Introduction

Healthcare is a critical field as it contributes to one of the fundamentals of life: well-being. Healthcare helps prevent epidemics, pandemics, diseases, and many other threats that risk the well-being of people. And to ensure that everyone is provided with this facility and no one suffers, we have established health equity, one of the most important factors of healthcare.

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According to the WHO, health equity is evaluated and determined by conditions that affect a person's health. That being said, factors such as where you are born, and what race you have and biological determinants affect the treatment you get. Nationwide Children also states that health equity is important because, “Health equity requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”Hence, health care should hold no bias. Unfortunately, though, this field still has a long way to go in terms of holding no bias, especially against underrepresented communities such as BIPOC and immigrants.

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Equity also differs between these communities depending on the country. Some countries have accomplished equity while others, do not so much. This bias especially affects BIPOC (Black, Indigenous, and other people of color) and immigrants who oftentimes have a lack of resources and usually have vulnerable circumstances. This contrast between different countries can be seen in Pakistan, Sweden, and the United States where the situation around health equity highly differs as they all are very diverse from each other with many humongous differences between each other.

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Sweden is a first-world country with a long history of being a socialist country with a thriving social democracy. This ideology leads them to hold equality very dear to their heart; equality between people is fundamental to them as it is one of the fundamentals of their system and thus is taken very seriously. Sweden usually falls at the top for having the best facilities for its people such as paid maternity leave, government-supported education, and more, thus, it comes as no surprise why many people regard it as a utopia. The healthcare system is another one factor contributing to this utopia as it is said to be one of the best in the world because it is very, very accessible, namely being free for the majority. (It is also something that attracts many people to Sweden; accessible or universal healthcare is one of the things which signify autopia.) But does Sweden have the same facilities for everyone? Put simply, yes, it is, for the most part the same for everyone. There is no discrimination based on racial and ethnic differences. Healthcare professionals are obliged by the law to treat everyone equally, which in turn helps with equity where BIPOC gets equipped with equal resources. If there is by some chance, racial bias then you can seriously be convicted and face some serious repercussions bylaw. Therefore, everyone is provided with equal facilities. But there are still some special groups that experience inequality, such as some they are immigrant groups that hold special circumstances.

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Immigration has increased a lot in the past few years because of multiple wars and other reasons. Sweden has been one of the countries which have experienced this as there has been a huge surge of immigrants in the past few years as they have received large amounts of refugees, asylum seekers, and immigrants. As new people come in, they bring with them different health issues with them. According to a health report from Göterborgs University, it is said that immigrants from non-Europea backgrounds are 3-4 times more likely to suffer from poor health compared to those who are born in Sweden, which is why there is a wider need for health services for immigrants. But as said, there is a difference in treatment depending on your citizen status.

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If a person is a documented immigrant, with a certified job contract, and they have an asocial security number, then they are bound to receive all of the same rights, including good healthcare assistance where healthcare is even free depending on what kind of diseases you are battling with. For example, cancer falls under this category, where you almost get almost fully free treatment. If a person is younger than 18 years, then they are permitted to have free healthcare until they turn 18 and they do not have to even pay a penny other than for certain medications. Moreover, suppose there are any language barriers between you and your physician. In that case, then you are provided with interpreters that help you with translating all of your health-related problems, and these interpreters are supported by the government. But there might be some differences if a person is undocumented or an asylum seeker.

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According to the Migration Center of Sweden (Migrationsverket), if you are an asylum seeker in Sweden, “You are entitled to emergency healthcare and dental care, and health care that cannot wait,” but there are still some gaps between the health rights that undocumented immigrants receive. If a child under the age of 18 falls under this category, they receive the same facilities as any other child in Sweden, irrespective of the citizen status. But adults still have to pay to receive the treatment. Usually, people, with this category of citizen status, don't have an asocial security number, as they usually illegally migrate. However, despite that, they are still entitled to medical care, but they would have to pay a bit more than other people. That being said, equity is still very, very accessible, especially if suffering from serious health issues, but there are still improvements that can be made for those with special status.

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In comparison to Sweden, Pakistan has a completely different healthcare system. Pakistanis a third-world country, almost at the brink of collapsing because of a declining economy and resources. Due to the political unrest and other crises going on, the healthcare system has been immensely suffering and has been deteriorating for the past many decades. Because of such difficulties, most people opt to not move to Pakistan (even the people living there want to move to other countries) unless they are put in rather difficult situations in their own countries and do not have the resources to migrate somewhere else.

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That being said, there is still a small population of immigrants who have legally migrated and are from wealthy backgrounds where they can afford healthcare as it is for-profit. The system itself doesn’t discriminate on your citizen status, as most good institutions are for-profit hence, the more money you pay to a hospital or a clinic, the better care you will receive.

