About Standard of Care
Standard of Care is a documentary series that will explore disparities in healthcare based on a variety of demographics. Click each topic to learn more:
- Around half of US prisoners have a chronic health condition.
- Correctional institutions are required to provide basic care to inmates, but often cut corners to save money:
- Food served to inmates is often not adequate to maintain good health. Prisoners across the country report meager portions, skipped meals, and rotting food being served in correctional facilities.
- Soap, menstrual products, and PPE are not readily available to inmates without commissary money.
- Medication is not always distributed on-time, even when inconsistent dosing can have detrimental health consequences.
- Healthcare providers split their time between different facilities, which makes it hard for inmates to get a timely appointment.
- Mental healthcare in prison is largely served in solitary confinement, whose dangers could be its own documentary.
- Many prisoners report that their health concerns are not taken seriously by corrections officers and that they are denied appointments to see medical staff. Inmates who do receive healthcare report feeling violated or gaslit by providers.
- Social distancing is nearly impossible in overcrowded prisons, and very few correctional facilities are equipped to manage severe COVID-19 symptoms.
- Most facilities do not have substance abuse treatment, leaving hundreds of patients to detox in cells, alone. If they are successful, staying sober in prison is also difficult due to the variety drugs available on the inside.
- Only 4% of prisons have a hospice care program, despite 200,000 people sentenced to die behind bars.
- After they are released, people impacted by the justice system face barriers to quality healthcare due to stigma surrounding their conviction.
- Many other components of prison healthcare are dangerous: from the transport vehicles that take people to/from the hospital, to restraint chairs, to giving birth while shackled. You can read more about unjust prison injuries and deaths here.
- Immigrants around the world are subject to lower quality healthcare compared to native-born citizens of their countries.
- In the US, many ICE detention centers are facing the same abuses as correction facilities (listed above).
- A recent investigation found that ICE even performed forced sterilizations on women held in these centers.
- Undocumented folks who are not detained may avoid seeking medical care and other social services for fear of deportation or detention.
- Documented immigrants and refugees are less likely to have health insurance and more likely to be affected by diseases, including COVID-19, in many countries.
- Patients who don’t speak a country’s native language are at a disadvantage when it comes to navigating the medical system, and may face discrimination from their providers.
- Although translators are available in many facilities, they cannot always ensure a solid understanding of medical explanations/terminology, and may not be available to help with paperwork, social work, and other essential services.
- For the 1 billion people living on less than $1 USD per day, hunger, poor sanitation, and inadequate shelter lead to high rates of infectious disease and malnutrition. Thousands of people die every year from preventable or curable diseases because they cannot afford medical care.
- In countries without universal healthcare, like the United States, the type of insurance (or lack thereof) a patient has will largely determine their access to care.
- Insurance limits which providers their clients can see, and may not cover specialty care, experimental or off-label treatments, or certain medications. They can refuse to pay for certain items they deem “not medically necessary” - even if a doctor says they are.
- Deductibles and co-pays limit access to healthcare for low-income people, even if they have insurance.
- In a for-profit healthcare system, the cost of basic medical care skyrockets. In the US, a single ambulance ride can cost hundreds of dollars even after insurance pays their share. For patients without insurance, medical care can cost hundreds of thousands of dollars. At least half a million Americans file for bankruptcy due to medical bills every year.
- For working-class families, taking time off work to pursue healthcare can be extremely difficult. Many hourly workers do not have adequate sick days and fear losing their job if they or a loved one are admitted to a hospital.
- Some healthcare providers base their medical recommendations on a patient's perceived social class or how much they might be able to pay. Patients on state insurance may be less likely to be referred for diagnostic procedures, while those who have better insurance may be subjected to more tests or treatment if a provider knows they can pay for it.
- The recent COVID-19 pandemic has shed light on income disparities in healthcare. Poor, essential workers have been disproportionately infected with the virus and more likely to die from it.
- Where a patient lives plays a large role in the quality of care they have access to.
- The type of healthcare system that a country has significantly affects their citizens' access to medical care:
- In countries with universal healthcare, medical treatment is available to all citizens at no cost to them, however the quality of public healthcare varies greatly between nations.
- Countries without universal health insurance face major disparities between citizens with private health insurance, subsidized public healthcare, or no coverage at all.
- Disparities exist within countries, too. Urban areas are more likely to have better healthcare systems.
- Rural health networks often have fewer specialists and resources.
- Patients living in remote areas may have to travel great distances to reach their nearest hospital.
- Areas without internet, cell phone access, and reliable transportation are less likely to have access to essential health services.
- When underfunded rural hospitals close, the death rate in communities rises by at least 6%.
