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In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Cardiovascular heart disease mortality in African Americans is the highest of all major racial/ethnic subpopulations in the United States. Examining race and ethnicity, Cardiovascular Disease in Racial and Ethnic Minorities will reveal that there are unacceptable healthcare disparities in risk factor prevalence, disease states, and cardiovascular outcomes in the United States. Written by a team of experts, Cardiovascular Disease in Racial and Ethnic Minorities examines to what degree biomedical and scientific literature can clarify the impact of genetic variation versus environment as related to cardiovascular disease. Chapters illustrate the magnitude of cardiovascular and metabolic disparities and the effect of environment on diseases.
As the population of older Americans grows, it is becoming more racially and ethnically diverse. Differences in health by racial and ethnic status could be increasingly consequential for health policy and programs. Such differences are not simply a matter of education or ability to pay for health care. For instance, Asian Americans and Hispanics appear to be in better health, on a number of indicators, than White Americans, despite, on average, lower socioeconomic status. The reasons are complex, including possible roles for such factors as selective migration, risk behaviors, exposure to various stressors, patient attitudes, and geographic variation in health care. This volume, produced by a multidisciplinary panel, considers such possible explanations for racial and ethnic health differentials within an integrated framework. It provides a concise summary of available research and lays out a research agenda to address the many uncertainties in current knowledge. It recommends, for instance, looking at health differentials across the life course and deciphering the links between factors presumably producing differentials and biopsychosocial mechanisms that lead to impaired health.
Chronic diseases are common and costly, yet they are also among the most preventable health problems. Comprehensive and accurate disease surveillance systems are needed to implement successful efforts which will reduce the burden of chronic diseases on the U.S. population. A number of sources of surveillance data-including population surveys, cohort studies, disease registries, administrative health data, and vital statistics-contribute critical information about chronic disease. But no central surveillance system provides the information needed to analyze how chronic disease impacts the U.S. population, to identify public health priorities, or to track the progress of preventive efforts. A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases outlines a conceptual framework for building a national chronic disease surveillance system focused primarily on cardiovascular and chronic lung diseases. This system should be capable of providing data on disparities in incidence and prevalence of the diseases by race, ethnicity, socioeconomic status, and geographic region, along with data on disease risk factors, clinical care delivery, and functional health outcomes. This coordinated surveillance system is needed to integrate and expand existing information across the multiple levels of decision making in order to generate actionable, timely knowledge for a range of stakeholders at the local, state or regional, and national levels. The recommendations presented in A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases focus on data collection, resource allocation, monitoring activities, and implementation. The report also recommends that systems evolve along with new knowledge about emerging risk factors, advancing technologies, and new understanding of the basis for disease. This report will inform decision-making among federal health agencies, especially the Department of Health and Human Services; public health and clinical practitioners; non-governmental organizations; and policy makers, among others.
Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.
Older Americans, even the oldest, can now expect to live years longer than those who reached the same ages even a few decades ago. Although survival has improved for all racial and ethnic groups, strong differences persist, both in life expectancy and in the causes of disability and death at older ages. This book examines trends in mortality rates and selected causes of disability (cardiovascular disease, dementia) for older people of different racial and ethnic groups. The determinants of these trends and differences are also investigated, including differences in access to health care and experiences in early life, diet, health behaviors, genetic background, social class, wealth and income. Groups often neglected in analyses of national data, such as the elderly Hispanic and Asian Americans of different origin and immigrant generations, are compared. The volume provides understanding of research bearing on the health status and survival of the fastest-growing segment of the American population.
In this exciting new book, William Cockerham, a leading medical sociologist, assesses the evidence that social factors have direct causal effects on health and many diseases. He argues that stress, poverty, unhealthy lifestyles, and unpleasant living and work conditions can all be directly associated with illness. Noting a new emphasis upon social structure in both theory and multi-level research techniques, he argues that a paradigm shift is now emerging in 21st century medical sociology, which looks beyond individual explanations for health and disease. As the old gives way to the new in medical sociology, the field is headed toward a fundamentally different orientation. William Cockerham's clear and compelling account is at the forefront of these changes. This lively and accessible book offers a coherent introduction to social epidemiology, as well as challenging aspects of the existing literature. It will be indispensable reading for all students and scholars of medical sociology, especially those with the courage to confront the possibility that society really does make people sick.
The book discusses the impact of genetics, social determinants of health, the environment, and lifestyle in the burden of cardiometabolic conditions in African American and Hispanic/Latinx populations. It includes fully updated and revised chapters on genetics and CVD risk, epidemiology of cardiovascular health, cardiovascular imaging, dyslipidemias and other emerging risk factors, obesity and metabolic syndrome, heart failure, and genetic variations in CVD. Unique aspects within African American and Hispanic/Latinx populations are explored with suggested appropriate therapeutic interventions. New chapters focus on ASCVD risk assessment, emerging precision medicine concepts, the impact of diabetes, resilience and CVD survival, and lifestyle and dieting considerations. Written by a team of experts, the book examines the degree to which biomedical and scientific literature can clarify the impact of genetic variation and environment on cardiovascular disease. The Second Edition of Cardiovascular Disease in Racial and Ethnic Minority Populations is an essential resource for physicians, residents, fellows, and medical students in cardiology, internal medicine, family medicine, clinical lipidology, and epidemiology.