Fundamental Causes, Inequity and Public Health

Social injustice particularly that of [public] health, has been a constant pariah to the common society. Various ‘theories’ were posited as to the root cause of public health inequity; Phelan and Link (2005) directly associated the ‘fundamental’ causes of public health inequity with the ‘socioeconomic statuses (SES)’, the ‘social conditions’, the ‘gradients’ that existed therein. The fundamental cause lies on the material/ resources imbalance as the authors Phelan and Link (2005), Farmer (1999), and Lynch et al (2000) demonstrated.

The fundamental causes of morbidity and mortality consist of: (1) influences to multiple disease outcomes, (2) operation through multiple risk factors, (3) intervening mechanism reproduce the association, and (4) finally, the most important feature of ‘fundamental causes’, it involves accession to resources that can be used to avoid risks or minimize the consequences of the disease involved. Health accession is shaped by extent of socio-economic resources (Phelan and Link, 2005). Here it is noted that the cognitive ability or intelligence cannot explain the relation between resource and health.

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SES, is, admittedly a ‘constant’ and persistent state of the general society (Phelan and Link, 2005). Not even the introduction of knowledge or the epidemiology of the disease was able to completely eradicate the health maladies present; instead, it seems to encourage health inequity.  The US, a supra-economic world engine, has a systematic health care delivery system yet a relatively large proportion of their population—American Indians, Blacks and Hispanic and Asian immigrants—do not enjoy the benefits of the health care system as much as their rich counter parts. Localization of public health inequity is fed by the health biased terms like ‘Third World’, ‘Blacks’, ‘the poor’, and other terms that denote social stigma and racism . The aggravation of health inequity is destined to worsen with the current trend on ‘commodifying’ medicine and health and their ‘money-making’ participation in the market industry.

Health inequity, as a result of multi-faceted elements of the society, is, as much as a disease as the feared bacillus ‘tubercle’, the causal agent of tuberculosis; Farmer (1999) illustrated the consumption of the disease agent ‘consuming the lives of the lower strata that existed in the late twentieth century. Farmer illustrates the case of societal ‘infection’ with different experiences of three stereotype tubercle patients—Jean Dubussoin (Haitian rural peasant), Corina Valdivia (Latin American with a multi-resistant drug strain of bacillus tubercle) and Calvin Loach (Afro-American and injection drug user). It was ‘social factors’ that determined the fate of these three-infected persons.

Their struggle against their disease demonstrates the common obstacles they faced during health accession. Jean’s very low income and the long distance from the hospital dilapidated her chance at having a good accession to medical services offered. Corina’s case was exactly the same except that it demonstrated that of improper treatment of her disease and medical wariness. Calvin’s case was psychosocial wherein there was suggested wariness between him and the medical practitioner due to ‘[racial] wariness’ and late detection.

Health inequity of tubercle bacillary patients does not stem from medical mismanagement, from physician-directed errors, as the three ‘stereotypes demonstrate, but more on the conglomeration of factors like race, income, economic policies, ease of health accession and fear of being apprehended or ignored by the medical staffs (Farmer, 1999). According to Lynch et al (2000), health inequity may also be associated with neomaterial interpretation —differential accumulation of exposures and experiences that have their sources in the material world—and differences in individual income. Health inequity, then, in general, is highly dependent on the resources of the individual. This is in opposition of the psychosocial theory which precludes that inequity is, more or less, a result of hierarchy stress or the combination of maladaptive behaviours as a reaction to the SES.

The association between the standard of living and health cannot be easily dismantled, yet, on the face of such social health injustice, what actions are available for the State to remedy this particular problem? Lynch et al’s (2000) on solubilizing the problem was vague and inconclusive:

.. strategic investments in neo-material conditions via more equitable distribution of public and private resources that are likely to have the most impact on reducing health inequalities and improving public health in both rich and poor countries in the 21st century…(p. 1203)

Farmer’s (1999) ultimate solution is pragmatic solidarity. The term was rather vague and inconclusive with no proper definitum; Pragmatic solidarity was loosely defined as something that would mean ‘increased funding for control and treatment [of diseases]’, ‘making therapy available in a systematic way’ and preventing ‘emergence [of diseases]. Farmer’s primary intent is to target the health anathema at the specific level. On the other hand, Link and Phelan’s approach was different. Link and Phelan (2005)   posited a barrage of solutions which capitalizes on policy consideration as macro-level approach to the problem— creating intervention that benefit state members irregardless of their own resources and actions, monitoring the dissemination of health enhancing information and interventions and creating policies that would  distribute resources to the poor.

A good solution to the problem would be targeting health inequity using combinatorial methods on the macro and micro-level approach. Interventions created at the larger scale such as policy consideration is a good approach and finding out the etiology of various diseases obviously have positive outcomes for ‘curing’. Such interventions are necessary to preserve not only the health of the general public but also to maintain a relatively pure, socially just and a healthy environment.

 

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