Adam,
And I thank you. Creating a more equitable society sounds to me like "a
great rallying cry."
In a country that really places a high value on competition, individual
initiative/responsibility,
and winner-take all rewards, and that basically believes economic inequality
fuels the
motor of a dynamic economy, creating a more equitable society sounds as
"impossible" as the
goal of "eliminating health disparities."
Anyway, neither are easy nor do I expect either to be achieved in the short
term in the US --
but that doesnt mean it isnt worth working toward both of those goals.
Barbara
-----Original Message-----
From: Oliver,AJ [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 12:00 PM
To: [log in to unmask]
Subject: Re: SES and the doctor-patient communication
Barbara
Thanks for your message. I think a first point a call, however, that I don't
think you mention in your reply, is "do we know why, which and to what
extent we wish to reduce health disparities". Of course, calling for the
elimination of health disparities is a great rallying cry (not least because
many people - I think incorrectly - equate inequality with inequity), but it
might not have that much to do with creating a more equitable society.
-----Original Message-----
From: Barbara Krimgold [mailto:[log in to unmask]]
Sent: Wed 8/14/2002 4:36 PM
To: [log in to unmask]
Cc:
Subject: RE: SES and the doctor-patient communication
Dear Adam,
This is not lobbying. This is part of the US Department of Health
and Human
Services (DHHS) Report,
Healthy People 2010, which guides US health policy for the decade.
The goal
-- whatever you
or others may think of its feasibility -- is the elimination of
health
disparities by race/ethnicity,
gender and income/socioeconomic status. Our previous Surgeon
General, Dr.
David Satcher,
promulgated this goal -- along with several disease-oriented
objectives --
and the DHHS has research
programs, Centers of Excellence, and intervention demonstration
programs --
focused on disparities
by socioeconomic status, gender and/or race ethnicity -- underway to
pursue
this goal.
While some researchers acknowledge, as you do, that this goal may be
"impossible" to achieve,
many policy officials involved in establishing this policy for DHHS
Healthy
People 2010 believed
it was important, as Martin Luther King's "I have a Dream" speech
was
important, to have a goal
to reach for, a real vision of fairness in health -- which makes it
different from other Healthy People
2010 incremental disease-oriented goals,which may be more amenable
to health
care interventions.
Of course, the goal of eliminating health disparities implies
reducing
differential outcomes.
At the DHHS minority health summit in June, there were panels on 1)
Do We
Know What We Need to
Know to Reduce Disparities in Healthcare Access? and 2) Do We Know
What We
Need to Know to Reduce
Disparities in Health Outcomes? These are two quite different
issues &
research areas in the US.
The Institute of Medicine Report, not official policy but our highly
regarded medical research part of
our National Academy of Sciences, released their report "Unequal
Treatment:
Confronting Racial and
Ethnic Disparities in Health Care" this spring, a report on
differential
treatment in the health care sector,
also with differential outcomes, attributable not to lack of
insurance, but
to differences in health care.
We realize that health treatment disparities are an important part
of -- but
clearly not the only factor in
health disparities.
In short, I didnt make this up, and it is not lobbying, although it
is
certainly advocacy for more equity in health --
in US health care, in health policy, in social & economic policy.
The goal
is part of official US DHHS policy goals,
however unrealistic it might seem to you -- or to others in the UK
or EU.
In the US, I would be the first to admit, we have some gaps between
our
ideals and our policy & practice.
Barbara
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
[log in to unmask] <mailto:[log in to unmask]>
-----Original Message-----
-----Original Message-----
From: Oliver,AJ [mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 11:19 AM
To: [log in to unmask]
Subject: Re: SES and the doctor-patient communication
Dear Barbara,
I don't mean to sound awkward, but isn't the goal of "eliminating
health
disparities by race/ethnicity, gender and income/socioeconomic
status"
verging on the ridiculous.
What sort of disparities? (e.g access, utilisation or outcome? Did
you mean
'health' or 'health care')
How can they possibly be eliminated by 2010? (there's hardly any
proven,
effective policies to reduce disparities in health)
And won't at least some of the disparities possibly be equitable
(i.e.
arising from choice)?
Perhaps its just me, but I see the creation of equitable societies
as rooted
in ethics and social science rather than lobbying.
Adam
-----Original Message-----
From: Barbara Krimgold [mailto:[log in to unmask]]
Sent: Wed 8/14/2002 2:53 PM
To: [log in to unmask]
Cc:
Subject: Re: SES and the doctor-patient communication
You might look at work in the US around Race and Unequal
Treatment,
in particular the recent study of the US Institute of
Medicine,
"Unequal Treatment:
Confronting Racial and Ethnic Disparities in Health Care."
In the
US, we
have a goal, in our governmental health document, Healthy
People
2010,
of eliminating health disparities by race/ethnicity, gender
and
income/
socioeconomic status. Since the US does not always collect
data by
class/SES, much of our literature -- literally hundreds of
studies
of
differential treatment for cancer and cardiovascular
disease, etc --
uses race as a proxy for class (plus other discriminatory
treatment)
and documents unequal treatment by race.
This might provide a comparison to your work in the EU on
doctor-patient
communication by SES, the "white coat" phenomenon etc.
If you find this idea of interest, you can find the study on
the IOM
website,
www.nas.edu. Look under www.nas.edu/health and you will
find the
executive summary of the report which you can read or order
online,
if you find it of interest.
Best regards,
Barbara Krimgold
Center for the Advancement of Health
2000 Florida Ave. NW, Suite 210
Washington, DC 20009
Tel: 202-387-2829 ext. 109
Fax: 202-387-2857
[log in to unmask]
-----Original Message-----
From: Jan De Maeseneer
[mailto:[log in to unmask]]
Sent: Wednesday, August 14, 2002 6:14 AM
To: [log in to unmask]
Subject: Fw: SES and the doctor-patient
communication
----- Original Message -----
From: Jan De Maeseneer
<mailto:[log in to unmask]>
To: [log in to unmask]
Sent: Friday, August 02, 2002 4:25 PM
Subject: SES and the doctor-patient communication
Dear Mr. Oliver,
I work as a PhD and assistent at the University of
Ghent. In
february this year I received a scholarship for a project about the
influence of the socio-economic status of patients on the
doctor-patient
communication. The aim is to review the literature and to use the
Eurocom
Study-database to perform a quantitative study on this subject.
Unfortunately, little has been published concerning this particular
part of
inequalities in health.
I performed a thourough search using Pubmed and
journal
databases, now I am writing this email to several people who I think
might
have interesting articles or other links that could help me.
Would you be so kind as to consider my question?
Any tips can be send to my private email:
[log in to unmask]
Thank you for your cooperation!
Dr. Stéphanie De Maesschalck
Vakgroep Huisartsgeneeskunde
en Eerstelijnsgezondheidszorg.
Department of General Practice and Primary Health
Care.
U.Z. - 1K3
De Pintelaan 185
B-9000 Gent
Tel: ++32 9 240 35 42
Fax: ++32 9 240 49 67
e-mail: [log in to unmask]
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