Laryngeal Cancer: A Review

Laryngeal cancer is one of the most common cancers of the head and neck in the United States (Baird, Sung, Beadle, & Divi, 2018; Mannelli, Lazio, Luparello, & Gallo, 2018; Taito et al., 2019).  This diagnosis occurs more frequently in men 65 years or older, with a median age of death of 68 years (Obid, Redlich, & Tomeh, 2018).  While laryngeal cancers account for only part of new cancer cases (13,000 new cases), the disease greatly impacts patient’s ability to speak, breath, and swallow (Anis, Razavi, Xiao, & Soliman, 2018; Baird, Sung, Beadle, & Divi, 2018; Forastiere et al., 2018; Obid et al., 2018).  The impact on quality of life makes understanding this type of cancer important.

The course of treatment, and the chances of survival, are influenced by the initial stage of disease (Obid et al., 2018).  Cure rates are between 80-90% for early stage (T1 or T2 tumors), and as low as 40% for more advanced stages (T4) (Obid et al., 2018).  This low cure rate for advanced stages may relate to the variety of different lesions, clinical presentations, biological behaviors and prognosis that clients present with (Mannelli et al., 2018).  Many patients are diagnosed with T3 or T4 or regional nodal metastases, which contribute to the low survival rates (Forastiere et al., 2018).  The advanced stage diagnoses cause an increase in adverse side effects due to necessary treatments such as total or near total laryngectomy, intensive radiotherapy, and chemotherapy (Forastiere et al., 2018).  This report reviews current treatments for all stages of laryngeal cancer.

Literature Review

Although laryngeal cancer is one of the most common cancers of the head and neck, the decrease in the use of tobacco has caused the incidence to decline over the past decade (Baird et al., 2018; Forastiere et al., 2018; Obid et al., 2018).  However, the five-year survival rate of laryngeal cancer has remained steady (Forastiere et al., 2018; Obid et al., 2018).  Therefore, further investigation on the development, treatment and adverse reactions on the patient’s health needs to be completed.

Anatomy of the Larynx

The larynx involves three anatomical regions which help protect the airway and aid in vocalization (Obid et al., 2018).  These regions include the supraglottic larynx, the glottic larynx, and the subglottic larynx (Obid et al., 2018).  The first region, the supraglottic larynx, includes the laryngeal surface of the epiglottis, aryepiglottic folds, arytenoids and false vocal cords (Obid et al., 2018).  This area can cause difficulty in the detection of malignant tumors, with an endoscopic evaluation needed to detect a tumor in this location (Obid et al., 2018).  The next region, the glottic larynx, includes the true vocal cords, involving the paraglottic space, and the anterior and posterior commissures (Obid et al., 2018).  The last anatomical region (subglottic larynx) includes the inferior aspect of the true vocal cords and extends to the inferior edge of the cricoid cartilage (Obid et al., 2018).  The movement of airflow through the larynx is supported by the thyroid cartilage (Obid et al., 2018).  This system maintains the speed of airflow through the system while preventing the collapse of the mucosal surfaces due to an increase in pressure (Obid et al., 2018).  A tumor at any of the above anatomical regions provides a different clinical presentation and challenge for treatment (Obid et al., 2018).

Risk Factors and Diagnosis

The greatest risk factor for the development of laryngeal cancer is chronic exposure to an irritant, including tobacco use, acid reflux, alcohol consumption and environmental exposures (Anis et al., 2018; Muderris, Gul, Doblan, Ergin, & Muderris, 2019; Obid et al., 2018).  These irritants increase inflammation and impair defense mechanisms (i.e. impairing macrophages, dendritic cells, and natural killer cells), which results in an inability to kill bacteria and remove dead cells in this area (Muderris et al., 2019).  This allows mutated cells to spread throughout the area (Muderris et al., 2019).  Due to the inflammation, T-helper 1 and 2 cells accumulate, which causes interleukin (IL-17) to secrete T-helper 17 cells (Muderris et al., 2019).  Study results reveal that patients with laryngeal cancer (as compared to benign laryngeal lesions) have higher levels of interleukin (IL)-17 and IL-22 (Muderris et al., 2019).  Therefore, the role of T-helper cells may be further examined as a part of the development of laryngeal cancer (Muderris et al., 2019).

