Discrimination in Medical Treatment

 

Discrimination in Medical Treatment

Bruhaspati Samal

General Secretary

Confederation of Central Govt. Employees and Workers

Odisha State Coordination Committee, Bhubaneswar

eMail: samalbruhaspati@gmail.com, Mobile:9437022669

In the hallowed halls of hospitals and clinics worldwide, a disturbing reality often lurks beneath the surface: discrimination in medical treatment. Despite healthcare being a fundamental human right, millions face unequal access based on factors ranging from race and economic status to gender and geographic location. Let’s dive deep into the shadows of healthcare disparity, uncovering poignant stories and stark statistics that illuminate the urgent need for equity in our medical systems.  

  Discrimination in medical treatment manifests in various forms, impacting individuals across different demographics and socioeconomic backgrounds. It transcends geographical boundaries and affects both developed and developing countries, albeit in different degrees and contexts. Furthermore, discriminatory practices can be embedded within healthcare institutions, affecting policies, procedures, and interactions with patients. Implicit biases among healthcare providers may influence clinical decisions and patient outcomes, perpetuating disparities. A study published in 2022 found that medical students and healthcare professionals often hold implicit biases against certain racial and ethnic groups, which can impact treatment decisions and patient care. Structural barriers such as inadequate healthcare infrastructure, insufficient funding for public health programs, and disparities in health insurance coverage contribute to unequal access to medical treatment. Social determinants of health, including education level, employment status, housing conditions, and access to nutritious food, significantly influence health outcomes and access to healthcare services. Low-income families in urban areas of developing countries may struggle to afford basic healthcare services and medications, leading to higher rates of preventable diseases and poorer health outcomes.

In many parts of the world, maternal mortality rates vary significantly based on socioeconomic status, geographic location, and access to quality healthcare. Women from marginalized communities often face higher risks during pregnancy and childbirth due to barriers such as inadequate prenatal care and limited access to emergency obstetric services. In Nigeria, where maternal mortality rates are among the highest globally, women from rural areas and lower-income families are disproportionately affected due to limited access to skilled birth attendants and emergency obstetric care. Members of the LGBTQ+ community (Lesbian, Gay, Bisexual, Transgender, Queer and individuals born with variations in sex characteristics including Asexual and Pansexual) in the United States frequently encounter discrimination when seeking healthcare services, ranging from refusal of care to derogatory remarks from healthcare providers. A survey conducted by the Human Rights Campaign found that nearly one in five LGBTQ+ individuals reported having been refused care by a healthcare provider due to their sexual orientation or gender identity. Indigenous Australians experience significant disparities in healthcare access and outcomes compared to non-Indigenous Australians. Historical and ongoing systemic discrimination, coupled with cultural insensitivity in healthcare delivery, contributes to higher rates of chronic diseases and lower life expectancy among Indigenous populations. Research by the Australian Institute of Health and Welfare has shown that Indigenous Australians are twice as likely as non-Indigenous Australians to report fair or poor health status, highlighting persistent health inequities.

India continues to grapple with high maternal mortality rates, exacerbated by disparities in access to quality healthcare services. Women from marginalized communities, particularly those in rural areas and from lower socioeconomic backgrounds, face significant challenges in accessing timely prenatal care and skilled birth attendants. In states like Uttar Pradesh and Bihar, which have some of the highest maternal mortality rates in India, women from disadvantaged communities often lack access to adequate healthcare facilities and trained healthcare providers. This results in higher rates of maternal deaths due to preventable causes such as postpartum hemorrhage and infections. The lack of accessible healthcare facilities and skilled birth attendants disproportionately affects marginalized women, perpetuating intergenerational cycles of poor health outcomes and socioeconomic disadvantage. Members of the LGBTQ+ community in India frequently face discrimination and stigma when seeking healthcare services. Deep-rooted societal prejudices and legal ambiguities contribute to healthcare providers' lack of understanding and sensitivity towards LGBTQ+ individuals' unique healthcare needs. A survey conducted by the Naz Foundation in 2022 found that nearly 40% of LGBTQ+ individuals in India had experienced discrimination or harassment while accessing healthcare services. Instances include healthcare providers refusing treatment or making derogatory remarks based on sexual orientation or gender identity. Indigenous and tribal communities in India face significant healthcare disparities, stemming from historical neglect, geographical isolation, and cultural barriers. Limited access to healthcare facilities, inadequate infrastructure, and insufficient healthcare resources contribute to poor health outcomes among these populations. Tribal communities in states like Jharkhand and Odisha often lack access to basic healthcare services such as immunizations, prenatal care, and treatment for common ailments. Healthcare facilities in tribal areas are understaffed and under-equipped, resulting in higher rates of preventable diseases and maternal mortality. The healthcare disparities faced by indigenous populations perpetuate cycles of poverty and ill health, further marginalizing these communities within the broader socio-economic framework of India.

