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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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