Equality and Discrimination
Concepts of Inequality
- Inequality: the state of not being equal, especially in
status, rights, and opportunities.
- Economic inequality: inequality in “living conditions”
- Inequality of rights and associated obligations: rights-
based, legalistic approach to inequality.
Two Perspectives of Economic Inequality
- Inequality of outcomes: occurs when individuals do
not possess the same level of material wealth or
overall living economic conditions.
- Inequality of opportunity: inequalities that arise
between individuals due to the groups they identify
with.
- “Economic inequality refers to how economic
variables are distributed – among individuals in a
group, among groups in a population, or among
countries.”
From ‘Glass Ceilings’ to ‘Firewalls’ – Different
Metaphors for Describing Discrimination
- Metaphor: a way of conceiving one thing in terms of
another, and its primary function is understanding.
- Glass-ceiling: defines the invisible barrier that
prevents many women and minorities from advancing
into senior and executive management positions
within organizations.
- Firewall: for describing discrimination against women
and other minority groups.
- Domain-Interaction Model: embraces the analogies
as well as the differences between the two terms or
domains in question.
Evaluation of the Glass Ceiling Metaphor: Structural
Aspects
- Structure: the arrangement of and relations between
the parts or elements of something complex.
- Discrimination: pinpoints the ‘relation between parts’
by ‘the unjust or prejudicial treatment of different
categories’ and ‘the difference between one thing
and another’.
- Glass Ceiling: -
Evaluation of the Firewall Metaphor: Processual
Aspects
- Process: a series of actions or steps taken in order to
achieve a particular end.
- Discrimination: as being represented by the terms,
race, age, and sex
- Firewall: conveys operation and thus, process in
different settings, which implies a course of action and
movement with different effects.
* Glass ceiling < Firewall
Eliminating Racial and Ethnic Health Disparties; A
Business Case Update for Employers
- Race-based minorities, including Hispanics, African
Americans and Asians, which currently represent
one-third of the US population, will become a
majority in 2042.
- The working-age population is projected to
become more than 50 percent minority in 2039.
What are Disparities and Health Disparities?
- Disparities in health status: differences in health
conditions and in health outcomes.
- Disparities in health care: differences in the
preventive, diagnostic and treatment services
offered to people with similar health conditions.
- Differences in access to or availability of facilities
and services.
* Disparities (a great difference) in health and health
care exist, even among employees with equal
benefits.
Examples of Racial and Ethnic Health Disparities
- Low income individuals have higher mortality rates
than high-income individuals, even when health
insurance is universally available.
- Infant mortality rates among African Americans are
twice as high as those among whites. African-
American infants are almost four times as likely to die
from complications related to low birth weight as
white infants.
- The rate of treatment for depression is significantly
lower for blacks and Hispanics than for whites.
- Hispanics are less likely to receive or use
medications for asthma, cardiovascular disease,
HIV/AIDS, mental illness or pain, as well as
prescription medications in general.
Health disparities – equity issue
- Equity: the quality of being fair.
- Equality: the state of being equal.
Factors that Contribute to Health Disparities
1.) Patient-Level Variables – the characteristics of a
patient that contribute to health disparities.
- Socioeconomic status
- Language barriers
- Poor health literacy
- Cultural Beliefs and Preferences
2.) Health Care Systems Level Variables
- The organizational complexity of a health care
system.
- The financial complexity of the system; and
- The geographic location of the health care
facility.
- Unavailability of translation services.
3.) Care Process
- characteristics of an individual provider that
contribute to disparities.

How do Disparities affect employers?

- “Business must realize there are real bottom-line
costs associated with health disparities.”

Direct Benefits to Employers

- Decreases in utilization and medical costs
- Decreases in medical claim costs for serious
conditions avoided by better screenings,
treatments and preventive care.

Indirect Benefits to Employers

- Increased employee and dependent
Satisfaction with health care benefits.
- Increased productivity.
- Workforce stability
- Increased longetivity and quality of life
because o earlier detection of disease and
better management of chronic conditions.
- Decreased short- and long term disability
costs
- Decreased workers’ compensation claims

Employers as Part of the Solution

- The majority of employers were unaware of
disparities as a business issue.
- Only one-third of respondents believed that
reducing disparities was an “important” or “very
important” issue.

What Can Employers Do?

Step1: Understand Legal Myths and Realities
Step2: Know Your Data
Step3: Work with Employees
Step 4: Work with Health Plans and Other Health
Vendors