A physical examination of the neck and an endoscopic evaluation are used to determine the extent of the tumor and the stability of the airway (Obid et al., 2018).  Specifically, this procedure provides information about the obstruction of the airway, the mobility of the vocal cords, and if endotracheal intubation is necessary or feasible (Obid et al., 2018).  The stability of the airway is also assessed through the patient’s ability to breath, use accessory muscles, fatigue, and mental status (Obid et al., 2018).  Depending on the location of the cancerous mass, a patient may present with a neck mass, muffled voice, or a compromised airway (Obid et al., 2018).  Ultimately, the most important factor in determining prognosis is neck dissection, which considers the status of the cervical lymphatics (Obid et al., 2018).

The specific staging classification is determined by the location of the primary tumor, the mobility of the vocal cords, and whether the tumor has metastasized (Obid et al., 2018).  An early stage tumor (T1) describes a primary tumor that is limited to one anatomical area (i.e. supraglottis, true vocal cord involvement, or subglottic) (Obid et al., 2018).  The next stage (T2) describes a tumor that has metastasized to an area outside of the supraglottis or has extended to the vocal cords (Obid et al., 2018).  A T3 tumor (considered advanced stage), when looking at the supraglottic anatomical area, is a tumor that is limited to the larynx, with the tumor extending to the postcricoid area, preepiglottic space, paraglottic space, or inner cortex of the thyroid (Obid et al., 2018).  In the glottic anatomical area, a T3 stage, is limited to the larynx with an affect on the vocal cords, with the tumor extending to the paraglottic space and/or inner cortex of the thyroid cartilage (Obid et al., 2018).  In the subglottic area, a T3 tumor has extended to the larynx with movement toward the vocal cords and/or the inner cortex of the thyroid cartilage (Obid et al., 2018).  Considered the advanced stage of laryngeal cancer, a T4a stage tumor in any of the anatomical areas, has moved throughout the outer cortex of the thyroid cartilage and/or has impacted the tissues beyond the larynx (Obid et al., 2018).  A T4b stage tumor represents an invasion of prevertebral space, carotid artery encasement, or metastasizing to the mediastinal structures in any of the anatomical areas of the larynx (Obid et al., 2018).  A pathological report on the tumor is completed to determine the appropriate diagnosis which informs treatment methods (Locatello et al., 2019; Obid et al., 2018).

Treatment

Previous treatment modalities included resections, intensive radiation, or chemoradiation (Obid et al., 2018).  These extensive treatments resulted in negative impacts on the functions of swallowing, breathing, voice, and a lower quality of life (Kim et al., 2016; Obid et al., 2018).  Today, treatment aims to preserve the larynx and maintain quality of life, which many times necessitates a variety of approaches (i.e. surgery, radiotherapy, and subsequent treatments) (Bernier, 2009; Kim et al., 2016; Obid et al., 2018).  Therefore, a multidisciplinary team of head and neck surgeons, oncologists, radiologists, pathologists and psychologists are necessary to address the complex nature of laryngeal cancer (Locatello et al., 2019).  Factors such as age, medical comorbidities, lymph node metastases, and the extent, volume and location of the primary tumor are all considered when determining if a surgical or nonsurgical approach is more appropriate (Baird et al., 2018; Obid et al., 2018).

Treatment goals for early stage laryngeal cancer (T1 and T2) are to remove the disease while preserving the function of the larynx (Baird et al., 2018; Obid et al., 2018).  Based on these goals, a multi-approach treatment (i.e. surgery, radiation therapy and/or chemoradiation) may be too rigorous, resulting in a negative impact on the function of the larynx (Baird et al., 2018; Obid et al., 2018).  Single modality treatment options may include transoral laser microsurgery, open partial laryngectomy, endoscopic resection or radiation therapy alone (Kim et al., 2016; Obid et al., 2018).  When the risks of surgery outweigh the benefits, radiation alone is considered the standard treatment for these stages (Obid et al., 2018).

