The Invisible Borders Of New York City

Rayhana Bouhara, ‘23

         In New York City, East Harlem’s life expectancy is on the city’s low side, but just south of 96th street on the upper east side, residents can expect to live the longest in the city. Why is there such a drastic difference between two places that are a few blocks away from each other? According to Katelyn Andrews, director of public policy at LiveOn NY, it is because the average income of each neighborhood results in health disparities. While many people think that they know the true meaning of health disparities, the vast majority only have a vague understanding of what it means and how it affects our daily lives. 

In the article titled, What Are Health Disparities and Health Equity? We Need to be Clear by Paula Braveman, health disparities and health equity are both explicitly defined and thoroughly explained. The article elaborates on the importance of  knowing the definitions and how we, as a society, can help to eliminate both of the aforementioned issues. According to the article, health disparities are: 

         “A particular type of health difference that is closely linked with economic, social, or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social or economic obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, or mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

In summation, health disparities are differences that give people different health programs that could potentially result in economic, social, or environmental disadvantage. The author articulates what shouldn’t be considered health disparities but should still be considered disadvantages.  Along with the definition and counter examples of health disparities,Braveman, touches on the meaning of health inequity and how it is similar to health disparities. Health inequity is, “differences in health status or in the distribution of  determinants between different population groups. For example, differences in mobility between elderly people and younger populations or differences in mortality rates between people from different social classes” and “Health equity and health disparities are intertwined.”  A decrease in health disparities will result in  greater equity. Basically, if health disparities did not exist, then there would be more equity. The main purpose of this article is to show the importance of knowing what health disparities and health inequity are  and how to fix both.

Another article  on this topic titled, Health Disparities and Health Equity: The Issue Is Justice, addresses the definitions of health disparities and inequity, how they are perceived in different places and the underlying values and principles of human beings. Paula Braveman states,   

“ Eliminating health disparities is a healthy people goal” According to [Author], “Every person should be able to achieve his/her optimal health status, without distinction based on race or ethnic group, skin color, religion, language, or nationality; socioeconomic resources or position; gender, sexual orientation, or gender identity; age, physical, mental, or emotional disability.” As asserted within this article, being ill and not getting the right treatment could potentially interfere with human rights. This concept is repeatedly emphasized throughout the sections of this text. Social disadvantage was also defined and compared to unavoidable physical advantage. Social advantage refers to “the unfavorable social, economic, or political conditions that some groups of people systematically experience based on their relative position in social hierarchies.” Following this point, Braveman’s analysis goes more into detail about how race affects  differences in the determinants of health. For example, “African American or Black women, and babies born to hispanic immigrant women often have more favorable birth weights than those born to non-hispanic whites.” The author next mentions how health disparities are the metric to assess progress toward health equity. If there is less social disadvantage, there would be fewer health disparities. This was described as a correlation. However, there are limitations and challenges that come with achieving this goal, such as “identifying the social groups to be compared and specifying the general criteria for appropriate reference groups for these comparisons.” The last topic to be covered in this article was that justice is the underlying issue. Bravemen believes that even though there were actions taken, there is still a problem because of the existing unjust systems that allow people of power to  ignor the major issue with health disparities and inequity.  In a final analysis, the main idea of Braveman’s article  is to show readers how important it is to recognize the definitions of health disparities and health equity. If people don’t understand the distinctions and definitions of the two terms, it is impossible to combat and identify the inequity. Justice plays a huge part in how the issue is being resolved.

            Reading these two articles stirs controversy on  healthcare and whether it should be considered a right or a privilege. “The resources needed to be healthy – including not only medical care – but also health-promoting living and working conditions – should not be treated as commodities such as designer clothing or luxury cars,” wrote Braveman in the article, What Are Health Disparities and Health Equity? We Need to Be Clear. This means that good  healthcare should not be something that only the privileged receive. On a personal standpoint, I agree with Paula Bravemen when she said that healthcare should be a right, not a privilege. For example, in Canada health care is of little to no cost in comparison to the United States. This helps minimize  health disparities as all citizens are given the help that they need, creating an equitable system. equity. Everyone needs health care because everybody gets sick. No matter what one’s race, sexuality, or yearly income is, we all have our health needs that need to be taken care of. People can easily live without luxurious cars and clothing, but they cannot live well without the proper healthcare that they need. 

             Some may argue that healthcare is a privilege because people in the past did not have the right to healthcare. In Healthcare is a Privilege, not a Right, Stephen Kershnar writes, “Government healthcare did not exist a hundred years ago. The MRI machine didn’t exist until the late 1970s, so therefore, every human who died before its invention lacked the “right” to healthcare including an MRI.” Kershnar believes that since there was not any kind of healthcare equipment then, healthcare  cannot be a right now. “Can it truly be considered a right even if it did not exist years ago?” The answer is yes. Less than one hundred years ago women were not allowed to vote, but voting is considered a right for all people now even though that was not the case in the past. As time goes on, views about the world change and it is okay to add rights that humans did not have before. On top of that, when it comes down to health, human rights are, “held social values that call for everyone to have a fair chance to be healthy, given that health is crucial for well being.” That does not necessarily mean that all of the people that existed before us should have this right. The world is changing.  

          In connection to healthcare rights and health, Braveman also touches on “the right to health”. In the article, What are Health Disparities and Health Equity: the issue is justice, Braveman writes, “The “right to health” (i.e., the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”) is “not to be understood as a right to be healthy,” because too many factors beyond states’ control influence health. One factor that supports this idea is that not everyone is born with perfect health. For example, one may be born with one kidney, no arms or legs, Spina Bifida, and other defects/diseases. This cannot be controlled as it is impossible for everyone to be born healthy. Another factor that Braveman explained is that the right to health is not only a right to health care, saying, “A large body of knowledge, including sources cited previously, indicates that the resources needed to be healthy include not only quality medical care, but also education and health-promoting physical and social conditions in homes, neighborhoods, and workplaces.” This is not achievable and it cannot be a right. In addition to this, it is not a part of human rights. Braveman states, “Human rights principles call for countries to remove obstacles to health in any sector- for example, in education, housing, or transportation--and they explicitly call for the right to a standard of living necessary to promote health”  This idea  elaborates on how it is impossible to expect health to be a right because of  birth defects and the fact that not everyone is born healthy, as well as it not being a human right. 

           In conclusion, both articles What Are Health Disparities and Health Equity? We Need to Be Clear, and The Issue is Justice elaborate on health disparities, what they mean, and  health inequity. In The Issue is Justice, the author mentions the unjust aspects of healthcare and how we can fix them as well as how other factors like race, sexuality, income, etc.. segregate people when it comes to opportunities to receive healthcare. This results in conflict when it pertains to health equity and it interferes with human rights. Braveman made sure to mention how healthcare should be seen as a right, not a privilege by writing, “ the resources needed to be healthy – including not only medical care – but also health-promoting living and working conditions – should not be treated as commodities such as designer clothing or luxury cars.” I agree with this, but people may not because they feel like healthcare was not a right back then, so it should not be a right now. However, this could easily be debunked by the fact   that the world changes and rights will change over time. Braveman also mentions, “ the right to health” which differs from healthcare because it technically is not a right and it involves more than just healthcare. Two factors that support Braveman’s claim are that not everyone is born with good health, and health is beyond what healthcare is, making it an impossible task to achieve health for everyone in all aspects. As Martin Luther King Jr once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Health disparities are a major issue in today’s society and they need to first be  defined properly to then be prevented.