other countries leave much to be desired. Ideally, a good health system would have
a fair distribution of health, responsiveness, and finance. The World Health Organization
(WHO) has three primary goals of a good health system: the health status of a population must
be good across their life cycle; the responsiveness of their system must meet the expectations of
treatment; and the system must be fair in financing, meaning an even distribution throughout the
population and financial protection for everyone. When comparing countries internationally, the
basis includes the cost, access to health care, the health and well-being of their citizens, their
responsiveness, their attainment and performance, fairness in financing, and overall satisfaction
with the health care system. Every country around the globe aims to have a high standard of

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health, but in order to achieve this goal, an increase in the access and tools to health are
necessary.
Evaluating Access
The Universal Declaration of Human Rights was adopted by the United Nations (UN) in 1948. It
was initially drafted as a set of achievements for fundamental human rights to become
universally protected across all nations. Article 25 of the Declaration states that “Everyone has
the right to a standard of living adequate for the health and well-being of himself…
including…medical care” (United Nations, 1948). The human right to a high standard of health
includes the right to access essential medications and health technologies, basic healthcare
services, water, and other foundational resources for health. True access, however, must be
defined. According to the United Nations Committee on Economic, Social, and Cultural Rights,
true access can be evaluated by determining the availability, accessibility, affordability,
acceptability, and quality of the system (Committee on Economic, Social, and Cultural Rights,
2000). In order for a health care system to have availability and accessibility, it must have a
sufficient amount of medical and public health facilities that are highly functioning, well-staffed,
and fully stocked with necessary medical supplies, and must be geographically and physically
accessible to all. A health care system should be acceptable of all patients, regardless of race,
sex, age, culture, or religion. It should also be affordable, meaning that payment for services
should be proportionate with the ability to pay, or economically accessible. Finally, all health
care facilities should be high in quality, with a skilled staff, a clean environment, and a well-
stocked supply.

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Determining Access
Gaps and limited access to health care impact people’s ability to liv/////e to their full potential,
which negatively affects the quality of their life. Limited access includes lack of availability,
high costs, and lack of insurance coverage (HealthyPeople.gov, n.d.). There are many types of
factors that affect one’s level of access into the health care system. Individual-level factors
include stigma and fear, limited communication, lack of knowledge about symptoms or services,
and personal beliefs. Practitioner-level factors can include poor attitude towards patients or
inadequate assessments due to limited information about a range of multiple issues, such as
cultural background. System and service-level factors can be identified as a lack of flexibility in
health care systems, and resource-based or practical factors can include transportation issues or
poor appointment systems (National Collaborating Centre for Mental Health, 2011). Because
limited access to health care is still a major issue in every country across the globe, universal
health care, which will be affordable and accessible to all, is still a long ways away. One major
issue that prevents universal health care to become realized is a country’s world view. While
some governments believe that health care is a basic human right, other countries, such as the
United States of America, treat health care as a commodity that can be bought and sold. By
focusing on monetary growth rather than the health of their people, countries who have similar
views tend to rank lower on the standard health of their people, as many of those who live in
poverty cannot access the basic medication they need. These views limit the access granted to

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people in various countries and therefore prevent the world from moving forward toward a
universal health care system.
Socioeconomic Status
There are many factors that have an impact on a person’s health status, but by far the most
important is ones socioeconomic status or position. “Socioeconomic status indicates an
individual’s standing in society based on social, economic, and educational characteristics”
(Jacobsen, Introduction to Global Health, 2014). These social determinants of health are
conditions that directly influence a person’s access to health services, and therefore their health
status. For example, a person who is well educated, or with a high educational status, is more
likely to get a better paying job, or occupational status, and therefore have a higher wage, or
economic status. Other social determinants can include a person’s social class, sex, geographical
location, ethnicity, or religion. Those with greater economic, social, or political power tend to
have greater access to health services, and in turn, those with power can limit the access of
others. Furthermore, a person’s culture can also influence their health status. Culture is a way of
life that is shared by other members of a social unit, and can include a group’s norms, morals,
values, beliefs, customs, rules, behavior, and communication. An individual’s culture influences
the way they interpret illnesses and seek help. While some countries like the United States use
modern medicine, other cultures, such as the Chinese, use more traditional methods of healing,
such as acupuncture. Having a clear understanding of global diversity and how health, disease,
and medicine is perceived across different cultures is vital to ensuring that access to health care
can become socioeconomically available to all.

