The midth century phenomenon of the large-scale migration of white middle-class families from urban centers has coined the term white flight.
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While the current state of housing discrimination can be partly attributed to this phenomenon, a larger set of institutionalized discrimination , like bias in loan and real estate industries and government policies, have helped to perpetuate the division created since then. These include bias found in the banking and real estate industries as well as discriminatory public policies that promote racial segregation. Government policies that have tended to promote spatial inequalities include actions by the Federal Housing Administration FHA in promoting redlining , a practice where mortgages could be selectively administered while excluding certain urban neighborhood deemed risky, oftentimes because of race.
Practices like this continued to prevent home buyers from getting mortgages in redlined areas until the s, when the FHA discontinued the determination of restrictions based on racial composition. The advent of freeways also added a complex layer of incentives and barriers which helped to increase spatial inequalities. First, these new networks allowed for middle-class families to move out to the suburbs while retaining connections like employment to the urban center.
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Second, and perhaps more importantly, freeways were routed through minority neighborhoods, oftentimes creating barriers between these neighborhoods and central business districts and middle class areas. Highway plans often avoided a more direct route through upper or middle class neighbors because minorities did not have sufficient power to prevent such actions from happening.
Massey identifies three goals specifically for the United States to end residential segregation: reorganize the structure of metropolitan government, make greater investment in education, and finally open housing market so full participation  More specifically, he advocates broader, metropolitan-wide units of taxation and governance where the tax base and decisions are made equally by both the urban and suburban population.
Education is the key to closing employment inequalities in a post-manufacturing era. And finally, the federal government must take large strides towards enforcing the anti-segregation measures related to housing it has already put into place, like the Fair Housing Act , the Home Mortgage Disclosure Act , and the Community Reinvestment Act. Another set of divisions that may be useful in framing policy solutions include three categories: place-based policies, people-based policies, and indirect approaches. Place-based policies include improving community facilities and services like schools and public safety in inner-city areas in an effort to appeal to middle-class families.
These programs must be balanced with concerns of gentrification. People-based policies help increase access to credit for low-income families looking to move, and this sort of policy has been typified by the Community Reinvestment Act and its many revisions throughout its legislative history. Finally, indirect approaches often involve providing better transportation options to low-income areas, like public transit routes or subsidized car ownership.
These approaches target the consequences rather than the causes of segregation, and rely on the assumption that one of the most harmful effects of spatial inequality is the lack of access to employment opportunities.
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In conclusion, a common feature in all of these is the investment in the capital and infrastructure of inner-city or neighborhood. The quality of healthcare that a patient receives strongly depends upon its accessibility. Kelley et al. In fact, studies have shown that income-related inequality in healthcare expenditures favors the wealthy to a greater degree in the United States than most other Western nations.
Racial disparity in access and quality of healthcare is a serious problem in the United States and is reflected by evidence such as the fact that African American life expectancies lag behind that of whites by over 5 years, and African Americans tend to experience more chronic conditions. These reports developed about measures of quality of care and about measures of access to care, which were used to measure the healthcare disparities.
The first reports, released in December , found that blacks and Hispanics experienced poorer healthcare quality for about half of the quality measures reported in the NHQR and NDHR. Also, Hispanics and Asians experienced poorer access to care for about two thirds of the healthcare access measures. Compared with white patients, blacks receive far fewer operations, tests, medications and other treatments, suffering greater illnesses and more deaths as a result.
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One specific study showed that African Americans are less likely than whites to be referred for cardiac catheterization and bypass grafting, prescription of analgesia for pain control, and surgical treatment of lung cancer. Both African Americans and Latinos also receive less pain medication than whites for long bone fractures and cancer. Other studies showed that African Americans are reported to receive fewer pediatric prescriptions, poorer quality of hospital care, fewer hospital admissions for chest pain, lower quality of prenatal care, and less appropriate management of congestive heart failure and pneumonia.
Language-barriers became a large factor in the process of seeking healthcare due to the rise in minorities across the United States. In , an estimate done by the Census Bureau stated that Thus, demonstrating the rapid increase of minorities over time within the United States and the importance of it. In addition to race, healthcare inequality also manifests across gender lines. Though women tend to live longer than men, they tend to report poorer health status, more disabilities as they age, and tend to be higher utilizers of the healthcare system.
