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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.
As the United States population becomes increasingly diverse, the need for guidelines to assure competent healthcare among minorities becomes ever more urgent. Cross-Cultural Medicine provides important background information on various racial, ethnic, and cultural groups, their general health problems and risks, and spiritual and religious issues. Individual chapters are devoted to the special concerns of several groups: blacks and African Americans, Latinos, American Indians and Native Alaskans, Asian Americans, and Arab Americans and American Muslims. These chapters lay the foundation for exploring an individual's health beliefs and concerns in the context of his or her sociocultural experiences.
In Rituals of Resistance Jason R. Young explores the religious and ritual practices that linked West-Central Africa with the Lowcountry region of Georgia and South Carolina during the era of slavery. The choice of these two sites mirrors the historical trajectory of the transatlantic slave trade which, for centuries, transplanted Kongolese captives to the Lowcountry through the ports of Charleston and Savannah. Analyzing the historical exigencies of slavery and the slave trade that sent not only men and women but also cultural meanings, signs, symbols, and patterns across the Atlantic, Young argues that religion operated as a central form of resistance against slavery and the ideological underpinnings that supported it. Through a series of comparative chapters on Christianity, ritual medicine, burial practices, and transmigration, Young details the manner in which Kongolese people, along with their contemporaries and their progeny who were enslaved in the Americas, utilized religious practices to resist the savagery of the slave trade and slavery itself. When slaves acted outside accepted parameters—in transmigration, spirit possession, ritual internment, and conjure—Young explains, they attacked not only the condition of being a slave, but also the systems of modernity and scientific rationalism that supported slavery. In effect, he argues, slave spirituality played a crucial role in the resocialization of the slave body and behavior away from the oppressions and brutalities of the master class. Young's work expands traditional scholarship on slavery to include both the extensive work done by African historians and current interdisciplinary debates in cultural studies, anthropology, and literature. Drawing on a wide range of primary sources from both American and African archives, including slave autobiography, folktales, and material culture, Rituals of Resistance offers readers a nuanced understanding of the cultural and religious connections that linked blacks in Africa with their enslaved contemporaries in the Americas. Moreover, Young's groundbreaking work gestures toward broader themes and connections, using the case of the Kongo and the Lowcountry to articulate the development of a much larger African Atlantic space that connected peoples, cultures, languages, and lives on and across the ocean's waters.
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.
With the abolition of the transatlantic slave trade in 1808, many African Americans began calling for "a day of publick thanksgiving" to commemorate this important step toward freedom. During the ensuing century, black leaders built on this foundation and constructed a distinctive and vibrant tradition through their celebrations of the end of slavery in New York State, the British West Indies, and eventually the United States as a whole. In this revealing study, Mitch Kachun explores the multiple functions and contested meanings surrounding African American emancipation celebrations from the abolition of the slave trade to the fiftieth anniversary of U.S. emancipation. Excluded from July Fourth and other American nationalist rituals for most of this period, black activists used these festivals of freedom to encourage community building and race uplift. Kachun demonstrates that, even as these annual rituals helped define African Americans as a people by fostering a sense of shared history, heritage, and identity, they were also sites of ambiguity and conflict. Freedom celebrations served as occasions for debate over black representations in the public sphere, struggles for group leadership, and contests over collective memory and its meaning. Based on extensive research in African American newspapers and oration texts, this book retraces a vital if often overlooked tradition in African American political culture and addresses important issues about black participation in the public sphere. By illuminating the origins of black Americans' public commemorations, it also helps explain why there have been increasing calls in recent years to make the "Juneteenth" observance of emancipation an American -- not just an African American -- day of commemoration.
This resource supports evidence-informed approaches to improving the cultural competence of health service delivery. By reviewing the evidence from Australia, Canada, New Zealand and the US, it provides readers with a clear and systematic overview of the interventions and indicators applied to enable health system agencies and professionals to work effectively in various cross-cultural health care situations. The book highlights the importance of cultural competence and describes the current situation in the studied countries; identifies effective approaches and strategies for improving the situation; reviews the indicators for measuring progress; assesses the health outcomes associated with cultural competence; summarizes the quality of the evidence; and presents an evidence-informed conceptual framework for cultural competence in health. Cultural competence is critical to reducing health disparities and has become a popular concept in these countries for improving access to high-quality, respectful and responsive health care. This book provides policy makers, health practitioners, researchers and students with a much needed summary of what works to improve health systems, services and practice.
Strive for health equity and surmount institutional oppression when treating marginalized populations with this distinct resource! This unique text provides a framework for delivering culturally safe clinical care to LGBTQIA+ populations filtered through the lens of racial, economic, and reproductive justice. It focuses strongly on the social context in which we live, one where multiple historical processes of oppression continue to manifest as injustices in the health care setting and beyond. Encompassing the shared experiences of a diverse group of expert health care practitioners, this book offers abundant examples, case studies, recommendations, and the most up-to-date guidelines available for treating LGBTQIA+ patient populations. Rich in clinical scenarios that describe best practices for safely treating patients, this text features varied healthcare frameworks encompassing patient-centered and community-centered care that considers the intersecting and ongoing processes of oppression that impact LGBTQIA+ people every day--particularly people of color. This text helps health providers incorporate safe and culturally appropriate language into their care, understand the roots and impact of stigma, address issues of health disparities, and recognize and avoid racial or LGBTQIA+ microaggressions. Specific approaches to care include chapters on sexual health care, perinatal care, and information about pregnancy and postpartum care for transgender and gender-expansive people. Key Features: Emphasizes patient-centered care incorporating an understanding of patient histories, safety needs, and power imbalances Provides tools for clinician self-reflection to understand and alleviate implicit bias Fosters culturally safe language and communication skills Presents abundant patient scenarios including specific dos and don'ts in patient treatment Includes concrete objectives, conclusions, terminology, and references in each chapter and discussion questions to promote critical thought Offers charts and information boxes to illuminate key information