Although the availability and accessibility of high quality health care services play an obvious and indispensable role in enhancing individual and community health status, health care by itself is not sufficient to produce desirable outcomes. Family history helps to determine the degree to which an individual may be at a higher risk for acquiring various ailments, such as cancer and cardiovascular disease. Poverty can affect the ability to obtain an education, live in a safe neighborhood in housing that is not substandard, afford a nutritious diet, have access to suitable transportation, and be able to meet any out-of-pocket health care expenses. Lifestyle factors from the standpoint of avoiding substance abuse and engaging in risky behavior that increases the risk of accidents also will be determinants of health status.

Poverty Rates For Blacks And Hispanics Reach Historic Lows

The state of the U.S. economy influences the kinds and availability of employment opportunities open to individuals seeking jobs. Positions that pay a satisfactory wage and include health insurance coverage contribute to improved health. In 2019, the poverty rate in this nation was 10.5%, the lowest since estimates were first released for 1959. Poverty rates declined between 2018 and 2019 for all major race and Hispanic origin groups. Blacks and Hispanics, reached historic lows in their poverty rates in 2019. The rate for Blacks was 18.8% and for Hispanics, it was 15.7%. These estimates were released on September 16, 2020 by the U.S. Census Bureau. They are from the Current Population Survey Annual Social and Economic Supplement. Nonetheless, it remains significant that inequalities persist. Even with these gains, Blacks and Hispanics continue to be over-represented in the population in poverty relative to their representation in the overall population.

In 2019, the share of Blacks in poverty was 1.8 times greater than their share among the general population. Blacks represented 13.2% of the total population in the United States, but 23.8% of the poverty population. The share of Hispanics in poverty was 1.5 times more than their share in the general population. Hispanics comprised 18.7% of the total population, but 28.1% of the population in poverty. In contrast, non-Hispanic Whites and Asians were under-represented in the poverty population. Non-Hispanic Whites made up 59.9% of the total population but only 41.6% of the population in poverty. Asians represented 6.1% of the population and 4.3% of the population in poverty. These disparities are especially pronounced among children and individuals ages 65 and older.

Necessity Of Having An Adequate Supply Of Competently-Prepared Health Personnel

Much emphasis is placed on health policy development regarding the provision of health insurance coverage and beneficiary ability to obtain care. An aspect that deserves considerably more attention is the health workforce. An implicit assumption seems to be that everything will fall into place nicely once the insurance coverage and access to health care parts of the puzzle are resolved. A different kind of problem that needs to be addressed is whether there is a proper mix of health professionals and the extent to which they are distributed evenly in all regions of the U.S. where their services are required. For example, rural areas tend to experience severe shortages of all kinds of health personnel. A key ingredient in the ability to produce an adequate supply of competently-prepared health professionals is scope of practice legislation where the major focus is at the state rather than the federal level.

States across the nation represent battlegrounds where different professional groups (e.g. psychiatrists vs, psychologists, dentists vs. dental therapists, anesthesiologists vs. nurse anesthetists) vie with one another to determine which practitioners should be given sole authority to treat patients. Claims for exclusivity tend to be based on protecting the safety of patients. California in September 2020 is the scene of a dispute between physicians and nurse practitioners. AB 890 is a hotly contested bill that would grant full practice authority to nurse practitioners by allowing them to practice without physician supervision. The Golden State is behind most other states in empowering nurse practitioners. Currently, nearly 40 other states grant some level of independence to the nursing group and 22 states grant full independence. Nurse practitioners argue that the measure would ease primary care shortages, especially in rural areas, a problem exacerbated by the COVID-19 pandemic. Physicians counter with a view that eliminating oversight by them would lead to a lower standard of care, while also expressing doubt that nurse practitioners would go to rural areas once unencumbered by medical supervision.

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