Patients diagnosed with advanced stage laryngeal cancer (T3 or T4) a total laryngectomy or chemoradiation are the standard treatments (Baird et al., 2018; Locatello et al., 2019; Mannelli et al., 2018; Obid et al., 2018).  Unfortunately, these treatment options results in a lack of preservation of the larynx, functional deficits, and poorer rates of survival (Baird et al., 2018; Obid et al., 2018).  Voice preservation during treatment planning has caused a push towards preservation surgery and nonsurgical techniques (Mannelli et al., 2018; Obid et al., 2018).  For patients diagnosed with T3 tumors, a laryngeal preservation surgery may be considered with a discussion of the high-risk features that necessitates adjunctive radiation therapy (Obid et al., 2018).  Some patients with T3 tumors may be treated with chemoradiation, with surgery being reserved as a treatment option for cancer recurrence (Locatello et al., 2019; Obid et al., 2018).  However, nonsurgical perseveration techniques do not provide a higher survival rate compared to total laryngectomy (Obid et al., 2018).  Laryngeal cancer may be treated by a variety of surgical procedures, including partial laryngectomy and transoral laser microsurgery (Mannelli et al., 2018; Obid et al., 2018).

Surgical modalities.

Transoral laser microsurgery is a minimally invasive endoscopic treatment that utilizes microsurgical instruments that remove the primary tumor (Baird et al., 2018; Obid et al., 2018).  This approach, when used independently, provides the best post-operative functional benefits (Obid et al., 2018).  The level of functionality is based on the extent of the tumor, vocal cord lesions, and whether the tumors involve the vocal cords (Obid et al., 2018).

The open partial laryngectomy procedure is a conservative procedure that utilizes hemilaryngectomy and supracricoid partial laryngectomy (Mannelli et al., 2018; Obid et al., 2018).  This procedure is utilized as a primary treatment for T3 laryngeal cancer that is not amenable to transoral laser microsurgery (Obid et al., 2018).  A horizontal partial laryngectomy encompasses sectioning the portion of the larynx above the glottis, while preserving the vocal cords and arytenoids (Mannelli et al., 2018; Obid et al., 2018).  This approach is utilized for individuals who have a T3 or T4 stage cancer, with tumors involving one vocal cord and one arytenoid, extending to the base of the tongue (Obid et al., 2018).  A supracricoid partial laryngectomy involves a complete resection of the thyroid cartilage, true and false vocal folds and paraglottic spaces (Obid et al., 2018).

A total laryngectomy is the standard surgical treatment for advanced stage laryngeal cancer (Obid et al., 2018).  This treatment includes the removal of the entire larynx, strap muscles, paratracheal lymphatics, and the ipsilateral thyroid lobe (Obid et al., 2018).  This option offers higher chances of survival but is not amenable to organ preservation (i.e. permanent tracheostoma and loss of voice) (Obid et al., 2018).  Chemotherapy and radiotherapy, other treatment options, are discussed in the next section.

Chemotherapy and radiotherapy.



To preserve the larynx, there has been an increase towards chemoradiation therapy (Mannelli et al., 2018).  However, it should be noted that nonsurgical techniques do not offer a higher survival rate when compared to a total laryngectomy (Mannelli et al., 2018).  Chemotherapy may be utilized as a stand-alone treatment, or in combination with one of the above modalities or radiation (Pignon, Maître, Maillard, & Bourhis, 2009).  Chemotherapy treatment may be administered at different points in relation to radiotherapy.  Chemotherapy administered before radiotherapy is referred to as induction chemotherapy, that administered during radiotherapy is referred to as coadministration, and that administered after radiotherapy is called maintenance therapy (Bernier, 2009).  Induction chemotherapy can help to eradicate micro-metastases and can help increase the survival rate of patients (Gau et al., 2019).  It may also decrease tumor volume, making surgery a viable option for previously inoperable tumors, which may impact the patient’s quality of life (Gau et al., 2019).

