Wealth inequalities are typically the first types of inequalities that come to mind when thinking about disparities in the world. In that context, is the world as a whole growing more or less equal? Even though this is not a simple question to answer, based on extensive research by many economists data suggests that inequalities within nations are increasing, whereas inequalities globally are decreasing, as many underdeveloped nations are suddenly producing a very large middle class. Does this mean that at some point in time all the world economies will intersect and result in total wealth equality among all nations? The answer: not really, as there are many variables that contribute to this equation, including population growth, migration, underestimation of top incomes and tax, gender equality issues, war and violence, and cultural barriers.
How does this wealth inequality relate to health equality? It has been common practice to use a nation’s GDP as an indicator of the health of that nation’s population. Until recently, it was assumed that those countries with a lower GDP had poorer health outcomes as measured by infant and maternal mortality rates, and that more affluent countries had better outcomes. It is a fact that a nation’s GDP relates to its health, but not in a positive way always. On the contrary, the economic inequality within a sample population has a bearing on many health outcomes in that population, with bad outcomes at both ends of the spectrum, as exemplified by infant and maternal mortality at one end and obesity, cardiovascular disease, and diabetes at the other end. Social habits that breed with increasing affordability affect the rich and the poor equally in their own way, as evidenced by increased rates of cancer, violence, drugs, and trafficking and their impact on the society. Inequality also causes social isolation among all ages, especially in the elderly, which in turn leads to depression and other mental illness and more morbidity and mortality.
Additionally, it is ironic to see that the economic value of health care is an oxymoron in that if a nation faces a pandemic and a lot of money is spent on medical care, the nation’s GDP will artificially rise; however, it is not a desirable situation, and it does not relate to the nation’s health in a positive way. Because GDP takes into account all work regardless of its impact on the net financial change, it is misleading to rely on that metric to evaluate the status of a nation’s health. On the other hand, other measures like standard of living, discretionary income, human utility, mental status, and general happiness present in the population are a better indicator of a population’s state of wellbeing.
As depicted in Julie Livingston’s Improvising Medicine, there is a clear difference in the care given to cancer patients in Botswana when compared to similar patients in the U.S. This discrepancy not only stems from the socio-economic conditions in Botswana but also from lack of education, awareness, and cultural beliefs inherent in that area. The attitude of the caregivers towards their patients is also less than optimal, be it because of frustration or helplessness. This also ultimately affects the health outcomes of patients. I have had firsthand experience addressing malaria in Cambodia. The global statistic that 1 child dies every minute from malaria is astounding, especially because malaria is a preventable disease. Lack of awareness of the resources available to treat and prevent the disease, combined with gender discrimination, leads to further spread of the infection. Besides not being able to afford treatments, many in these endemic areas believe that some homemade concoctions can cure malaria, a cultural belief that leads to inequality of use of medical resources. If a family believes in the power of modern medicine but has limited financial resources, a sick male in the family receives treatment over a sick female. Gender-based discrimination results in inequality of medical resources, a practice that is not easy to uproot from societies.
In conclusion, it is important to recognize that there are many inequalities in medical resources, based on not only wealth, but on the type of insurance a patient carries, the society and cultural environment one lives in, and ultimately, one’s own willingness to either accept or reject the available resources. So one formula and rule does not fit everyone and the approach should be tailor-made based on each situation.
- In order to inculcate healthy habits and create wellness, it is oftentimes necessary to eliminate cultural bias. How important is it for the respective governments to get involved in the process? If there is resistance from the government, how should volunteers and health workers enter communities and impart education?
- Gender bias has been a universal problem for centuries, and even in the United States, there remains some discrimination against women. Granted, the degree of discrimination is different, but the fact that it exists is true. That said, do we as a nation have a right to expect and enforce changes in other countries? Are we the gold standard that other nations need to follow against their will?