A 2017 survey conducted by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health found that 22 percent of African Americans reported that they avoided needed medical care because of fear of discrimination, and more than half did not go to the doctor when they needed care because of cost.
A similar survey of Hispanic Americans found that 17 percent avoiding medical care out of fear of discrimination, while 58 percent reported that they did not seek medical care because of the cost.
Insurance matters, too. A 2002 report from the Institute of Medicine (U.S.) Committee on the Consequences of Uninsurance concluded that "Uninsured women receive fewer prenatal care services than their insured counterparts and report greater difficulty in obtaining the care that they believe they need."
That report also found, unsurprisingly, that "Health insurance status affects the care received by women giving birth and their newborns. Uninsured women and their newborns receive, on average, less prenatal care and fewer expensive perinatal services."
It concluded, "Uninsured newborns are more likely to have adverse outcomes, including low birth weight and death, than are insured newborns."
Poverty SickensPoverty itself makes people sick.
Environmental problems plague lower-income communities and communities of color. Jasmine Bell listed five of the environmental injustices faced by communities of color, including higher exposure to air pollution; greater proximity to landfills, toxic waste sites, and industrial facilities; higher rates of lead poisoning; water contamination; and greater vulnerability to the effects of climate change.
Each of these factors can directly affect the health of children. An in-depth report in Scientific American, "Pollution, Poverty and People of Color: Children at Risk," detailed the harmful health effects of environmental pollution and chronic stress. The complex relationship between poverty and health was explored further in a journal article entitled "Epigenetics and Understanding the Impact of Social Determinants of Health."
Low-income housing can make you sick, too. A report for the Philadelphia Department of Health outlined the harmful impact of inadequate housing on children's health. Housing can cause or exacerbate asthma, lead poisoning, and physical injury, and can inflict emotional harm on both parents and children.
Childhood obesity is singled out in the Health Affairs study. It's worse among poor children, and its effects are more severe. Other factors affecting child health include nutrition for both mothers and children.
Inequality: Economic, Medical, and PoliticalThe 2018 World Inequality Report (by Alvarado, Chancel, Piketty, Saez, and Zucman) found that "the divergence in inequality levels has been particularly extreme between Western Europe and the United States, which had similar levels of inequality in 1980 but today are in radically different situations."
Today, according to a related paper, the top percent earn more than 20 percent of the nation's income, up from 10 percent in the 1970s. The share going to the bottom 50 percent of earners fell from 20 percent of national income to 12 percent.
Why do we spend more on health care than other countries, and get less in return? There are many answers to that question. One of them is inequality of care. Some people can afford all the medical treatment they need. Others, even those with health insurance, may struggle to get needed care. Others have no way of affording it. And our system permits financial exploitation by pharmaceutical companies and other for-profit players, leaving less money for actual care.
The UN Special Rapporteur for Extreme Poverty and Human Rights, Phillip Alston, recently visited the United States. In an eloquent and comprehensive statement at the end of that visit, Alston noted the erosion of democracy in the U.S. and said:
"My visit coincides with a dramatic change of direction in U.S. policies relating to inequality and extreme poverty... The dramatic cuts in welfare, foreshadowed by the President and Speaker Ryan, and already beginning to be implemented by the administration, will essentially shred crucial dimensions of a safety net that is already full of holes."
GOP GamesTo be clear, the problems with U.S. child mortality began well before the 1980s, when inequality began to soar. But inequality makes the problem worse, and the growing political power of the wealthy makes it more difficult to find solutions. Healthcare remains inaccessible to millions of Americans, with that number about to increase dramatically. Forty million Americans are still impoverished, including more than one child in five.
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