Introduction

Ideally, all Americans should have equal access to physicians, hospitals, and medical tests in
their communities. The fact is that large disparities exist in access to U.S. health care services
based on race, ethnicity, socioeconomic status, and education. The elderly, minorities, and lowincome individuals are most likely to experience various obstacles to receiving quality health
care services.
Given the changing demographics of American society and the link between high quality health
care and quality of life, health care disparities are likely to soon become a pressing problem in
communities across the country.
Consider these facts:

One-fourth of older adults have no supplemental insurance coverage for their health care
needs, while 16 percent of Americans under age 65 have no health insurance coverage.

Preventive health screening rates are particularly low for minorities, low-income
individuals, and older adults.

Health care facilities are often not accessible or do not have the necessary equipment to
serve people with disabilities.

Americans now live longer than ever before. Medical advances have boosted the life expectancy
from less than 50 years to more than 76 years and have greatly improved the overall health of
Americans in the past century. Since people are living longer, however, the number of
individuals who experience higher rates of illness and disability is expected to increase
dramatically.
By 2030, there will be roughly 70 million Americans age 65 years or older, which is more than
double the number of age 65+ Americans in 2000, according to the Federal Interagency Forum
on Age-Related Statistics. In 25 years, the number of people age 85 or older is expected to
double, while the number of people age 100 or older is expected to triple.
Older adults experience the effects of health care disparities more dramatically than any other
population group. They are particularly at risk because they are more likely than younger people
to have chronic illnesses, make frequent visits to medical facilities, and live in poverty.
Disparities in Clinical Trials

While a disparity certainly exists between older adults and those under age 65 in access to
medical professionals and services, there is also an age disparity in medical research practices.
Older adults are markedly underrepresented in clinical trials.

Historically, clinical trials have focused on relatively young participants. As a result, treatment
decisions for older adults are based on the knowledge gleaned from the younger population. As
one example, the Journal of the American Medical Association noted that older adults make up
63 percent of cancer patients, but only 25 percent of participants in clinical trials.
A lack of transportation to the research site is one reason to explain this disparity. In addition,
older adults are often excluded from research studies since they are more likely to have chronic
conditions and take numerous prescription drugs; therefore, they dont meet strict research
protocols. Insurance is also a contributing factor since Medicare and many insurance companies
will not pay for experimental treatments.
Most diseases affecting older adults have been studied primarily in white male populations.
Research on the health conditions of women, minorities, and other sectors of the older adult
population is limited because these groups have traditionally been excluded from major research
studies.
Despite the fact that the imbalance in study participants has been recognized for years, the
disproportionate lack of older people participating in clinical trials still exists. Yet, finally this
trend appears to be shifting as both the research community and policy groups have begun to
emphasize the inclusion of older adults in clinical trials.
Public Policies

Improving access to health care services for older adults has been an important public policy
objective for decades. Many policy initiatives, such as Healthy People 2010 and Medicare
reform, call for eliminating disparities in health care to foster better qualify of life for current and
future older Americans.
Community governments, social service agencies, health care facilities, and other entities will
need to prepare for the increasing older adult population to ensure that older adults health needs
are addressed and that quality medical services are readily available. The social work profession
is dedicated to addressing the health care disparities issue and is promoting equal health care
access, especially for vulnerable populations that need health care services the most.
###
Source: Older Adults and Health Disparities: The Impact on Access to Care by Lisa Yagoda,
LICSW, ACSW, published in the NASW Specialty Practice Sections Annual Bulletin
InterSections in Practice, Volume 4, Fall 2005.

Health Care Disparities

Elderly Filipino Americans, like other ethnic minorities in the US, are not exempt from the
disparities within the health care system. Data from the California Health Interview Survey

showed that lack of health insurance is a major factor that prevents elderly Asian Americans,
including Filipino Americans, from accessing mental health care. Less educated foreign-born
older adults and those without US citizenship were more likely not to have health insurance
(Mold, Fryer, & Thomas, 2004). Lack of mobility and poor English language proficiency are also
two major barriers to health access (Trinh- Shevrin, 2009).
Health care access, utilization, and assimilation in the US health care delivery system can be
very challenging for ethnic elderly minorities, including Filipinos, particularly for the newly
arrived immigrants. In addition to financial constraints, lack of or minimal English proficiency
and tenacious adherence to their own cultural and health beliefs can create a barrier to health care
utilization. Immigrating to a new country can precipitate a stressful life event for the elderly.
They tend to rely on their families for support since the majority of them are not eligible for
government health care funds and social security benefits (Gorospe, 2006).
Compared to their Caucasian counterparts, multigenerational and multifamily households are
common among Asians, including Filipino Americans. They are three times more likely to live in
a household with spouse and other kin present, and are one-third less likely to be institutionalized
(Himes, Hogan, & Eggebeen, 1996). Caring for elderly parents is taught and expected among
children as part of their filial responsibility.
This practice is deeply embedded and integrated over time into their culture and passed on to the
next generation (Mc Bride, 2006). Although acculturated families have become more accepting
of the concept of institutionalization of their elderly relatives, they are still more reluctant to do
so than the general population (Watari & Gatz, 2004).
Traditional Asian families, including Filipino Americans, may be less likely to seek professional
caregiver, respite, and supportive services, and consider it their responsibility to care for their
elderly relatives.
https://geriatrics.stanford.edu/ethnomed/filipino/health_risk_patterns/disparities.htm
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