Social Determinants of Health

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Martha is a mother, who was recently diagnosed with gum disease and was instructed to take certain medications and visit her dentist. Unfortunately, Martha is unemployed and cannot afford to see a dentist. This case is set in Canada, a country in which universal healthcare is provided to all their citizens. It seems, however, that dental care is not included and pharmaceuticals are difficult to acquire by the poor. Although this case is based off of the Canadian healthcare system, social determinants of health are virtually the same across the globe and access to health care should be a right no matter what country a person is living in. Because Martha is unemployed, this case raises the dilemma of whether health care should be available as a public good or whether Martha’s situation is a product of her own poor decision-making.

The case gives no reason to believe that Martha chose to be unemployed or was in some way making irresponsible choices. I think this case is representative of a number of other cases, specifically in the United States, when a person if faced with a drastic medical change or emergency and simply cannot afford care. These medical emergencies are never chosen and nor is their inability to pay for medical insurance. As Beauchamp and Childress argue, there are a number of other uncontrollable factors such as race, gender, and ethnicity that play into a personals health status (Beauchamp and Childress 264). Disparities such as these not only directly affect a person’s health, but they also influence whether or not they will have medical insurance if it is not universal.

In a number of other countries that are comparable to the United States in terms of economy and development, Great Britain, France, Germany, Taiwan, and Japan all provide healthcare for their citizens. While these countries may not face as vast of disparities in terms of race as the United States, they still have large inequalities based on socio-economic status. Depending on the country, they usually have higher taxes, but they are more efficient with the money in terms of health care spending. It is almost unheard of to go bankrupt over a medical bill, except for the United States where medical bills are one of the leading causes of bankruptcy. Although, longer life expectancy and overall better health cannot be pinpointed to better healthcare systems, it is definitely a large contributing factor.

Many other countries in the world are able to provide healthcare to every citizen without questioning whether or not health care service companies should be making a profit or whether providing coverage for everyone is infringing one’s rights to make decisions for themselves (Thomas, Waluchow, and Gedge 101). We would never say that someone could not have clean water because we want them to make a decision about whether they want to purchase Aquafina or Dasani and we would never say that their utility is maximized by making the decision about what type of water they want to purchase. Clean water is simply something that is expected to be provided because it is necessary for life. Likewise, a comprehensive health care package should be provided to Martha because it is necessary for her life.

 

Beauchamp, Tom, and James Childress. Principles of Biomedical Ethics. 7th ed. New York: Oxford UP, 2009. Print.

 

Thomas, John, Wilfrid J. Waluchow, and Elisabeth Gedge. “Social Determinants of Health”.” Well and Good. Toronto: Broadview, 2014. Print.

 

5 thoughts on “Social Determinants of Health”

  1. This case is actually very interesting because dental health is so important to overall general health. Many countries do not cover dental in their health care programs nor do most insurance companies. Many times dental health is overlooked and not seen as important but that is far from true. There are countless disease that can be diagnosed at their earliest stages through a thorough dental exam. Dental checkups are actually a way that systems could save money because they can catch a disease early enough to treat it at a much lower cost than if they were to wait until an individual develops the full blown disorder. I personally think dental should be considered as a determinant of health. This does not mean having full braces and getting your teeth whitened. I mean this more on a basic level as more of a preventative measure which can ultimately save money.

  2. I absolutely agree with your point that Martha deserves dental health, and I was surprised to read that while Canada provides universal health care, dental care is lacking. Martha’s dental health will only get worse if she is unable to get the appropriate treatment, such as the necessary antibiotics. Therefore, in cases similar to Martha’s, the nonmaleficence principle is clearly violated since harm is being caused to the patients. In order for this problem to be prevented, like you said, I believe that dental care should be provided to all patients who need it.

  3. Morally speaking I do think Martha should be given healthcare for her gums. However this case seems more like a resource allocation issue and thus becomes a justice issue. There is a limit to how much resources are given for any country and not everyone can be treated. So is it unmoral and unjust to deny her treatment? I do not think so, gum diseases while painful is in many cases not life threatening. In America the only treatment that is never refused is emergency treatment. Regardless of wealth, income, or social status, if it is treatment in the ER thy cannot be refused. This is justified by the principles of non-maleficence and beneficence. Unfortunately there is a limit to beneficence and a utilitarian argument is that this money can be used for other treatments that are more life threatening and vital. In terms of a egalitarian argument since everyone has medical care she is not being gimped because no one else is getting covered for the same care. For a libertarian case if she’s given a fair chance to obtain dental care then there should be no problem. In a capitalist environment this means if you can earn the money for it you can get it then it should be just by a libertarian argument. Thus I do think it’s just for her to be refused care. The bigger issue that should be addressed is how to remove poverty and unemployment. As the saying goes if you feed a person a fish you feed them for a day. If you teach them how to fish you feed them for a lifetime.

  4. I’d like to echo what Rebecca said about oral health being essential for overall health.
    Gum disease and general poor oral health have been identified as a risk factors in the etiology of several chronic diseases. For example, periodontal disease is associated with increased severity of diabetes and decreased metabolic control (Grossi and Genco 1998). If Martha’s gum disease is left untreated, it could potentially lead to further health complications and expenses. Thus, in the interest of non-maleficence and overall health care costs, Martha and other individuals who are unemployed should receive dental care.

    Furthermore, it is important to note that the implications of poor oral health extend beyond biological consequences. According to the NIH’s executive summary of “Oral Health in America: A Report of the Surgeon General,” employed adults lose more than 164 million hours of work each year due to dental disease or dental visits. Although we are not informed of the severity of Martha’s gum disease, it is not out of the question that it may be impeding her ability to return to work and, if she becomes employed, may cause her to miss work and not be able to maintain employment.

    In my global health class this semester we discussed the concept of structural violence at length. As defined by Johan Galtung, structural violence is occurs when “social structures or institutions harm people by preventing them from meeting their basic needs.” By not providing people in Martha’s situation with basic dental care, the Canadian healthcare system is denying Martha a basic service that may dramatically impact not only her health but her employment status and thus financial status.

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