Ayushman Bharat Yojana (PMJAY) introduced in 2018 aims to provide health coverage to over 50 crore individuals from economically weaker sections. However, disparities exist in the implementation across states. For example, as of 2023, states like Kerala and Tamil Nadu reported higher utilization rates compared to states like Bihar and Uttar Pradesh, where utilization remains lower despite similar population demographics. This discrepancy indicates uneven access to healthcare services based on geographic location within India itself. In Bihar, only 25% of eligible families utilized PMJAY services in 2022, while in Kerala, the utilization rate was nearly 70%. This highlights stark regional disparities in access to healthcare under the same national scheme. National Rural Health Mission (NRHM) launched in 2005 to address healthcare disparities in rural areas aims to provide accessible, affordable, and quality healthcare to marginalized communities. However, resource allocation and healthcare infrastructure development under NRHM vary significantly across states, leading to disparities in healthcare quality and access. As of 2023, rural health infrastructure in states like Rajasthan and Madhya Pradesh lags behind southern states such as Karnataka and Andhra Pradesh. This disparity affects the quality of medical treatment available to Indian nationals residing in rural areas. Private healthcare facilities in metropolitan cities often cater to affluent individuals, resulting in higher treatment costs that are prohibitive for many Indian nationals from economically disadvantaged backgrounds. A study conducted in 2023 revealed that the average cost of a major surgical procedure in private hospitals in Delhi is approximately Rs.2 lakh, whereas the same procedure costs around Rs. 50,000 in government hospitals. This cost disparity underscores the economic discrimination faced by Indian nationals seeking medical treatment in urban centers. The concentration of high-quality private healthcare facilities in urban centers creates geographical barriers for Indian nationals residing in rural or remote areas. In 2023, only 35% of rural households in India had access to healthcare facilities within a 5 km radius, compared to 85% of urban households. This disparity in geographical accessibility limits the healthcare options available to Indian nationals living in rural areas. Indian nationals with pre-existing conditions or from economically disadvantaged backgrounds often face difficulties in obtaining insurance coverage for specialized medical treatments. According to a survey conducted in 2023, only 15% of Indian nationals below the poverty line have health insurance coverage, compared to 70% of individuals from higher income brackets. This disparity in insurance coverage contributes to unequal access to specialized medical treatments for Indian nationals. Disparities in the availability of specialized medical treatments such as organ transplants and cancer care persist across different regions of India. In 2023, southern states like Tamil Nadu and Karnataka reported higher rates of successful organ transplant surgeries compared to northern states such as Uttar Pradesh and Bihar. This regional disparity underscores the unequal distribution of healthcare resources and infrastructure, impacting the medical treatment options available to Indian nationals in different parts of the country.

According to a survey conducted by Oxfam India, one in four Indians faced discrimination while accessing health services due to their caste and religion. A third of Muslim respondents, over 20 per cent Dalit and Adivasi respondents, and 30% of overall respondents reported being discriminated against on the grounds of religion, caste or because of illness or health conditions in a hospital or by a healthcare professional. Fifty per cent respondents said they were not provided with an estimated cost of treatment / procedure before the start of the treatment / procedure when they or their close relatives were hospitalised in the past 10 years, it claimed. While 31% respondents reported being denied case papers, patient records, investigation reports for treatment/procedure by the hospital even after requesting for the same, 35% of women said they underwent physical examination by male attendant without a female present in the room, the report said. Nineteen per cent of the respondents whose close relatives were hospitalised said they were denied release of dead body by the hospital. The surveys show that the basic rights of patients' in India are being routinely denied in healthcare facilities, for the poor and middle class alike.  While 74% respondents were asked to get tests / investigations done without explaining their disease, nature and / or cause of illness, nearly 57% who were themselves or their relatives had been hospitalised did not receive any information about investigations and tests being done.

Discrimination in medical treatment is a complex and multifaceted issue that undermines the fundamental right to health for millions of individuals worldwide. Addressing healthcare disparities requires a concerted effort from governments, healthcare providers, civil society organizations, and the broader community to dismantle institutional biases, eliminate structural barriers, and promote equitable access to healthcare for all. By advocating for inclusive policies, investing in healthcare infrastructure, and fostering a culture of respect and empathy in healthcare delivery, we can strive towards a future where every individual receives dignified and equitable treatment, regardless of their background or identity. Together, let us commit to building a healthcare system that upholds the principles of justice, compassion, and human rights for generations to come.

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