The ideal treatment protocol is coadministration, this typically involves administration of 100 mg/m² every 3 weeks during radiation therapy (Haddad et al., 2013).   This treatment causes a shift in the cell-survival rates toward a higher rate of cell-killing, this results in a decrease in the tumor mass, selective toxicity, cytokinetic cooperation, and increased apoptosis (Bernier, 2009; Haddad et al., 2013).   Additionally, this treatment influences DNA replication, specifically in interrupting microtubule function leading to interference with mitosis and eventually cell death (Bernier, 2009).  Drugs such as cisplatin or carboplatin associated with 5-FU or other poly-chemotherapy including either platin or 5-FU may all be utilized during chemotherapy (Bernier, 2009; Haddad et al., 2013; Pignon et al., 2009).  Although coadministration is the ideal choice, this choice is dependent on the tumor’s location and progression (Bernier, 2009; Gau et al., 2019).  This intensive treatment can result in poor treatment adherence, which should be discussed with the patient prior to a treatment protocol being determined (Bernier, 2009).

Radiation may also be utilized as a sole treatment and may be recommended when adverse features are present (i.e. lymphnode metastasis, lymphovascular invasion) (Kim et al., 2016; Obid et al., 2018).  Specifically, the standard radiotherapy treatment (i.e. Conventional radiotherapy or CRT) delivers opposed-lateral radiation beams to the cancerous area (Zumsteg et al., 2015).  This treatment is used to preserve the larynx with patients in which the risks of surgery outweigh the benefit of it, however, it is not an ideal treatment option for many patients (Bernier, 2009; Obid et al., 2018).  CRT may adversely affect functionality of the larynx and surrounding area, leading to aspiration, damage to healthy tissue, fibrosis, and even an increased risk of carotid artery stenosis and stroke (Kim et al., 2016; Zumsteg et al., 2015).  In response to these adverse effects, intensity-modulated radiotherapy (IMRT) is causing a shift in treatment practices (Zumsteg et al., 2015).  This technique delivers high doses of radiotherapy with sharp dose cut-offs which prevent the surrounding normal tissues from being affected (Zumsteg et al., 2015).  However, IMRT is not considered the standard radiotherapy treatment for laryngeal cancer due to the small area (5×5 or 6×6 cm) that is targeted during radiation in laryngeal cancer (Zumsteg et al., 2015).  Further research is needed to evaluate the long-term impact of radiotherapy alone to determine a standard radiotherapy protocol (Zumsteg et al., 2015).  Ultimately, research has shown that the combination of chemotherapy and radiation improve the results of radiotherapy results alone (Bernier, 2009; Zumsteg et al., 2015).

Conclusion

Adverse treatment effects should be considered before a treatment option is chosen.  Specifically, managing laryngeal cancer while understanding the impact that treatment may have on patient’s quality of life is essential (Taito et al., 2019).  The use of radiotherapy has caused adverse long-term reactions including inflammation-induced circulatory disturbances,

dry throat, reduced sensation, voice function, and estraesophageal reflux disease (Anis et al., 2018; Lazarus, 2009; Taito et al., 2019; Zumsteg et al., 2015).  Additionally, research has shown a connection between radiation therapy and carotid artery stenosis and cerebrovascular morbidity two-years post treatment (Kim et al., 2016; Zumsteg et al., 2015).  These factors all affect a patient’s ability to eat, communicate, and survive post-cancer treatment (Kim et al., 2016; Lazarus, 2009).  As technology advances, additional research is necessary to determine the most affective cancer-eliminating practices, while preventing negative impacts to a patient’s quality of life (Kim et al., 2016; Mannelli et al., 2018; Zumsteg et al., 2015)

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Market Justice and Social Justice: How They Conflict, Complement and Reform Healthcare

Abstract

Market justice asserts that in a free market economy, market forces can achieve a fair distribution of healthcare among individuals who have the freedom to purchase the healthcare services they value. In market justice, healthcare is rationed by the willingness and ability of people to pay for healthcare. Alternatively, social justice asserts that it is the responsibility of society to ensure equitable distribution of healthcare services provided through a central agency. In social justice, healthcare is rationed through supply-side rationing, in which the government limits the availability of certain healthcare services by deciding how they will be dispersed. These two types of approaches complement each other in our current healthcare system. Private, employer-provided health insurance, which mainly applies to middle class Americans, is driven by market justice, as this group has the ability to pay for healthcare often through the employer. Publicly financed programs like Medicare, Medicaid, and workers’ compensation, covers groups who are unable to pay for healthcare, and are based on social justice. Market justice conflicts with social justice in that it emphasizes individual wellbeing rather than collective wellbeing. Market justice reform aims at market efficiency, high quality, and low costs with greater share in the market. Social justice reform aims to rid healthcare of discriminatory systems that can affect society as a whole.