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The majority of immigrants, though, in Pakistan, today, are refugees and migrants, mostly from Afghanistan. Many Afghans moved to Pakistan during the Afghan war to seek refuge but the Pakistani government has not been able to handle the migration in a good way which is why there are many gaps such as medical care is one of them.

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Afghans living in Pakistan today, as refugees, have mostly very low socioeconomic status with dire living situations where overcrowding in small houses is very common and because they do not have access to a wider range of resources and usually work low-wage jobs, they, therefore, cannot afford the healthcare. Although, registered refugees still have access to national healthcare and can get help in regards to health at public hospitals, but that is not the case for unregistered refugees. There are still no clear policies on how to deal with health among refugees which automatically pulls down the equity numbers.

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There are some schemes that help unregistered refugees initiated by organizations such as U.N.H.C.R. where they have provided Villegas, with large populations of refugees, with BasicHealth Units, which, as the name suggests, provide refugees with basic health necessities and examinations but it still does not count for the same level of treatment as the one in a hospital.The government or the sectors themselves have not done a lot of work on this specific question and there has been no response from their side which is why the situation around migrants' health is still a gray space.

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If we were to instead look at the health disparities among BIPOC, then it would be difficult to define it. BIPOC (Black, Indigenous, and other people of color) is a term used to describe underrepresented groups in majorly Western countries; this term applies to Pakistanis who are living abroad, rather than the ones currently living in Pakistan. If we were to classify the BIPOC community in Pakistan, then almost the whole population would be counted in this realm as the majority are people of color. Hence, when discussing health equity and health disparities, we would rather be talking about the effects it has on the whole population than just an underrepresented group.

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The United States, in contrast to other countries, has a completely different system. The country is a first-world country that has a relatively stable healthcare system where you can find the most futuristic technology and new discoveries but it isn’t as accessible to everyone.Most healthcare institutions are for-profit unless your job, for example, provides you with insurance which would help you support your medical expenses. But many times, insurance is not healthcare equity, and inequity amongst BIPOC and immigrants 8even enough to pay for medical care; thus, the inequity is very high. This inequity is even higher for people with different backgrounds, such as immigrants and BIPOC, because of the historical structures that hinder them from receiving equal services. The health disparities among these groups depend on many things, such as systematic racism and social determinants.

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As said, social determinants are key to health disparities and equity, especially in the US. Some of the social determinants that contribute to health disparities: are poverty, policies and laws, socioeconomic status, housing insecurity, and the healthcare system itself.

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Your socioeconomic status, for example, for the most part, determines what is available to you and what is not. Immigrants are often more prone to having poor social determinants, such as low socioeconomic status, where they are often low income or live in poverty because of a lack of resources. Immigrants are more prone to poverty because of the lower wages they receive and because, usually, their jobs don't support employee benefits such as health insurance.Not having insurance, together with low wages, forces them not to seek health care as it is very expensive. If, for example, an undocumented parent who is also a financial provider is deported,the financial means for that family automatically get lower, which leads to them suffering from,again, not prioritizing health, and that, in turn, leads to that family receiving more diseases. This also affects the mental health of the members in that family, but they still do not seek proper support from certified institutions as they are costly.

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Because of the financial burden among immigrants, housing insecurity alwaystheir lower wages and because their jobs usually follows them. As mentioned before, having low-wage jobs with no additional benefits leads to tough living conditions among immigrants, which in turn affects health disparities. Because of the increasing housing prices, many individuals live together in very small houses, which leads to affecting their health as well. Crowded houses have a terrible effect on the mental health of the people living in that house as there is more stress and disturbances, in, for example,sleep. But because money is tough, it is harder for these individuals to seek medical services, and they are still stuck in this vicious cycle where many things add up to their helpless situation.

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The chances of larger health problems occurring in undocumented immigrants are higher than in documented immigrants. This is because of the experiences they have had prior, the trauma of their previous country, their escaping (and the means they used then), and their living situation in the new country; all these take a toll on their mental health, which in turn affects their physical health. That being said, there is a higher need for health services, and the situation in the US right now hinders them from receiving it, which contributes to the iniquity, and there is a need to combat it.

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And policy- and lawmakers do not help with this issue. The US laws and policies make health access very restricted and hence very difficult for immigrants to receive. It has also been seen that through using the words “undocumented” and claiming that the immigrants are not people of the country, irrespective of how long they have lived there, the ones in charge kept them away from many of the facilities. They are, for example, excluded from federally funded health facilities. While undocumented immigrants are completely excluded from these benefits, documented immigrants become ineligible for such benefits after five years of residence in the US.