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Poverty
Because socioeconomic status is such a huge factor on a person’s access to health care, we can
clearly see the affects that poverty can have on one’s health status. “Even in countries that
provide universal coverage, persons with less income and education do not use health services in
the same way that their wealthier, better-educated peers do” (Adler & Newman, 2002). Those
who are poor simply do not have the ability to access even the minimum level of health care that
they need in order for them live healthily and productively, especially those who are born into
poverty. People in poverty live in less sanitary conditions, therefore becoming exposed to more
diseases. They lack the money to pay the steep prices of proper medicine. The Millennium
Development Goals (MDGs), which were adopted in the year 2000 by the United Nations, has
set out eight major goals to significantly reduce global poverty by 2015. These goals are to:
eradicate extreme poverty and hunger; achieve universal primary education; promote general
equality and empower women; reduce child mortality; improve maternal health; combat
HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a
global partnership for development (Jacobsen, Introduction to Global Health, 2014). These eight
goals provide a definite plan toward international development. Another plan to combat poverty
and its effects is the UNs Sustainable Development Goals (SDGs), whose main priority is to end
poverty by the year of 2030, and achieve a future that can sustain itself from reverting back to
poverty (Jacobsen, Introduction to Global Health, 2014). These seventeen goals include ending
world hunger and achieving food security, ensuring inclusive and equitable quality education,
finding affordable and clean energy, making clean water accessible to all and maintaining

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sanitation, conserving nature, and promoting peace and justice, amongst others (United Nations
Department of Economic and Social Affairs, n.d.). The Sustainable Development Goals provide
a framework that will make leaps in the right direction toward a better future for the earth. By
ending poverty, hunger and disease also follows; no poverty means no poor living conditions,
creating cleaner environments and eradicating many opportunities for disease. By ensuring that
these goals are sustainable, that is to say that they can provide for current human needs without
compromising the ability of future generations to meet their own needs, we eliminate any further
problems with poverty, hunger, or disease. Sustainable health programs will create long-term
health benefits that can endure even after specific projects are over. Many current insurance
plans do not properly cover what people actually require, instead only covering broad areas and
offering benefits that aren’t being put to use. This is a huge waste of money that can be utilized
elsewhere. Unfortunately, the health care system is primarily monetary based; by creating a
system that paid by focusing on actually improving the health of the patients, the health care
system could change overnight. Those who were in the profession solely for monetary gain
would be filtered out, and those who truly cared about the well-being of their patients would
remain. This should be the focus of healthcare. The socioeconomic status or wealth of a person
or their family should not be the determining factor of their access to quality health care.
Disparities in the Health Care Workforce
Studies show that the distribution of health care providers in rural and urban communities is
unequal, with more shortages in rural areas. This is primarily due to the increase in population

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and the Health Care Labor shortage. Rural communities tend to suffer from low physician supply
even though they depend on primary care providers as their leading source of health care.
Despite this, rural residents are more likely than urban residents to have a usual source of health
care, particularly in the rural versus the urban uninsured (Rural Health Information Hub, 2015).
Nevertheless, “rural residents have difficulty accessing after hours care and traveling to see their
usual provider” (Muskie School of Public Service, 2011). Insured or uninsured, the health care
work force and its distribution shortage in rural America is still a major issue. This disparity is
caused by various factors. One factor is education. “The current rate of training of new health
professionals is falling well below current and projected demand, which will make it hard in the
coming years for people to get the essential services” (Brooks, 2013). There is a lack or limit of
proper health care education in rural areas. They tend to lack providers, and the education
provided does not properly prepare providers for working in rural areas. Furthermore, some
medical professions require even more extensive and in-depth education, making it extremely
difficult for students living in rural areas to afford. “There must be continual investment in the
education and funding of the public sector workforce to maintain quality and ensure equity”
(World Health Organization, 2014).There are also fewer role models for potential students in
rural communities. Those who are studying health care tend to move to urban areas to learn, and
those who come from a rural area might not want to move back. This is because the competition
from urban facilities lure providers away for better benefits, salaries, and working conditions.
This migration of health care professionals trained in low-income countries to higher paying jobs