According to Stephen Krau (2015), the goal of justice in the healthcare system “can be considered that persons with the same medical conditions should have availability of the same treatment options.” Market justice and social justice are two models within the healthcare system, with differing approaches that potentially are divisive for many Americans on how our healthcare system should function. This paper will outline the ways that market justice and social justice complement each other, conflict in healthcare delivery, and contribute to the probability of healthcare reform.

Market Justice

Market justice subscribes to the idea that in a free-market economy, market forces can achieve a fair distribution of healthcare among people. However, not all people are guaranteed distribution of healthcare. Market justice relies on people’s willingness and ability to pay as a basis for healthcare services. Therefore, people have the freedom to purchase the healthcare goods and services that they value. People pay for these goods and services through their own financial means that they have acquired through their own “legitimate efforts” (Shi and Singh, 2015). Most goods and services within a free market are acquired similarly. Thus, it stands that providing people healthcare that they have not earned through their own financial efforts is not just. As a result, the production of healthcare is determined by the quantity and cost that consumers are willing to pay. Consequently, those who are not able to pay or who are uninsured will have great difficulty acquiring healthcare (Shi and Singh, 2015). In other words, this system “allows for inequality as long as [it is a] result of a fair market system” (Matthews, 2006). Supporters of market justice believe in the logic of supply and demand within the healthcare system, arguing that minimal government intervention leads to “optimal outcomes of healthcare sources” (Matthews, 2006).

Market justice operates on a multitude of free-market assumptions. First, healthcare functions as any other economic good or service, rendering it subject to market forces of supply and demand. Second, individuals are held responsible for their own economic and financial achievements. When individuals pursue their own best interests (i.e. purchasing healthcare services), society as a whole benefits. Third, people tend to make rational decisions in their choice to purchase healthcare services that promote individual health. Fourth, people informed by physicians know what is best for their own health, implying that people place a great deal of trust in their physicians. Lastly, a free market, rather than the government, can distribute healthcare efficiently and equitably (Shi and Singh, 2015).

Social Justice

In social justice, it is the responsibility of society to ensure equitable distribution of healthcare. This equitable distribution of healthcare is achieved by letting a “central agency,” usually the government, distribute and produce healthcare. Within social justice, healthcare is regarded as a social good that should be financed by all citizens regardless of the healthcare recipient’s ability to pay. It is considered unjust in this system to let an individual go without healthcare services because of the individual’s inability to pay (Shi and Singh, 2015). In other words, social justice says that “basic needs such as: income, housing, and healthcare should be given to all citizens as part of their fundamental rights” (Matthews, 2016).

As with market justice, social justice grants a multitude of assumptions. First, healthcare is different from all other goods and services and should be regarded as its own entity. Secondly, there is a shared responsibility for health. Individuals are not held solely responsible for their bad health, because they are not in control of outside factors like economic inequalities, unemployment, lack of sanitation, or poor air quality. Furthermore, society has an obligation to do what is best for everyone. A single individual in bad health could affect everyone, as that individual could be carrying a deadly infection that presents a threat to society as a whole. Therefore, it is the responsibility of society to eliminate the problem by finding a cure, because in doing so, all people benefit. Finally, the government, instead of the free market, can best decide how much healthcare should be produced and distributed so that it is available to all citizens (Shi and Singh, 2015).