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However, if the US was to introduce more sympathetic and morally right policies and programs such as DACA, then many lives would improve. After the implementation of DACA, For example, it was shown that the kids in this program improved their living situations and social determinants by a great margin. Multiple studies have shown that those kids are expressed to have more positive mental health and have experienced a better equity rate at different institutions. As DACA improved many lives, it is important that the government ensures new plans such as this in relation to health, which would improve the livelihood of many immigrants living in the US.

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Additionally, health disparities are also very common among the BIPOC community where. Many argue that healthcare facilities discriminate on the basis of race and ethnicity, which in turn increases inequity. But discrimination is not the only reason; many BIPOC individuals suffer from the same social determinants as the ones mentioned above but in addition to that,personal bias from physicians and racism is other contributors to inequity.

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Systematic racism is, as said, a huge reason for inequity as it repeatedly shows itself in the system. Many critics have used COVID-19 as an example to justify this claim. It was seen that people with ethnic backgrounds were more infected and died quicker compared to the White population. This is because of the structures that are built throughout history that prevent BIPOC people from receiving quality care in comparison to their white counterparts. Not only that, it can also be because of a doctor's personal bias and opinions that they decide what kinds of care their patient should get. And depending on their own opinions and if they feel like it, they will provide better care.

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The American Bar Association even claims that black people are likely to receive inferior care compared to their “white counterparts,” even if they have the same circumstances, hence why black people suffer and are more likely to die from diseases because of careless care from their physicians. They support this claim through multiple studies done where it has shown that physicians, because of their pro-white bias, are more likely, for example, to prescribe medication more easily to white patients than black irrespective of the patients showing the same symptoms.

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Discussion

If we were to compare all the countries with each other then the health systems in all the countries have drastic differences from each other.

Pakistan is the most unstable out of them as it does not have any adaptations for either the refugees or its own population and therefore is in a dire need of improvement. Sweden on the other hand is very stable and does not have an explicit bias towards any of the groups. And the U.S. is stable but its system hinders the groups from revealing impartial care and hence why they still need to improve their system.

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Proposals

In order to combat health inequity and improve equity among BIPOC and immigrants, there are some essential steps that need to be taken in order to have a more fair system that provides everyone with the resources which helps them succeed.

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One of the first steps to help health equity is to break down the healthcare system and try t reform it in a way so that it is fair to all, especially in countries such as the United States and Pakistan. The reform of the whole system needs to be done in order to increase equity among people and improve the livelihoods of marginalized groups that otherwise do not have the resources.

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In this reform, things such as appropriate treatment ways need to be addressed. Appropriate treatments, in the sense that the treatment should be adapted to each and every one, individually based on their differences. This means acknowledging cultural, ethnic, and even religious differences and acting accordingly to them. There needs to be a more open and wide environment of e.g. cultural and religious adaptations. This will greatly help in ending ethnic health disparities where cultural norms hinder patients from getting the treatment they require.

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Another one of the key steps in this reform is raising awareness in respective countries. Actively educating people on these issues will be valuable to the improvement of inequity and it is one of the main ways you can reach people to help develop healthcare. This is especially crucial for healthcare professionals so that they can limit their own racial biases. There is also a need to teach about laws and policies related to health equity in addition to scientific theory as that is a way to change the discriminatory patterns from a young age and give people leeway to actually make changes. Integrating awareness about health equity is important to do in medical schools and even high schools (biology) courses as this is also a crucial step in developing an understanding of this issue. It is just as important to learn medical ethics and how it can properly be adapted to different individuals, in different places. Even at a young age, so that people can even recognize their own rights as individuals.

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In order to support these steps, the financing of healthcare facilities especially from the government sector needs to be increased, specifically, in Pakistan. There needs to be an increase in government funding for insurance for health care coverage or even private sectors but what it should ensure is that everyone is getting equal pay to cover for their medical expenses.

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There also needs to, for example, be an increase in open clinics and health workers who visit densely financed areas populated with immigrants and BIPOC so that these individuals don’t have to worry about money and can still get some kind of help. In addition to that, there also needs to be an improvement in policies, especially for immigrants so that they can get better livelihoods.

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This a very brief list of what few steps can be taken to improve health inequity. This still needs to include a lot of great ideas and ways to tackle inequality. But these proposals are a starting point to think about the ways we can improve.

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Opinions

For either Pakistan or the US, I think health reform is extremely crucial for everyone so that each person can have better living standards without being discriminated against. I also think there is a need for more government involvement which hopefully abolishes for-profit healthcare, as I think that it is highly unethical that you are essentially profiting off of somebody else’s suffering. I also think that the tougher policies that the government will set for healthcare professionals, the more the biases will drop, and equity rates will increase. Sweden, I believe, is the fairest in terms of equity among different communities, but there is still room for improvement for immigrants, and this can be done through better municipal policies. I also think that discriminating based on your citizen status and race is completely wrong and morally incorrect. If a person contributes to the country and the society through working and doing other things, then I think it is very, very wrong to still provide them with no benefits that should actually be considered fundamental hence why it is something governments should focus on when making decisions.

