Hindering Access to Healthcare: An Eastern Perspective on a Universal Problem

Healthcare, while imperative to maintaining the quality of life on both an individual and community-wide level, has unfortunately become less of a guaranteed service and more of a luxury withheld by privilege and status. Numerous circumstances influence one's ability to access quality healthcare, ranging from general socioeconomic factors to country-specific limitations stemming from cultural norms. While oppressive systems such as sexism, racism, and ableism have been entrenched into several aspects of life on a worldwide scale and contribute significantly to disparities in access to healthcare, there are also additional barriers that are unique to the healthcare experience in non-Western communities. Highlighting and understanding these barriers is crucial to encouraging essential improvement toward universally equitable healthcare globally.

Universal barriers to healthcare

Sexism: There are various examples of inequitable disparities between men and women in the world of healthcare access and treatment quality. A study conducted by Cameron et al. in 2010 found that women in the U.S. had less frequent hospital visits than men of similar socioeconomic status despite their relatively more significant need for care. Additionally, an investigation from Deloitte found that employed women in the U.S. spend significantly more money on healthcare annually (approximately $15 billion) compared to their male counterparts, even when maternity-related costs are accounted for. While there are undoubtedly additional factors that play a role in access to healthcare, these examples still present a clear indication of inequity towards women. Another study performed by Hoffman and Tarzian in 2001 found that women, despite reporting more severe symptoms of pain, were less likely to be prescribed pain medication compared to men and were instead given sedatives. This highlights the fact that, along with access to care in general, access to quality care is also mainly hindered for women relative to men.

Racism: In the U.S., racial minorities, including Black, Indian, and Hispanic individuals, experience significant drawbacks compared to their White counterparts, with these communities showing increased rates of morbidity for particular diseases. Similar statistics are seen in the United Kingdom, as Black and South Asian communities display higher incidences of infant mortality. These examples suggest that racial minorities are inordinately disadvantaged in their access to adequate healthcare compared to non-minorities. Relatedly, the U.S Center for Disease Control and Prevention found that Black women have a three-times higher chance of mortality due to pregnancy compared to White women, attributing this statistic partially to systemic racism in the medical industry.

Ableism: Sundry aspects of the healthcare industry involve ableism. A study published by VanPuymbrouck et al. in 2020 found that, out of a sample of 25,006 U.S healthcare providers, 83% displayed an underlying positive bias towards non-disabled patients, while 32% expressed this predilection explicitly9,10. Alongside this bias stemming from healthcare workers, the systems themselves are also prone to inherently disadvantage disabled individuals. Healthcare services, including in-person facilities and online options, can significantly lack accessibility for disabled people, resulting in increased difficulty in receiving the needed care10. Disabled people are also rarely considered during clinical trials, which results in unpredictability for the effects of certain medications or treatment techniques about particular disabilities.

Barriers unique to Eastern communities

Stigma: Despite the gradually increasing normalization of mental health and its related conditions in the West, the stigma surrounding mental health is still widely prevalent in certain Eastern countries such as India and Singapore. Clinical psychiatrist Dr. Navodita Kumar ascribes this taboo to traditional beliefs rooted in the idea that mental disorders are the result of negative karma or personal frailty. Additionally, another factor that contributes to this idea is the collectivist nature of Eastern societies, which heavily emphasizes the concepts of honor and shame, thus stigmatizing mental health disorders as they can be viewed as disgracing an individual and their family. The result of this stigma is low self-reporting of mental health disorders, which can potentially result in the deterioration of one's condition.

Caste system: While racism takes place on a global scale, caste-based discrimination can be an additional barrier to many services in South Asia, including healthcare. "Scheduled castes" are groups in India who are considered to be of lower social status and are exposed to the most prejudice. An investigation conducted by Kowal and Afshar in 2015 found that elderly individuals from scheduled castes in India had increased rates of poor health and disabilities compared to those of non-scheduled castes. Additionally, Dalits, who are one of the most significantly disadvantaged castes, have lower life expectancy and higher rates of childhood anemia than non-scheduled castes. Being of lower caste is associated with a range of disadvantages; the combination of practical and social disadvantage results in compromised access to quality healthcare, leading to adverse health outcomes.

Lack of access to family planning services: Though access to family planning is a worldwide issue, Focus 2030 claims that the proportion of individuals with unsatisfied needs for contraception is 13% in Southeast Asia and only 8% in North and South America, with this difference being attributed to lower access to quality family planning services. This issue is further exacerbated by socioeconomic differences between groups within these countries, as disadvantaged communities have even less access to such services18. An example of this is Meghalaya, India, where 36% of couples seeking counseling for contraception are unable to access it. Similarly, a study conducted by Nagai et al. in 2019 concluded that approximately 73% of women had missed opportunities to receive counseling for family planning during their recent visits to healthcare facilities in the Philippines. These examples indicate that family planning services need significant improvement to improve access to contraception.

Why intersectionality matters

When considering all of the barriers mentioned above to healthcare alongside the various others that exist worldwide, we must reflect on intersectionality. Intersectionality suggests that each individual's experience with the systems of the world is a result of the several characteristics of their identity and how they, combined, expose that individual to a combination of oppressive factors such as sexism, racism, and ableism concurrently. Recognizing this concept is critical to understanding the full complexity of how inequity manifests itself in different places and varying ways depending on the person. It also highlights the fact that these phenomena do not occur in a vacuum; an individual, for example, could be considered disadvantaged due to racism and sexism while concurrently being advantaged in the context of ableism, resulting in a profoundly unique and involuted personal experience. Keeping this concept in mind in the context of healthcare equity allows us to circumvent the oversimplification of attributing certain phenomena to only one system of oppression at a time, while the reality is that they are all active simultaneously.

Conclusion

There is a widely spread range of barriers that impact access to healthcare services on a global scale, with some, such as sexism and racism, being universal. In contrast, others, such as the caste system, are more specific to particular regions. We must not only investigate these issues individually and seek solutions but also acknowledge their overlapping effects and strive to make healthcare genuinely equitable for everyone, regardless of identity or geographic location.