- The quality of care provided by free clinics and preventative care centers varies greatly between communities.
- In low-income school districts, students are less likely to have a school nurse, counseling services, and preventative care screenings.
- Mental healthcare is inaccessible to many patients due to cost, stigma, and lack of resources. In the developed world, 44-70% of individuals who need mental health care do not receive treatment. In lower-income countries, that number can reach 90%.
- Cost: Many insurance plans fail to cover behavioral health care, creating financial barriers to treatment for patients around the world.
- Stigma: Although attitudes toward mental illness vary among individuals, communities, and cultures, patients around the world report that they have experienced stigma related to their mental health condition.
- In cultures where conformity is valued, psychiatric conditions might be seen as shameful or a poor reflection on one’s family.
- In more individualistic cultures, patients may view suffering from conditions like depression as a “personal weakness” that they opt to deal with themselves.
- Lack of Resources: At least 1/3 of the world’s population lives in a country that allocates less than 1% of their health budget to mental health.
- At least 20% of countries do not have any common antidepressants or antipsychotics available in primary care settings.
- In lower-income countries, there are only about .05 psychiatrists and .16 psychiatric nurses per 100,000 people. Children are even more disadvantaged, with one pediatric psychiatrist for every 1-4 million people.
- Substance use disorders are among the most stigmatized conditions in the Western world. Even after they have recovered from their addiction, patients report being treated as “drug seekers” in emergency rooms and clinics.
- Doctors commonly assume that a mentally ill patient's physical symptoms are a result of their underlying mental health condition without investigation - which can delay essential medical care.
- There is a long history of racism in medicine:
- In the late 19th century, doctors practiced surgical techniques on enslaved Black women, often without anesthetic.
- In the 1930s, the US recruited hundreds of Black syphilis patients to participate in a study by promising them free medical care. In reality, the participants received placebos and diagnostic procedures while researchers observed the effects of their untreated disease for 40 years.
- In the 1950s, a Black cancer patient, Henrietta Lacks' cells were harvested for medical research without her consent.
- Throughout the 20th century, hundreds of Latinx and Black women were subjected to compulsory sterilization through experimental birth control or medically unnecessary hysterectomies, sometimes without their consent.
- Medical students are still taught myths about Black health rooted in eugenics. For example, half of white medical trainees believe that Black people's nerve endings are less sensitive.
- Diagnostic indicators, such as pulse oximetry (used to evaluate how well someone is breathing), are dangerously inaccurate for darker-skinned patients.
- BIPOC have been left out of drug testing and many doctors cannot recognize important disease features (such as blood pooling or rash) on dark skin.
- BIPOC have disproportionately poor health outcomes. For example, Black mothers are 243% more likely to die in childbirth than white mothers in the United States.
- Diseases that primarily affect dark-skinned patients receive less research and funding.
- Patients of color have been disproportionately affected by COVID-19, with Indigenous patients dying at higher rates than any other race in the United States.
- Women's health concerns are frequently downplayed by doctors as being “all in their heads.” They are less likely to receive pain medicine, and more likely to be referred to psychologists in situations where men would undergo diagnostic testing.
- Doctors aren't always trained to recognize how serious diseases present in women. For example, women are frequently sent home from the Emergency Room during a heart attack, because symptoms of cardiac arrest for women are different than men's.
- Until recently, drug trials were primarily performed on men, meaning we don't know how many common drugs affect women's bodies.
- In some countries, women need permission from a male family member in order to receive medical care.
- Gender diverse patients are frequently misgendered in the healthcare system and often have to educate their providers about trans and nonbinary people in order to receive proper care.
- Patients frequently report that their health concerns are blamed on their weight without further investigation, or that treatment options are contingent on their weight loss.
- The medical field is the second most common place to experience weight bias.
- Doctors spend less time in appointments with their overweight patients, and are more likely to view them as “non-compliant”.
- In a self-reported study, nurses said that their patients with obesity disgusted them. Many reported that they don’t want to care for obese patients, and some didn’t want to touch them.
- Not all medical facilities are equipped to care for larger patients: ill fitting gowns, too-small blood pressure cuffs, exam and x-ray tables that cannot support higher weights, and small waiting room chairs all create barriers to healthcare for larger bodies.
A note about intersectionality: Intersectionality describes how aspects of a person's identities combine to create different modes of discrimination and privilege. Different medical professionals can hold implicit bias toward patients with specific diagnosis, identities, and backgrounds. Each patient's experience is unique and likely influenced by more than one of these categories. This is not an exhaustive list! If you have a suggestion of another identity that should be included here, let me know!