Achieving health equity requires understanding the circumstances that lead to poor health outcomes in certain populations and tailoring responses that are appropriate to each affected population. Numerous studies and measures indicate where disparities in access to care exist along racial, ethnic, and socioeconomic lines, underscoring the need for policy to address gaps in vision and eye health across populations and to apply appropriate solutions.
Because health equity is such a vast topic that affects a number of national health policies and programs, legislation and regulatory policies that seek to address health inequity across populations and subgroups may be introduced or integrated on a program-by-program or issue-by-issue basis, requiring foresight of whether various legislative and regulatory proposals will improve or harm vision and eye health equity. Numerous issue-based thought leaders will attempt to define health equity as a matter of informing policy movements. It will be critical for Prevent Blindness to elevate the reality of disparate equity in vision and eye health by identifying existing and new advocacy partners to work together on legislation, appropriations, and rulemaking to ensure that vision and eye health plays an early role in shaping national policy on health equity.
Social Determinants of Health
Many of the circumstances that contribute to vision loss or eye disease are as the result of both health and non-health related factors, requiring policy approaches to consider how factors external to health or “social determinants of health” may contribute to individual and community health status. Social and economic conditions including housing, employment status, income level, ability to access or afford healthy foods, and education level can all impact how an individual accesses care as well as the health of their community. Addressing social determinants of health is a population health approach to vision and eye health as it allows for the opportunity to factor individuals’ ability to access and afford care, encourage innovations at the community level in early detection and intervention approaches that connect high-risk patients to care, and can foster greater understanding of the barriers that prevent patients from accessing care.
Rural Health and Health Care Shortage Areas
Many Americans live in areas of the country that are considered to be rural, underserved, or a health shortage area. According to federal guidelines through the Health Resources and Services Administration, there are only a certain number of providers available to serve a designated population figure. Current data indicates that 24% (721) of 3,006 American counties have no ophthalmologist or optometrist. The National Rural Health Association estimates approximately one fifth of the nation’s population lives in rural America with only 10% of the country’s physicians practicing in rural communities. For patients, this means that a needed or failed preventive vision screening or presence of a chronic illness may require them to travel—which means time away from work or home responsibilities, added costs, and difficulty with appointment availability—to seek the level of care required to ensure they maintain their vision health. Adding these additional burdens to a patient makes adherence to care very difficult, in some cases, and could lead to worsened eye health and potentially loss of vision. In addition, population demographics of rural areas tend to be older adults at risk or living with chronic illness.
Clinical interventions, such as those in primary care settings and in community health centers, are especially critical for rural and health shortage areas; however, federal policy needs to create incentives that drive qualified providers to serve in rural and underserved areas, equip communities with appropriate infrastructure such as broadband to support communications, extend appropriate telehealth flexibilities, and stabilize community health facilities (such as federally-qualified health centers, critical access hospitals, and community health centers), and expand the community and public health workforce with supportive mechanisms that promote early detection, prevention, health promotion, and disease state monitoring. For many underserved and low-income communities, federally funded community and rural health centers may be the only source of eye and vision care services.