BARRIERS TO EQUITABLE ACCESS
In every society, barriers inhibit universal access to high quality evidence-based health care, including:
1) Economic barriers (lack of insurance, underinsurance, out-of-pocket payments, poverty)
2) Supply and distributional barriers (shortages of goods and services, not available or of sufficient quality)
3) Sociocultural and ethnic barriers (misunderstandings or mistrust among individuals of different backgrounds)
4) Ignorance, misinformation and misapprehension (bias against certain health conditions types and people)
5) Geographic impediments (access and quality differences among different areas, remote, predominately minority or black, or poor)
Equitable access also raises the issue of voluntary risk versus involuntary risk. Voluntary risk is associated with activities in which individuals participate by choice. Involuntary risk takes place when individuals engage in activities without recognition or prior consent. For example, people who smoke may knowingly take risks with their health, whereas nonsmokers can unknowingly risk exposure to secondhand tobacco smoke.
Should equitable access to high quality evidence-based health care differ by voluntary or involuntary risk? Should society be obligated to address the consequences of those knowingly taking risks with their health?
Drawing a clear line between voluntary and involuntary actions is difficult. It is unjust to always blame individuals for their health problems. As the health capability paradigm describes, individuals are responsible for the choices they make. However, individual and societal efforts must focus on developing health agency and external capabilities so people can make good choices under good conditions and achieve optimal health outcomes. Society should err on the side of greater social responsibility, while developing individual responsibility through individual and collective health agency. The goal is to create positive social environments that enable positive individual choices for optimal health for everyone.