If you were to spend a few minutes brainstorming a list, what would you include as the most important requirements to keeping your family healthy? While this chapter has focused on health care and health insurance as important aspects of health management, the authors of this text would like to emphasize that health care starts with access and decision-making related to exercise, diet, relationships, work, sleep, intellectual stimulation, addictive substances, education, and social life. This is our list; perhaps you have other aspects to add!

Importantly, those individual and family decisions are directly impacted by the social institutions and processes at the core of the United States. Past and present laws, policies, practices, and biases that create and reinforce inequities mean that families live with vastly different access to resources, including food, safe and stimulating outdoor environments, time, work environments, social life, and health care.

For example, many families live without easy access to recreational trails and playgrounds. Chapter 8 details the ways in which laws, regulations, and lending corporations have actively participated in pushing minoritized racial-ethnic groups into these areas. We must pay attention to these past practices and the ways that they impact present families’ health. During the COVID-19 pandemic, it became clear that the virus is transmitted more easily in crowded spaces indoors than in the outdoors (Figure 7.19).

Figure 7.19. Tips for physical distancing outside during the Covid-19 Pandemic. Which families might have a more difficult time with being outdoors or social distancing?

There is a disproportionate number of coronavirus cases and deaths among marginalized populations in the United States, and it is possible that lack of access to outdoor spaces plays a role (Godoy & Wood, 2020). So at the same time that this lack of resources makes it more difficult to maintain everyday physical and mental health, it may also contribute to illness, hospitalization, loss of employment, and even death during the pandemic.

Institutionalized inequities have been amplified during the coronavirus pandemic as illustrated in Figure 7.20. Some of the factors that contribute to greater numbers of Black, Native, and Latinx families being affected by the COVID-10 virus include the following:

• Crowded work environments such as meat-packing facilities
• Food deserts
• Less health insurance
• Less access to health care and virus testing as measured by geography and transportation options
• Greater likelihood to experience discrimination, stress, and lack of sleep (Center for Disease Control and Prevention, 2020).

Figure 7.20. Aletha Maybank, MD, MPH, discusses COVID-19 and health equity | COVID-19 Update for April 21, 2020 [YouTube Video]. This video from the American Medical Association features an interview with Doctor Aletha Maybank and explains how funding, data collection, and the overlap with structural discrimination affect the rates of the virus

Activism can help alleviate social problems, including the problem of poor health experienced by so many in the United States. With adequate health care, there . is hope; many countries have successful models of health care that give all citizens access. In this country, groups, many led by physicians or other medical professionals, are working to create and/or modify systems to increase access to basic health care. Two prominent organizations are Health Care for ALL Oregon and Physicians for a National Health Program.

The United Nations Universal Declaration of Human Rights Article 25 identifies health as a human right:

(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection (United Nations, 1948).

Some non-industrialized nations and all industrialized nations, with the United States as the notable exception, have adopted some form of universal healthcare system since the 1948 adoption of this Declaration. The irony is that the framework for the human rights declaration came from the United States and the work of President Franklin Delano Roosevelt and his wife and Statesperson Eleanor Roosevelt (Gerisch, n.d.). The United States does not have an actual health care system, but rather multiple systems of health insurance. These systems are accessed through a variety of providers: employers,state-funded block programs, and federal programs for specific groups such as people who are indigent, disabled, or older. In other words, not all people have access.

While families in the United States strive to make the best choices for themselves, they are limited by the existing access to resources needed to be as healthy as possible. Some of these inequities were created by past laws and practices. But those, and others, can be adjusted and changed. The societal and governmental commitment to the standards of health and well-being as identified in the United Nations Declaration of Human Rights is one way to begin.

7.5.3 References

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Reid, T. R. (2010). The healing of America: A global quest for better, cheaper, and fairer health care. Penguin Books.

U.S. Census Bureau. (2017). Coverage numbers and rates by type of health insurance: 2013, 2016, and 2017 [table]. Retrieved June 8, 2020, from https://www2.census.gov/programs-surveys/demo/tables/p60/264/table1.pdf

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Godoy, M. and Wood, D. (2020, May 30). Growing data show Black And Latino Americans bear the brunt. NPR. https://www.npr.org/sections/health-shots/2020/05/30/865413079/what-do-coronavirus-racial-disparities-look-like-state-by-state

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