With April being National Minority Health Month and May Older Americans Month, the time is now to stand against the barriers that create the social, health and economic disparities experienced by the older adult population – a population that demographic data clearly tells us is becoming more and more diverse. That’s why we were struck by the most recent issue of Generations, the quarterly journal of the American Society on Aging, which is entirely devoted to these timely and critical issues.
First Let's Talk About the Landscape
African Americans, Latinos and Native Americans in the U.S. receive lower quality health care and experience disproportionately high rates of mortality and health status disparities compared to other high-income countries, say Alberto Palloni and James Yonker. And as author Steven P. Wallace states in his article, “Health inequities are the result of avoidable differences between populations that affect less powerful groups in society. They stem from a pattern of health determinants, outcomes and resources associated with broader social inequities.”
Several other authors in Generations argue that we need public policies and institutions that create healthy environments for older adults with diverse backgrounds, that make the “healthy choice the easy choice.” Determinants such as economic status, safety and adequate housing, are important as these facilitate healthy behaviors.
Valuing caregivers can also help address disparities, author Nancy R. Hooyman argues. Most caregivers and care recipients are women. Hooyman's article points out that gender inequities experienced by women are inextricably linked to the widespread undervaluing of caregiving, saying, “These disparities are reinforced by social institutions of the family and the labor market.” The solution lies in viewing caregiving as a “public value” rather than a private duty, as is often the attitude in the U.S.
Taking a Closer Look: LGBT Older Adults
Generations features a number of articles focused on particular populations, including one about lesbian, gay, bisexual or transgender (LGBT) older adults. According to Karen I. Fredriksen-Goldsen, there are 2.4 million adults 50 and older in the U.S. who identify as LGBT, accounting for 2.4 percent of the population in that age range. She goes on to say that “LGBT adults who are middle-age and older experience significant health disparities, defined as variations in health attributable to systemic environmental, economic and social barriers that place individuals at a disadvantage in the larger society.”
It is critical to ensure comprehensive support services for mid-life and older LGBT adults. Adequate resources will ensure that this population does not experience social isolation and poor health outcomes. The Affordable Care Act (ACA) provides important steps forward in advancing policies that address the needs of LGBT older adults, such as establishing the non-discrimination protections in health care services based on sexual orientation or gender identity.
Taking Advocacy to the Next Level
So, which strategies and advocacy approaches can take this movement to the next level? Generations authors highlight initiatives underway through the Administration on Aging (AOA), including the Administration for Community Living and the Older Americans Act. For example, authors Boutaugh et al, suggest that these initiatives offer lessons that can help address the issues of access for racial and ethnic minorities. One such initiative the AOA has supported bolsters evidence based health and prevention programs such as the Chronic Disease Self-Management Program. Other initiatives, made possible through the ACA, can also advance health equity for vulnerable, diverse older adult populations, such as the demonstrations to integrate care for those dually eligible for Medicare and Medicaid.
The Bottom Line
The latest Generations issue* keenly reminds us that the transformation of our health care system must fully recognize the diversity of America’s aging population and tackle, head on, the social and health disparities it experiences. Fortunately, the ACA offers myriad opportunities to take on this challenge and, critically, to make older adults’ voices central to the decisions being made about their health.
*This issue is available to ASA members or for single-issue purchase here.