How Market Justice and Social Justice Complement Each Other

Despite the multitude of differences between market justice and social justice, the two complement each other. For example, private, employer provided health insurance, which mainly applies to middle class Americans, is driven by market justice, as this group has the ability to pay for healthcare, because the employer is willing to provide. Publicly-financed programs like Medicare, Medicaid, and workers’ compensation, which cover disabled, elderly, and low-income groups, are based on social justice. The inability of these groups to pay for their own coverage is financed by society (Shi and Singh, 2015).

According to John Derrick, there are five areas in which market justice and social justice complement each other: equality, time, freedom, and fundamental rights. With regard to equality, Derrick (2017) says, “Both social justice and market justice emphasize equality and fair treatment of individuals in a society, even though each philosophy envisions different means for achieving this goal.” Social justice aims to treat all members of society rich or poor, healthy or ill, equally. Market justice gives every individual equal opportunity to participate in the exchange of healthcare goods and services. With regard to time, Derrick (2017) says, “Both market justice and social justice take time for their effects to be fully realized.” Within social justice, individuals must understand the needs of all members of society, a feat which takes times to fully ascertain. Similarly, market justice requires time for the forces of supply and demand to be felt (Derrick, 2017).

Market justice and social justice complement each other in their common goal of freedom, which Derrick (2017) says, “Social justice and market justice hold that freedom of action and freedom of choice need to exist.” Social justice purports that individuals in society can choose what is best for them collectively, while market justice maintains that individuals can freely participate in the exchange of goods and services “as governed by free market forces” (Derrick, 2017). Furthermore, market justice and social justice uphold fundamental human rights. Social justice holds that basic needs like healthcare are fundamental rights, whereas market justice holds that in a free society people have the right to choose the healthcare services they will acquire.

How Market Justice and Social Justice Conflict in Healthcare Delivery

Market justice and social justice conflict as models of health delivery, because they emphasize different aspects of healthcare. In market justice, it is the responsibility of the individual to maintain health, and therefore benefits are based on the individual’s ability to purchase healthcare. Social justice, however, says that health is a collective responsibility in which everyone is entitled to basic benefits. Therefore, market justice values individual wellbeing with little obligation to collective health, while social justice emphasizes the acquisition of community wellbeing over individual health.

A key difference in market justice versus social justice is that market justice focuses on the individual rather than the collective population when determining who is responsible for health. It adheres to private solutions rather than government solutions to health problems. These principles work well when allocating economic goods, as long as their unequal distribution does not affect society at large. Market justice does, however, fail to take into consideration human concerns like crime, homelessness, and illiteracy which threaten that stability of society (Shi and Singh, 2015).

For social justice, community wellbeing is at its best when discrimination on the basis of “Race/ethnicity, skin, color, religion, or nationality; socioeconomic resources or position…; gender, sexual orientation, gender identity, age, geography, disability, illness, political or other affiliation; or other characteristics associated with marginalization” does not exist (Krau, 2015). According to the American Public Health Association, “more than 30 percent of direct medical costs faced by blacks, Hispanics, and Asian Americans can be tied to health inequities….[T]hese populations are often sicker when they do find a source of care and incur higher medical costs” (APHA, 2019). Social justice aims to eliminate statistics like this so that community health is equitable across all populations. Market justice is more concerned with the effect that these discriminatory phenomena have on the individual rather than the whole population. Furthermore, market justice and social justice conflict when “a significant number of uninsured still cannot afford health insurance and do not meet the eligibility criteria for Medicaid, Medicare, or other public programs” (Shi and Singh, 2015). Due to these differences, it is difficult for social justice and market justice to be equal participants in the healthcare system; one must be more prevalent than the other.

Healthcare Rationing

In market justice, healthcare rationing is called demand-side rationing or price-side rationing. In this type of rationing, quantity and type of healthcare services consumed by people are rationed by prices and ability to pay (Shi and Singh 2015). In social justice, healthcare rationing is called planned rationing or supply-side rationing. Because no country can afford an unlimited amount of healthcare for citizens, the government must limit the availability of certain healthcare services by deciding how they will be dispersed. Basic services will be available to everyone, but who will be allowed access and how they will be allowed access to certain services like technology for example will be determined by the government.