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Conclusion

Health inequity is, as said, still a very serious problem in all the countries where there is still room for a lot of improvement. Healthcare still holds bias, be it personal or affected by some other reason. Social determinants such as poverty and housing insecurity are a couple of factors which majorly affect the inequity which is why there is a serious need for powerful institutions and governments to take charge and initiate change., hopefully abolishing for-profit healthcare, as

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Acknowledgement

The Institute for Youth in Policy wishes to acknowledge Gwen Singer, Sarah Zhang, Paul Kramer, Carlos Bindert and other contributors for developing and maintaining the Effective Discourse Department and associated Fellowship programming.

References

1. Chang, C. D. (2018). Social Determinants of Health and Health Disparities Among Immigrantsand their Children. Current Problems in Pediatric and Adolescent Health Care.doi:10.1016/j.cppeds.2018.11.009
2. Wilson, V. (2020, September 16). Racial disparities in income and poverty remain largelyunchanged amid strong income growth in 2019. Economic Policy Institute. RetrievedApril 7, 2023, fromhttps://www.epi.org/blog/racial-disparities-in-income-and-poverty-remain-largely-unchanged-amid-strong-income-growth-in-2019/
3. Sajjad, W. (2022, December 5). Health care for Afghan refugees and migrants in Pakistan. TheNation. Retrieved April 8, 2023, fromhttps://www.nation.com.pk/05-Dec-2022/health-care-for-afghan-refugees-and-migrants-in-pakistan
4. The State of Health Disparities in the United States. (n.d.). NCBI. Retrieved April 8, 2023, fromhttps://www.ncbi.nlm.nih.gov/books/NBK425844/
5. Rice, D., & Galbraith, M. (2008, November 16). .,. ., - YouTube. Retrieved April 8, 2023, fromhttps://gh.bmj.com/content/5/8/e003394?s=09
6. Usman, M. (2021, January 6). Afghan Diaspora in Pakistan: Healthcare and Education PolicyRecommendations. Refugee Research Online. Retrieved April 8, 2023, fromhttps://refugeeresearchonline.org/afghan-diaspora-in-pakistan-healthcare-and-education-policy-recommendations/
7. Migration and public health Health in Sweden: The National Public Health Report 2012. Chapter13. Retrieved April 8, 2023, fromhttps://www.gu.se/sites/default/files/2020-06/Migration%20and%20public%20health.pdf
8. Closing the Health Disparity Gap in U.S. Immigrant Communities in the Era of COVID-19: ANarrative Review. (n.d.). Scholars Archive. Retrieved April 8, 2023, fromhttps://scholarsarchive.library.albany.edu/cgi/viewcontent.cgi?article=1011&context=covid_mhd_nys_white_papers
9. Rice, D., & Galbraith, M. (2008, November 16). .,. ., - YouTube. Retrieved April 8, 2023, fromhttps://www.nature.com/articles/s41562-020-0917-7#Sec3
10. Freese, J., Johnson, A. L., & Garcia, M. (n.d.). 'What's weighing heaviest' - Stanford Center onPoverty and Inequality. Stanford Center on Poverty and Inequality. Retrieved April 8,2023, from https://inequality.stanford.edu/covid/health-mental-health
11. Black, D., Acheson, D., Williams, E., & Raleigh, V. (2022, March 16). Equity and endurance:how can we tackle health inequalities this time? The King's Fund. Retrieved April 8,2023, fromhttps://www.kingsfund.org.uk/publications/how-can-we-tackle-health-inequalities
12. Promoting health and reducing health inequities by addressing the social determinants of health.(n.d.). WHO/Europe. Retrieved April 8, 2023, fromhttps://www.euro.who.int/__data/assets/pdf_file/0016/141226/Brochure_promoting_health.pdf
13. Williams, D. R., & Rucker, T. D. (n.d.). Understanding and Addressing Racial Disparities inHealth Care. NCBI. Retrieved April 8, 2023, fromhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194634/
14. Welker, S. (n.d.). Addressing Systemic Health Inequities Involving Undocumented Youth in theUnited States. AMA Journal of Ethics. Retrieved April 8, 2023, fromhttps://journalofethics.ama-assn.org/article/addressing-systemic-health-inequities-involving-undocumented-youth-united-states/2021-02
15. Zafar, I. (2019, July 16). A High-Tech Solution to Health Care Inequality in Pakistan.Association for Women in Science. Retrieved April 8, 2023, fromhttps://awis.org/high-tech-solution-health-care-inequality-pakistan/