Structural inequities and Social Determinants, lead to different outcomes
The principle of health equity recognizes that 2 patients with the same medical condition might have dramatically different outcomes based on structural inequities, for example:
- Race
- Ethnicity
- Gender or gender identity
- Class
- Sexual orientation
Or based on the social determinates of health, for example:
- Education
- Employment
- Available health systems and service (rural or urban)
- Housing
- Income and wealth
- The social environment
- Access to transportation
Unfortunately, it could be argued that being prescribed methadone of buprenorphine could be considered a structural inequity.
Often when our patients are seen by their family doctor or at the hospital the assumptions start and the conversation stops as soon as the patient says they are on OAT. This is never fair but it is especially discouraging when incorrect assumptions are made of a patient that has not been using illicit opioids for some time. Regardless, all people deserve the same respect and the same access to treatment.
As a stark example would be to imagine the difference in treatment for renal colic that one of our patients, on the standard of care for the treatment of their disorder, might be offered compared to someone that is not on OAT.