239599 Normative Dimensions in the Concept and Measures of Health Disparities

Monday, October 31, 2011

Andrew C. Ward, MPH, PhD, PhD , Center for Medicare and Medicaid Services, Center for Consumer Information and Insurance Oversight, Bethesda, MD
Pamela Jo Johnson, MPH, PhD , Center for Healthcare Innovation, Allina Hospitals & Clinics, Minneapolis, MN
Two recent examples demonstrate how concerns with health disparities are central to health policies. The first is Healthy People 2020's “focus on identifying, measuring, tracking, and reducing health disparities”. Although not an explicit topic area for Healthy People 2020, health disparities serve as one of four foundation health indicators to track success in meeting the overarching goals of Healthy People 2020. The second example comes from the Affordable Care Act (ACA). According to HealthCare.gov, the Website managed by DHHS to provide information about the ACA, one of the goals of the ACA is to reduce the prevalence of health disparities by “improving access to quality care for all Americans.” Both examples assume a well-defined concept of health disparity and the application of a clear metric to particular health outcomes (e.g., mortality) or determinants of health outcomes (e.g., health insurance). If health disparities were exclusively differences in health outcomes within domains such as age and race, the associated metric would be only statistical. However, not all differences in health outcomes are health disparities; the concept of a health disparity is inherently normative. Thus, assumptions about values are part of any health disparity metric – e.g., welfare optimization vs. opportunity optimization, health promotion vs. health protection. In this presentation, we identify and evaluate some of the value assumptions having the greatest plausibility. We discuss issues of distributive justice (e.g., Rawls), egalitarianism, liberty (e.g., Mill) and personal responsibility as they relate to socially prescribed and implemented goals of reducing or eliminating health disparities.

Learning Areas:
Advocacy for health and health education
Diversity and culture
Ethics, professional and legal requirements
Provision of health care to the public
Public health or related public policy

Learning Objectives:
1. Identify the normative dimensions present in descriptions and assessments of health disparities. 2. Describe the normative assumptions present in initiatives such as Healthy People 2020 and the Affordable Care Act (ACA). 3. Discuss and assess how concepts such as distributive justice and personal responsibility underlie socially socially prescribed and implemented goals of reducing or eliminating health disparities.

Keywords: Health Disparities, Ethics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have a Ph.D. in Health Services Research, Policy and Administration. I have been a Post-Doctoral Research Fellow at the University of Minnesota Population Center. I am currently an Insurance Specialist working for the Center for Consumer Information and Insurance Oversight.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Issues in Public Health Ethics
See more of: Ethics SPIG