Since the introduction of Medicare and Medicaid in 1965, the government has been moving towards social justice. In fact, the Affordable Care Act was spurred by this shift. Currently, the government finances a little less than half the healthcare services in the United States. Furthermore, the government exercises its control over the system by governing insurance, payment to providers, access to new drugs, availability of procedures, medical research funding, and mandating information (Shi and Singh, 2015).

What Market Justice Means for Reform

Policy analysts James Capretta and Kevin Dayaratna believe that because consumers act rationally when presented with market signals in healthcare, there is great probability of reform in the future. Market reform will present itself in a few ways. According to Capretta and Dayaratna, “Reform plans should be evaluated based not only on how they affect federal spending and taxation but also how they affect private health insurance premiums and insurance coverage rates” (2013). However, caps on spending could have a potentially negative effect on quality. When spending is hindered, Capretta and Dayaratna worry that quality healthcare will be less of a priority. Additionally, they express concern that a market-based approach to healthcare reform would “rely on defined contribution systems to support insurance purchases by consumers, which have far more potential to control costs” (Capretta and Dayaratna, 2013). Consumers tend to look for high values at low costs when it comes to spending their own money on healthcare. It follows, then, that the more involved consumers are when paying for their healthcare, the more transparent the prices will be. Ultimately, however, reform in “market-driven health system would work as one would expect it to—driving out waste and inefficiency and rewarding high quality and lower costs with greater market share” (Capretta and Dayaratna, 2013).

What Social Justice Means for Reform

Social justice calls for a very different type of reform as compared to market justice. Reform in social justice will take into account social determinants of health like racism, sexism, and xenophobia, as they influence health just as drastically as biological factors do (Westerhaus et al, 2017). According to an article written by the founders of the Social Medicine Consortium, discriminatory systems create stress and interfere with access to healthy, safe, and affordable food and housing as well as fair paying jobs. It is the role of the community, then, to rid healthcare of structural violence—”the idea that structures of a society can inflict damage on the health of poor communities” (Westerhaus et al, 2017). Consequently, social justice reform would provide a “preferential option”—healthcare services beyond the surplus—to the those who cannot afford healthcare or who feel discriminated against by healthcare. In an article written by the founders of the Social Medicine Consortium, reform would mean “the disruption and transformation of the way we train health professionals in the US and around the world to more honestly incorporate learning about the social and structural determinants of health so these professionals are prepared and able to make a preferential option for the poor” (Westerhaus et al, 2017).

Market justice and social justice theories add to an already complex healthcare system. Knowing the difference in the two and understanding how they exist in the current healthcare system helps to determine what Americans value in healthcare. As a result, market justice may be more prevalent than social justice in healthcare or vice versa, depending on what Americans prefer at the time and the political climate. Despite market justice and social justice complexities, however, it is possible for the two systems to concurrently and successfully exist in healthcare delivery, as they do today. However, there is room for reform in both models to better complement each other by providing quality healthcare for all Americans, whether through private or employer provided insurance or government programs.

References

• Capretta, J. Compelling Evidence Makes the Case for a Market-Driven Health Care System. Retrieved from https://www.heritage.org/health-care-reform/report/compelling-evidence-makes-the-case-market-driven-health-care-system
• Derrick, J. (2019, February 11). Similarities in Social Justice & Market Justice. Retrieved from https://bizfluent.com/info-11404225-similarities-social-justice-market-justice.html
• Difference between Market Justice and Social Justice. Retrieved from https://lawaspect.com/difference-market-justice-social-justice/
• Shi, L., & Singh, D.
  
  Essentials of the U.S. Healthcare System
  
  . Retrieved from http://samples.jbpub.com/9781284100556/Chapter2.pdf
• Social Justice and Health. Retrieved from https://www.apha.org/what-is-public-health/generation-public-health/our-work/social-justice
• Social Justice Should be a Key Part of Educating Health Professionals. Retrieved from https://www.statnews.com/2017/04/07/social-justice-health-education/
• S. D. (2015). Social Justice: A Basis for Health Care Delivery. Retrieved from https://www.nursing.theclinics.com/article/S0029-6465(15)00069-9/pdf