Race, Health Care and the Law 
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Equitable Health Systems and Latino Elders

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Vernellia R. Randall
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Steven Wallace and Valentine M. Villa

excerpted Wrom: AALPTCXLYRWTQTIPWI Valentine M. Villa, Equitable Health Systems: Cultural and Structural Issues for Latino Elders, 29 American Journal of Law and Medicine 247-267 (2003) (159 Footnotes Omitted)

This Article examines the extent to which the U.S. healthcare system is equitable for older Latinos, using the World Health Organization (WHO) and the related Organization for Economic Cooperation and Development (OECD) criteria on health outcomes, access/responsiveness and financing. We argue that improving health equity requires more than actions aimed at health behavior and culturally-based beliefs targeted at the individual. Improving equity also requires changes in broader social and political processes affecting entire populations and organizations of care, paying special attention to how these changes affect the Latino elderly.

Healthcare is particularly important for the older population. Persons age 65 and older have the highest overall rates of death, disease and disability, as well as the most frequent and intense use of medical services. U.S. public policy has acknowledged the high medical care needs of many elderly by establishing Medicare as a universal health insurance starting at age 65, and supplementing it with Medicaid, the public-assistance program for low-income older persons. Over the next five decades, members of the population age 65 and older are expected to double from nearly thirty-five million individuals to over eighty million, representing more than one-fifth of the total U.S. population. In recent years, much has been written about the aging of the U.S. population and its implications for the financing of federal and state programs including Social Security, Medicare and Medicaid.

The WHO has developed a set of criteria for evaluating the performance of health systems in their efforts to improve health. These criteria focus on three important areas of performance: health outcomes, the "responsiveness" of healthcare systems and the financing of those systems. Moving beyond the fiscal policy emphasis promoted by international lending institutions and many U.S. economists, the WHO argues that each area should be assessed on the equity of results in addition to a system's efficiency. This emphasis on equity draws attention to the distribution of results in each area, requiring us to identify population characteristics that are markers of inequality and stratification in society. The OECD recently expanded this framework to incorporate more attention to the equity of access to healthcare.

In the United States, race and ethnicity have historically served as principal fault lines in the distribution of social benefits and economic outcomes, notwithstanding the Fourteenth Amendment. Regardless, the substantial public resources and policy effort focusing on elderly health tends to assume a relatively homogeneous elderly population. Such assumptions are unwise given the increasing racial and ethnic diversity found among the elderly population. By 2050, an estimated 35% of this population will also be members of an ethnic minority population, double the number reported in 2000. Indeed, the Census Bureau projects that while the non-Latino white population age 65 and older will increase by 81%, the Latino population age 65 and older is expected to increase 592% between 2000 and 2050. While the Latino population is traditionally a younger population because of relatively high fertility rates, declines in mortality and reduced fertility, as well as the aging of immigrants have led to the "graying" of the Latino population.

The diversity of the elderly population is not only important from a demographic perspective, but also because the experience of aging varies greatly across groups, revealing significant inequities in health and socioeconomic status. For example, while poverty rates over the past few decades improved among the elderly population, minority elderly persons remain overrepresented among the ranks of the poor. Similarly, while the health of the older adult population has improved, Latinos and other minority groups have disproportionately high prevalence rates for chronic and disabling conditions. Additionally, access to the healthcare services to prevent and treat these conditions continues to vary by race and ethnicity. The Department of Health and Human Services (HHS) recognizes these inequities and has set a national goal to eliminate health disparities among segments of the population, including differences that occur by gender, race, ethnicity, education and income. Eliminating inequities in healthcare requires examination of the health of the population and the determinants of health at both the individual and broader sociopolitical level.

Demographics and the Latino Population
Latino Elderly Health Status Inequities
Inequities in Access for Latino
Health Care Financing and Latino Elderly
Cultural and Structural Roots of Inequities for Latino Elders
Policies to Alleviate Inequities for Elderly Latino

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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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