Division of Geriatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah, USA.
J Am Geriatr Soc. 2022 Dec;70(12):3366-3377. doi: 10.1111/jgs.18105. Epub 2022 Nov 10.
The American Geriatrics Society (AGS) has consistently advocated for a healthcare system that meets the needs of older adults, including addressing impacts of ageism in healthcare. The intersection of structural racism and ageism compounds the disadvantage experienced by historically marginalized communities. Structural racism and ageism have long been ingrained in all aspects of US society, including healthcare. This intersection exacerbates disparities in social determinants of health, including poor access to healthcare and poor outcomes. These deeply rooted societal injustices have been brought to the forefront of the collective public consciousness at different points throughout history. The COVID-19 pandemic laid bare and exacerbated existing inequities inflicted on historically marginalized communities. Ageist rhetoric and policies during the COVID-19 pandemic further marginalized older adults. Although the detrimental impact of structural racism on health has been well-documented in the literature, generative research on the intersection of structural racism and ageism is limited. The AGS is working to identify and dismantle the healthcare structures that create and perpetuate these combined injustices and, in so doing, create a more just US healthcare system. This paper is intended to provide an overview of important frameworks and guide future efforts to both identify and eliminate bias within healthcare delivery systems and health professions training with a particular focus on the intersection of structural racism and ageism.
美国老年医学会(AGS)一直倡导建立一个满足老年人需求的医疗保健系统,包括解决医疗保健中存在的年龄歧视问题。结构性种族主义和年龄歧视的交叉使得历史上处于边缘地位的社区所面临的劣势更加复杂。结构性种族主义和年龄歧视长期以来一直根植于美国社会的各个方面,包括医疗保健。这种交叉加剧了健康社会决定因素方面的差异,包括医疗保健获取不足和结果不佳。这些根深蒂固的社会不公正现象在历史的不同时期都曾被提上集体公众意识的前沿。COVID-19 大流行暴露并加剧了历史上边缘化社区所遭受的现有不平等。在 COVID-19 大流行期间的年龄歧视言论和政策进一步使老年人边缘化。尽管文献中已经充分记录了结构性种族主义对健康的不利影响,但关于结构性种族主义和年龄歧视交叉的生成性研究有限。AGS 正在努力确定和消除造成这些合并不公正现象的医疗保健结构,并通过这种方式创建一个更加公正的美国医疗保健系统。本文旨在提供重要框架的概述,并指导未来努力,以确定和消除医疗保健提供系统和卫生专业人员培训中的偏见,特别关注结构性种族主义和年龄歧视的交叉。