UofSC Psychiatry Resident || @TheHeadDocMD || MyStreetHealth Content Creator

What Determines the Health of an Individual

The similarities between the health disparities of African Americans and those affected by the opioid epidemic were not coincidental but emerged because of consistently strengthened institutionalized racism within the United States. The core elements of health disparities are the social determinants of health, and by examining them, the trends of reinforcement are recognizable as are its effects on the long-term health of an individual. The Center for Disease Control and Prevention (CDC) has attempted to simplify the elements related to opioid addiction as an "intertwined epidemic." The fact remains that the determinants of addiction and being African American overlap in several broad categories, including economic stability, access to healthcare, neighborhood, and community context. 
            This entanglement is attributable to the all-encompassing grasp of institutionalized racism, recognized in historical landmarks since the abolition of slavery such as Jim Crow laws, redlining, and Levittown. Dr. Camara Jones eloquently simplifies this concept into an allegory of the Gardener's Tale, rhetorically asking the reader if a gardener can determine vitality between two flowers if there were inherent differences in the soil used to nurture the seeds? Dr. Jones allows the reader to consider the variables outside of the flowers' control by illustrating the levels of racism. Of which, institutionalized racism has the most significant effect on the health of an individual by creating differences between races accessibility of goods, services, and opportunities within society. Its integration into laws and the way of life in a nation allows racism not needed to be perpetrated by any one person but the system as a whole.
            The first is economic stability, and according to the CDC, economic stability has the subcategories of poverty, employment status, and housing instability. Since the inception of housing in the United States, it has been unstable for African Americans with redlining and Levittown set as precedent. These disparaging housing rules and laws lead to unpredictable economic conditions, poverty prevalent within African American minority communities today. While substance use often operates synergistically to create a vicious cycle. This continuum often reinforces complementing underlying mental health disorders leading to unstable housing.
            Unstable economic conditions lead to low socioeconomic status (SES) neighborhoods. Employment among low SES classes is dominated by manual labor jobs, often giving rise to chronic pain conditions. While environmental and genetic factors often mediate an exponentially increased risk in African Americans to have chronic pain conditions, generally back pain. Consequently, manual labor jobs limit access to healthcare; the opioid use becomes self-treatment for physical and psychological trauma experienced throughout life under the self-medication hypothesis by Dr. Edward Khantzian. Insufficient alternatives in workforce options funneled the neighborhoods into a history of mass incarcerations for minor drug possession charges—further limiting one's ability to obtain gainful employment. 
             Lastly, the social determinant of health - community context combines the categories into a comprehensive vision of institutional racism through intergenerational trauma. The intertwined epidemic with opioid use disorder complements the social disadvantage and isolation of community members driving feelings of hopelessness in the whole communities. The euphoria opioids supply offers an outlet to manage social stressors and structural inequities. While barriers to evidence-based medications, including methadone and buprenorphine treatment to manage withdrawal symptoms, remain prohibited under Medicaid coverage and culturally competent physicians even more restrictive. Besides, addiction specialists and clinics in low-income neighborhoods are uncommon. All the while, the media portrayal during the war on drugs left a stigma plaguing addiction as a moral failure restricting others from seeking treatment. The next time we approach a patient with opioid addiction, use disorder, think of the Gardener's Tale and help nurture this community.

No comments

Post a Comment

Professional Blog Designs by pipdig