Introduction to the special issue on health care equity

The COVID‐19 pandemic has tested our health care system both in practice and in theory. Health care workers have experienced strains in their jobs that they had never imagined, and different health care systems in the same region have banded together to make sure that resources were shared as ethically as possible. Our current health care–and broader social–climate is one filled with the collective, traumatic experience of the pandemic. Life has shifted dramatically for everyone, even as we reclaim some sense of normalcy. One such aspect of that trauma is the impact of health disparities on individuals who contracted COVID‐19, and the health disparities that the pandemic has revealed. ¹

The world and its people are forever changed. As Moore et al. point out to, health disparities have played a major role in responses to COVID‐19. Indeed, one cannot study the COVID‐19 pandemic in the United States without also considering the disparities that put the most disadvantaged in our society at the greatest risk of harm and even death. They note, “Thus, health disparity issues are now being compounded by the fact that individuals that were already disproportionately affected by many common chronic diseases will also disproportionately suffer both the short‐term (acute disease/hospitalization) and long‐term morbidity and mortality associated with the pandemic.” ² Not to mention, those disadvantaged by health disparities must also incur the cost of long hospitalization and/or any treatment of long COVID‐19. If anything, the pandemic has highlighted how serious health disparities in the United States health care system are and has called scholars, ethicists, theologians, researchers, and health care systems to consider how best to reduce these disparities. ¹

1. SECULAR AND RELIGIOUS INTERSECTIONS ON HEALTH DISPARITIES

The questions raised by health disparities are of particular interest to the Catholic Health Association of the United States (CHA), of which I am president and CEO because they require not only a secular response but also a religious one. For CHA, the question that motivated our sponsorship of this special issue on health care equity was, “How ought society broadly and Christianity specifically address health disparities in a way that stays true to Catholic mission and values while also acknowledging each individual's humanity?” On health care equity, the ethics of the secular complement, in some ways, the teachings of Catholicism. It is this area of intersection that inspired CHA to bring the issue of health disparities to the fore of discussion in this special issue.

At CHA, our religious duty to address health disparities is grounded in the teaching of the Catholic Church. Five out of the seven principles of Catholic Social Teaching affirm such a duty: “respect for life and dignity of the human person, call to family, community, and participation, rights and responsibilities, option for the poor and vulnerable, solidarity.” ³ Respecting the life and dignity of persons requires that health disparities be taken seriously. ⁴ Health disparities inherently disavow the dignity of the person. The call to family, community, and participation also asks us to consider the needs of the people who live around us, both in close proximity (i.e., family), and our neighbors. It is not enough to identify health disparities and observe them, but we need to participate in the necessary changes. In accordance with participation is the acknowledgment that every human has basic rights, and those rights need to be protected and respected. Health disparities violate this tenet because they fail to see the basic human rights that individuals have. The principle of the “option of the poor and vulnerable” speaks directly to the issue of health disparities and the people most affected by them. The phrase “poor and vulnerable” directly evokes the teachings of Jesus in Matthew 25:40 when he identifies with the “least of these” and emphasizes that to encounter the “poor and vulnerable” is to encounter God himself. To study and suggest changes to improve health disparities is to honor the “option for the poor and vulnerable.” Lastly, the value of solidarity includes living in and among those who are most affected by health disparities. Catholics—and the world at large—should not forget those who are treated unfairly when seeking health care to improve their flourishing as human beings.

Religious and secular principles on health equity intersect with the four medical principles that also inform our duty to take health disparities seriously. The principles, as laid out by Beauchamp and Childress, are: “respect for autonomy, nonmaleficence, beneficence, and justice.” ⁵ Respect for autonomy requires that individuals be able to make informed decisions for themselves. If those decisions are not based on good information or if access to quality health information is impaired, then we cannot, truly, uphold the duty to respect individual autonomy. The twin principles of beneficence and nonmaleficence also will be violated because harm—even inadvertently—will be done to individuals who face discrimination, misunderstanding, and other disparities. Lastly, justice cannot be upheld for all if health care is not delivered in a way that includes their specific needs. If health care delivery and/or practice favors one group of people, then the practice and delivery are not just. These secular principles align with those of Catholic Social Teaching enumerated earlier and allow for a productive conversation between the religious and the secular toward the definitive goal of eliminating health disparities.

We also find religious and secular commonalities when considering, “What are health disparities?” The Centers for Disease Control and Prevention's definition is: “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by populations that have been disadvantaged by their social or economic status, geographic location, and environment.” ⁶ The Commission to End Health Care Disparities elucidates further, writing, “We recognize, however, that understanding health care disparities involves understanding the myriad historical, political, economic, social, cultural, and environmental conditions that have produced inequitable health status among numerous population groups in the United States, that is, health care disparities related to socio‐economic status, class, sexual orientation, gender identity, age, geographic location, education, language spoken, literacy, disability, and other factors.” ⁷ At CHA, we recognize that researching and addressing health disparities, then, requires looking at more than a person's race or socioeconomic status, but rather looking at their life holistically. We note current discussions about the impact of the pandemic on physical, psychosocial, and mental concerns and identifying health disparities and sometimes their causes. ⁸ , ⁹ , ¹⁰ , ¹¹ We believe these conversations would be enhanced by more recommendations on how to end them.

2. A CONVERSATION ON WHAT WE CAN DO

Fortunately, the growing awareness of health disparities in the United States led us, as well as researchers, scholars, hospital systems, and providers to ask, what can we do? We see three main approaches: The first step in addressing disparities is to identify those disparities, and the second step is linking those disparities to their sources or causes. The third step is to create practical solutions that can be implemented at every level and stage of health care delivery. Identifying and describing these health disparities is complicated work because their causes will vary widely from group to group and person to person. Even our understanding of how health disparities manifest and why needs further work. These complexities, though, do not absolve all of us of our duty to reduce health disparities, regardless of our motivating principles. Indeed, reducing health disparities is grounded in both a secular ethic as well as the tenets of Catholic Social Teaching. Although the articles in this issue do not necessarily explore disparities from a religious lens, we hope this special issue contributes to a broader conversation on practical steps to reduce health disparities from both secular and religious perspectives, with a focus on allowing human beings to flourish and receive the best possible health care.

FUNDING INFORMATION

No funding to report.

Haddad M. Introduction to the special issue on health care equity. Health Serv Res. 2022;57(Suppl. 2):165‐166. doi: 10.1111/1475-6773.14079