## Why Does Healthcare Feel Like a Losing Battle?
Picture this: you have a sniffle, maybe a cough. You visit the doctor, get the right treatment, and feel better in a week. Simple, right? For some, yes. But for millions, access to even basic healthcare remains a distant dream.
Improving Mental Health Care for Asian and NHOPI Communities
The COVID-19 pandemic has contributed to and coincided with worsening mental health across the population, including Asian and Native Hawaiian and other Pacific Islander (NHOPI) people. In addition to the negative health and economic impacts of the pandemic experienced across the population, Asian people also have experienced increased discrimination and hate crimes, which research suggests have negatively impacted their mental health.
These issues are not new, as Asian and NHOPI people have faced longstanding racism and discrimination among other challenges, including exclusionary immigration policies, internment, and stresses associated with the model minority stereotype, and acculturation. These experiences are linked to poor mental health.
The Need for Culturally Sensitive and Tailored Mental Health Services and Interventions
Overall rates of mental illness are generally lower among Asian people compared to White people, but this may reflect underdiagnosis and undertreatment among the population. In 2021, 16% of Asian adults reported any mental illness in the past year compared to 24% of White adults; there was no statistically significant difference in rates of mental illness between NHOPI and White adults.
The lower rate of mental illness among Asian adults may be reflective of underdiagnosis and underreporting. It also may mask variations in mental illness rates among subgroups of the population. Among people with mental illness, Asian people are less likely to utilize mental health services compared to other racial and ethnic groups.
The Role of Stigma and Cultural Attitudes towards Mental Health
In 2021, among adults with any mental illness in the past year, only 25% of Asian adults reported receiving mental health services compared to 52% of White adults (Figure 1). Data on utilization were not available for NHOPI people. Moreover, data show rising rates of suicide death among Asian and Pacific Islander adolescents (ages 12-17).
Although they have lower rates of suicide death compared to their White peers, suicides were the leading cause of death among Asian and Pacific Islander adolescents in 2020, and suicide death rates more than doubled among this population from 2010 (2.2 per 100,000) to 2020 (5.0 per 100,000).
The Importance of Addressing Systemic Barriers to Access and Promoting Health Equity
Gaps in the mental health care system pose an array of challenges to accessing care for Asian and NHOPI people. While stigma and cultural attitudes towards mental health are factors that may lead to lower reporting of mental health concerns and service utilization among Asian people, it is also important to consider how the health care system shapes their ability to identify needs and access care.
For example, research points to the lack of a diverse mental health provider workforce and the absence of culturally informed treatment options for Asian people, which may contribute to lower utilization. Moreover, the Asian population is not a monolith. There is wide variation in the characteristics of Asian and NHOPI people that affects their experiences, health needs, and ability to access health care.
Overall, over one in four Asian people is a noncitizen and nearly one in three speaks English less than very well. These differences are critical to understanding the mental health care needs of Asian and NHOPI people and developing effective interventions to address these needs.
The role of community-based initiatives and community-led solutions in improving mental health outcomes cannot be overstated. Such initiatives can help address the cultural and linguistic barriers that prevent Asian and NHOPI people from accessing mental health care.
Maternal Mortality and Global Health Inequality
The battle against maternal mortality has stagnated, and high rates of deaths continue to plague sub-Saharan Africa, as well as other low- and middle-income nations, said World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus.
“Progress has stalled, and still, a woman dies every two minutes,” he stated. He was referring to a bleak report from February 2023 showing the world is far off track for achieving Sustainable Development Goal (SDG) target 3.1 for reducing maternal deaths to less than 70 per 100,000 live births.
The State of Maternal Mortality
As of 2020, there was an average of 223 deaths of mothers per live births and in sub-Saharan Africa the death rate was 536 per 100,000 live births, according to the UN inter-agency report. Friday’s debate at the WHO Executive Board meeting revolved around a draft World Health Assembly (WHA) decision led by Somalia for consideration at the upcoming WHA in May (WHA77).
It is aimed at addressing the stark global disparities in maternal, newborn and child health that persist, falling far short of the targets set out in the 2030 Sustainable Development Goal targets on reducing maternal mortality (SDG 3.1) and ending preventable deaths of newborns and children under five years of age (SDG 3.2).
Addressing Global Disparities in Maternal Health
Somalia’s representative painted a vivid picture of the leading factors, which are deeply rooted in health inequalities between high- and low-income countries. “The tragedy of this statistic is that most of these deaths in mothers and their children are preventable or treatable with known effective interventions,” he lamented.
“We know that 70% of maternal deaths are due to direct obstetric causes,” he said, reciting a list of factors including hypertension, sepsis, abortion and embolism. Health system bottlenecks, including cost and capacity constraints, are responsible for an estimated 30% of deaths, he said.
A draft decision was proposed by Egypt, Ethiopia, Paraguay, Somalia, South Africa and United Republic of Tanzania to accelerate progress towards reducing maternal, newborn and child mortality in order to achieve SDG target 3.1 and SDG target 3.2 after data was shared that showed it is likely that more than four out of five countries (80%) will not achieve their national maternal mortality targets, 63 countries will miss their neonatal mortality targets and 54 countries will miss the under-five mortality target by 2030.
The Way Forward in Addressing Maternal Mortality
The draft decision called for focused, urgent and coordinated course-correcting, and country-led action for maternal, newborn and child survival. According to the DG’s report, there is ample evidence on effective interventions to monitor and improve the health and well-being of women and children.
He noted that multiple strategies have been developed that incorporate this evidence so as to support countries in identifying the high-impact interventions that should be included in their national health sector plans.
These strategies include the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the Every Woman Every Child movement, among others. The need for increased investment in maternal health and a focus on reducing health system bottlenecks cannot be overstated.
The importance of addressing the root causes of maternal mortality, including poverty, inequality, and lack of access to healthcare, is critical to achieving SDG target 3.1. Global partnerships and collaboration will be essential in accelerating progress towards reducing maternal mortality.
Conclusion
Health Inequality: A Persistent Puzzle
In the article “Why Do Health Inequality Solutions Keep Failing?”, we delve into the complex and pressing issue of health inequality, shedding light on the reasons behind the failure of existing solutions. At its core, the article highlights the interconnected nature of health disparities, socioeconomic status, and systemic barriers that hinder effective policy interventions. Key points discussed include the inadequate focus on upstream determinants of health, the lack of targeted interventions, and the limited engagement of local communities in health policy-making. The article also underscores the compounding effects of intersecting inequalities, including racism, sexism, and classism, which exacerbate health disparities.
The significance of this topic cannot be overstated. Health inequality affects not only individual well-being but also the economy and public health as a whole. The consequences of inaction will be far-reaching, with stunted economic growth, increased healthcare costs, and decreased productivity. Furthermore, the persistence of health inequality perpetuates social injustice, undermining the fundamental human right to health. As we move forward, it is crucial that policy-makers and stakeholders prioritize a holistic approach that addresses the root causes of health disparities.
The future implications of this issue are stark. Unless we adopt a comprehensive and inclusive approach to addressing health inequality, we risk perpetuating a cycle of disadvantage that will only worsen over time. As we strive for a more equitable society, we must recognize that the failure of health inequality solutions is not a reflection of our efforts, but rather a symptom of a more profound societal problem. “It is time to confront the hard truth: health inequality is not just a policy issue, but a moral imperative that requires a fundamental transformation of our values and our systems.”
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