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Why do some families face the horror of death when they shouldn't have to? Why can't everybody get equal care? This book addresses all of this and more, and it's not only a medical work but also an account of the families living through these situations every day.
Aug 21, Jennifer Richardson rated it it was amazing Should be required reading for anyone comparing the Obama health plan to Nazis, but then, they would have to know how to read.
I learned a lot reading it, and some of those thoughts are in this essay I wrote for the class it was assigned in: The Failure of Health Care in Urban America chronicles the consequences of an inadequate and inequitable health care system on an African American family living in Chicago, between May and April Jackson suffers from diabetes and loses first one leg then the other to infection.
Robert Banes is on dialysis due to focal glomerulosis, a disease that scars the kidneys until they are destroyed. All are publicly insured. As her various family members fall ill, Jackie Banes cares for them along with her three children, but oftentimes she simply cannot make ends meet.
She furthermore suggests reform to the system through universal health care, an overhaul of Medicaid, and a transition from emphasizing curing to emphasizing caring. Though Abraham clearly enumerates problems of racial disparities, unequal access to care, and overdependence on late-stage treatment for poor urban blacks, her proposed reform addresses mainly structural challenges of insurance coverage while doing little to ameliorate the social issues she discusses.
The poorer health outcomes experienced by urban blacks in comparison to other racial groups have many social influences, Abraham describes, including racial segregation, poverty and lack of communication with health care providers.
For instance, Tommy was just 48 when he suffered a stroke due to high blood pressure. Unsafe structures, insect and rodent infestations, mold growth and lack of heating are a few of the health hazards that substandard housing poses to poor urban blacks WHO, Indeed, the Banes are described dealing with cockroaches and a rat.
Once in health care settings, social factors can also interfere with communication; the Banes were often unclear on their medical statuses. Largely non-black upper- and middle-class health care providers are better able to communicate with non-black patients, and even well-intending practitioners may exhibit aversive racism, appearing cold and withdrawn, when interacting with black patients Van Ryn, Thus, black patients are less likely to receive the same quality of care that white patients do.
Abraham contends that inequities in health care access stem from the shortcomings of insurance. Many Americans are covered by their employers, but many low-wage jobs do not offer health benefits. Poor urban blacks, such as the Banes, rely on Medicaid, for the poor, and Medicare, for the elderly.
This leaves many uninsured, without reliable access to care. Even for those who do qualify, services are limited.
Thus, Jackie is forced to ration medicines and forgo multiple appointments for Mrs. Jackson when the household is strapped for cash.
Patchwork services exist that can provide additional care, but patients often are not aware of them. Jackson experiences major depressive disorder and could benefit from a home psychiatric program at Mount Sinai, but she is never referred and her family does not know to ask.
The confusing system of aid results in disadvantaged patients forgoing services. Emergency rooms, where ability to pay is not a factor in treatment, are where publicly insured and uninsured patients often turn to, but trauma units are not meant to build long-term relationships with patients and cannot substitute primary care.
This suggests that for individuals who are dying or who are permanently disabled, resources should be spent not on futile cures but on end-stage care for patients at the end of their lives and therapy and technical training for disabled patients and families to adjust to caregiving.
In the case of Mrs. Jackson, perhaps a feeding tube was less necessary than social counseling and hospice care. Before the progression of her illness to this point, Jackie could also have benefited from counseling and training to be a caregiver.
While this proposal seems useful, it is unclear why Abraham abandons the argument she earlier raised on emphasizing prevention over treatment. She also criticizes how Medicare refuses to fund bathroom bars that would prevent falls and hip fractures in the elderly, which Medicare must later treat.
Preventative measures have the highest cost-benefit ratios, and improved primary care for poor urban blacks would reduce later health issues. Early life exposures can have major impacts on health throughout life, from neurodevelopment to diabetes risks, and IQ to expected earnings WHO, Interventions early in childhood thus are crucial to improving health outcomes for disadvantaged groups.
While shifting from curing to caring may be a worthy redistribution of resources, a greater emphasis on prevention may better reduce the need for both.The book Mama Might Be Better Off Dead: The Failure of Health Care in Urban America, Laurie Kaye Abraham is published by University of Chicago Press.
Review MAMA MIGHT BE BETTER OFFDEAD: THE FAILURE OF HEALTH CARE IN URBAN AMERICA By Laurie Kaye Abraham, pp. Chicago: University of Chicago Press, , $ Mama Might Be Better Off Dead is a powerful and revealing ethnography of one African American family and its struggle with the prevailing health care system in the United States.
Evidence-Based Policy: A Practical Guide to Doing It Better [Nancy Cartwright, Jeremy Hardie] on vetconnexx.com *FREE* shipping on qualifying offers. Over the last twenty or so years, it has become standard to require policy makers to base their recommendations on evidence. That is now uncontroversial to the point of triviality--of course.
Mama Might Be Better Off Dead is an unsettling, profound look at the human face of health care. Both disturbing and illuminating, it immerses readers in the lives of four generations of a poor, African-American family beset with the devastating illnesses that are all too common in America's inner-cities/5.
The best opinions, comments and analysis from The Telegraph. Mama Might be Better Off Dead: The Failure of Health Care in Urban America (review) Constance Dean Qualls Journal of Health Care for the Poor and Underserved, Volume 9, Number.