Diversity, Disparity and the Common Good in Catholic Health Care · society confers upon white, educated men like me underlines the fact that I must cultivate a deliberate habit of

© The Catholic Health Association of the United States Diversity, Disparity and the Common Good in Catholic Health Care ǀ 1© The Catholic Health Association of the United States

Diversity, Disparity and the Common Good in Catholic Health Care

Fr. Charles Bouchard, OPSenior Director, Theology and Ethics

The Catholic Health Association

© The Catholic Health Association of the United States Diversity, Disparity and the Common Good in Catholic Health Care ǀ 2

“We know that having an unequal society brings down the health status of everyone, and brings up health costs for everyone,” says Dr. Gary Bloch, a member of the Ontario College of Family Physicians’ committee on poverty and health. Research estimates that medical care accounts for only 25 per cent of health outcomes, while another 25 per cent is related to genetics and fully 50 per cent depends on the socio-economic determinants of health like income, education, housing, physical environment and community engagement.”

(André Picard, Globe and Mail, Nov 8, 2013)

What determines health status?

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USInsured

US Uninsured

US White

US Non-white

Canadian White

Canadian Non-white

Regular medical doctor 84.6 40.0 82.2 72.7 85.6 80.7

Contacted any medical doctor in past 12 months 85.9 55.6 84.3 77.8 83.6 82.1

Dentist within past year 68.0 39.5 68.5 55.1 64.1 64.5

Treatment for high blood pressure in past year 92.9 83.5 91.8 93.8 88.9 91.5

Treatment for asthma in past year 83.9 52.3 79.7 81.5 82.7 68.3

Treatment for depression in past year 55.6 36.2 60.5 29.8 60.5 33.3

Needed medicines but could not afford them 7.6 28.3 8.3 14.4 4.9 6.0

Unmet health care needs 10.2 36.3 11.1 18.6 10.8 10.2

Quality of health care received - excellent 43.4 26.9 45.6 31.9 40.4 32.5

US-Canada Health Disparities

Karen E. Lasser, MD, MPH, et al., “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Based Survey”, Am J Public Health, 2006;96(7):1300-1307.


Kinds of Diversity – ECONOMICRemaining Years of Life Expectancy at 25

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“How Income Inequality Hurts Every Canadian’s Chance of Building a Better Life,” Globe and Mail, Nov. 8, 2013.


Kinds of Diversity - SOCIAL

Univ of Michigan, National Poverty Center, Policy Brief #9, Education and Health, by David Cutler (March 2007)


Kinds of Diversity - RACIAL


Kinds of Diversity - RACIAL



Kinds of Diversity - GEOGRAPHIC

Washington University study, St. Louis, 2014


1) Personality2) Internal dimensions (gender, country of origin,

race, physical ability)3) [Genetics and epigenetics]4) External dimensions (religion, parental status,

recreational habits)5) Organizational dimensions (management,

department, specialty)

Layers of Diversity

Jan Salisbury and Sam Byrd, “Why Diversity Matters” (California Society of Anesthesiologists, Spring 2006)


“I think the big problem this country has is being politically correct. I've been challenged by so many people, and I don't frankly have time for total political correctness. And to be honest with you, this country doesn't have time either.”


Diversity is an academic fad, a “substitute for true religion…”“The destructive quest for artificial diversification is an outgrowth of the scourge of the 20th century – the all pervasive creed of relativism.”

Wolfgang Grassl, “Diversity is Not A Catholic Value”


Diversity is not something we create; it is a given, and we are only able to acknowledge it and respond to it.

“The one God, creator of diversity, commands us to

honor his creation by respecting diversity. It is a

divine blessing at the core of sociality.”

Rabbi Jonathan Sacks, “The Dignity of Difference” Rabbi Jonathan Sacks


• A higher burden of illness, injury, disability or morality for one group over another.

• Distinct from inequity, which is unjust disparity. ‒ Racism (see Jaycox article): structural inequity?

What Do We Mean By Disparity?


1. Access: • Insurance• Care (e.g., no doctors near by)• Social support (no way to get there)

2. Quality of care: Jackson Infirmary, 1940s

3. Outcomes (e.g, readmissions, infections, medical errors)

Kinds of Disparity


Five things from our tradition that can help us arrive at a holy response to diversity

JusticeSolidarity

Common GoodNatural Law

Sacramentality


• Not transactional justice• Essentially about right

relationships• Logic of gift: who owns medical

resources? • Is our business logic too market

driven?

Justice


“The great challenge before us.. Is not only that traditional principles of social ethics like transparency, honesty and responsibility cannot be ignored or attenuated, but also that in commercial relationships the principle of gratuitousness and the logic of gift as an expression of fraternity can and must find their place within normal economic activity.”

Benedict XVI and Caritas in Veritate

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• Antidote to individualism and libertarianism• A virtue that is based on conviction that

relationships among us are real, even with people who are socially, economically or geographically distant from us.

Solidarity


“Man is by nature gregarious, born for cultivating society…[for this reason] God distributed his gifts unevenly, and wills that each need the service of others, so friendship would bind all together and no one would consider another to be valueless.”

Rabbi Jonathan Sacks, “The Dignity of Difference”


Common Good

A set of circumstances that create the conditions in which individuals and groups are able to achieve flourishing.

The common good is what we do with diversity … we weave a social fabric from it.


Internal MinistryOriented primarily

inward, for building up the inner life of the faith community.

Purpose is personal perfection

External MinistryOriented primarily

outward, its purpose is the common good, which is a reflection of the Reign of God


“If the vast institutional structure of Catholic health care is going to make an impact for the cause of racial justice [and health disparities] what is demanded is not primarly a medical intervention, but rather a political intervention…” (Michael Jaycox, “Justice and Health Equity”)

Catholic Health Care and Social Transformation

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• The “law” of human nature, or God’s plan implanted in creation.

• Known through reason rather than faith• Discovered through reasonable reflection

on human experience and diversity• In order for nature to be a reliable guide, it

has to include all the diversity of human nature.

Natural Law


Sacramentality – Beyond the Seven

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In our view, creation, is good enough to bear the weight of grace, to be an occasion of grace…..the fullest measure of God’s grace is experienced through diversity of creation and humanity


• Use Community Health Needs Assessments (CHNA) required every three years, to measure and target health disparities.

• Reduce implicit bias – individual and institutional• Develop partnerships with other community

organizations• Develop the concept of population health

• “Achieving Health Equity: A Guide for Health Care Organizations” Institute for Healthcare Improvement (IHI), 2016.

What are we doing?

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“The sheer amount of power our racist and patriarchal society confers upon white, educated men like me underlines the fact that I must cultivate a deliberate habit of de-centering my own voice, experiences and concerns in order to make me less likely to dismiss and more like to hear others…” (Michael Jaycox, “Justice and Health Equity”

A personal discipline: decentering

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Diversity, Disparity and the Common Good in Catholic Health Care · society confers upon white, educated men like me underlines the fact that I must cultivate a deliberate habit of