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in high-income countries is called the brain drain (Jacobsen, Introduction to Global Health,
2014). The demographics and health status of rural areas are also a major factor, as there is a
higher burden of disease. They also tend to have more elderly citizens, who require more service
care than can be provided. This creates more demand than there is supply of health care
providers. “The National Rural Health Association (NHRA) believes that it is essential for rural
areas to have an adequate and able workforce to deliver needed health care services” (Burrows,
Suh, & Hamann, 2003). It is important that the disparity of health workers is addressed to better
the health status of cities across the globe.
Policies and Programs to Help Shortages
Although the health care labor shortage is expected to last for some time, there are different
policies and programs that can help implement a change. Allowing new or alternative provider
types to provide their services in rural communities will bring in more supply of physicians.
There can also be policy changes to remove barriers to practice health care. Another potential
solution is telemedicine. Telemedicine, or telehealth, is “the use of medical information
exchanged from one site to another via electronic communications to improve a patient’s clinical
health status” (American Telemedicine Association, n.d.). It allows physicians to more easily
connect with and monitor their patients. Services provided include primary care and specialist
referral services, remote patient monitoring, consumer medical and health information, and
medical education. According to Forbes, telemedicine is already “well-established in rural areas
for specialty consultations, and has been widely used in many primary care practices like
pediatrics as a practical matter” (Frist, 2015). It allows non-physician providers to practice in

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multiple areas while still being advised by physicians. This increases the availability of
specialists, which is sorely needed in rural communities. It also helps prevent physicians from
transferring patients from rural to urban areas, since telemedicine gives them access to specialists
through their technology, along with helping to support the newly graduated providers that have
been recruited to rural areas. Telemedicine gives patients improved access and quality, and is
more cost efficient. Unfortunately, telehealth has yet to be adopted in many rural areas. Policy
changes in the area of education can also make a big impact. Developing distance-education
programs and offering a rural-centric curriculum and training in the health care education
program will help prepare physicians for working in rural areas. Supporting these training
opportunities, including various residency programs, can also encourage providers to stay and
work in rural communities. Additionally, using admissions criteria that are more likely to
produce individuals that are interested in rural practice—for example, admitting students from
rural communities—and giving out grants, loans, and scholarships can help promote people in
rural areas to pursue an education and career in rural health care. By assisting the recruitment
and retention of health care providers for rural communities and supporting the development and
growth of health care education programs, the number of graduates in rural communities will
increase.
Conclusion
Disparities in health care are a pressing issue and influence the daily lives of people all across the
globe, especially in rural communities. Though there are many factors that contribute to the
imbalance in the global health care system, it is possible for it to change. By redefining and

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reevaluating what true access in the health care system means, we can ensure that universal
health care is available to everyone—not just for those who can afford it, but for those who truly
need it. By striving to end poverty and ensure sustainability through the Millennium
Development Goals and the Sustainable Development Goals provided by the United Nations, the
world takes one step closer to ending world hunger and disease. The social determinants of
health majorly influence the accessibility of health care for many individuals, but by focusing on
a system that bases its economic growth on improving the health status of their patients, the
social determinants would have less of a compromising factor. Poverty should not be the
defining factor of a person’s health. Finally, the disparities in the health care workforce can be
improved by different policies and programs. Better implementations of policies and programs
regarding rural community health care, including the educational programs, will bring in more
physicians to the rural work force. This will balance the shortage of health care workers and
properly prepare them for working in a rural area. Telehealth saves time and money for both the
patient and the physician, and allows those in rural areas to remain where they are to receive
care, instead of traveling far distances to get the treatment they need.
An individual’s socioeconomic status should not have such a lasting impact on their health
status. Because vulnerable populations, such as racial, ethnic, or religious minorities, are not
typically factors that can or should be changed, they should not be the victims of an imbalanced
health care system. People should be mindful of one another’s cultures and traditions. Because
access to health care is so greatly influenced by the amount of economic, social, educational, or

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governmental power that one has, we leave millions across the world without the basic human
right to a high standard of health. By focusing on some of these issues and working to eradicate
these health care disparities, we can work toward a universal health care system that benefits
people of all types at a cost efficient price.

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