Such time must be scheduled around work whether formal or informal , child care needs, and the geography—which increases the travel time necessary for those who do not live near healthcare facilities. Spatial distribution and geographic location also affect access and quality of healthcare. A study done by Rowland, Lyons, and Edwards found that rural patients were more likely to be poor and uninsured.
Discrimination, Inequality, and Poverty—A Human Rights Perspective
This travel time often poses an obstacle to receiving medical care and often leads patients to delay care until later. For example, three of the five largest landfills in the United States are situated in communities which are predominantly African American and Latino, contributing to some of the highest pediatric asthma rates in those groups.
Socioeconomic background is another source of inequality in healthcare. Poverty significantly influences the production of disease since poverty increases the likelihood of having poor health in addition to decreasing the ability to afford preventative and routine healthcare. The same trend for uninsured versus insured patients holds true for children as well. Hadley, Steinberg, and Feder found that hospitalized patients who are not covered under health insurance are less likely to receive high-cost, specialized procedures and as a result, are more likely to die while hospitalized. Census data show that However, this inequality differs across age groups.
Inequality was shown to be greatest for senior citizens, then adults, and least for children.
This pattern showed that financial resources and other associated attributes, such as educational attainment, were very influential in access and utilization of medical care. The acknowledgement that access to health services differed depending on race, geographic location, and socioeconomic background was an impetus in establishing health policies to benefit these vulnerable groups. Medicare is a federally funded program that provides health insurance for people aged 65 or older, people younger than 65 with certain disabilities, and people of any age who have End-Stage Renal Disease ERSD.
Medicaid, on the other hand, provides health coverage to certain low income people and families and is largely state-governed.
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According to Fein , this goal could include equal health outcomes for all by income group, equal expenditures per capita across income groups, or eliminating income as a healthcare rationing device. Some have proposed that a national health insurance plan with comprehensive benefits and no deductibles or other costs from the patients would provide the most equity. He proposed instead paying physicians on a salaried basis. The study indicated that community health centers provided more preventive care and greater continuity of care, though there were problems in obtaining adequate funding as well as adequate staffing.
Increasing the racial and ethnic diversity of healthcare providers can also serve as a potential solution. Racial and ethnic minority healthcare providers are much more likely than their white counterparts to serve minority communities, which can have many positive effects. Advocating for an increase in minority healthcare providers can help improve the quality of patient-physician communication as well as reduce the crowding in understaffed facilities in areas in which minorities reside.
This can help decrease wait times as well as increase the likelihood that such patients will seek out nearby healthcare facilities rather than traveling farther distances as a last resort. Implementing efforts to increase translation services can also improve quality of healthcare. Studies show that non-English speaking patients self-reported better physical functioning, psychological well-being, health perceptions, and lower pain when receiving treatment from a physician who spoke their language.
Hispanic patients specifically reported increased compliance to treatment plans when their physician spoke Spanish and also shared a similar background. The idea of universal health care , which is implemented in many other countries, has been a subject of heated debate in the United States. However, unequal access to decent work and persistent labor market inequalities frustrate efforts to reduce poverty.
First generation discrimination occurs as an overt bias displayed by employers, and since the end of the civil rights era has been on the decline. Second generation discrimination; on the other hand, is less direct and therefore much harder to legislate against. For instance, gender discrimination often takes the form of working hours and childcare-related benefits. Employment discrimination is also closely linked to education and skills.
One of the most important factors that can help describe employment disparities was that for much of the post-WWII-era, many Western countries began shedding the manufacturing jobs that provided relatively high-wage jobs to people with moderate to low job skills. This may require legislative or administrative reform to repeal discriminatory provisions or address discriminatory practices by the government or private actors, a change in resource allocation, or educational measures.
The post frameworkshould embody the responsibility of states, when acting together or alone, to take proactive measures to identify and address entrenched discrimination, both direct and indirect. Itshould embody the responsibility of states, international institutions, and corporations to avoid and remedy discrimination for which they are directly or indirectly responsible.