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Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
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.
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.
Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large. Investing in The Health and Well-Being of Young Adults describes what is meant by the term young adulthood, who young adults are, what they are doing, and what they need. This study recommends actions that nonprofit programs and federal, state, and local agencies can take to help young adults make a successful transition from adolescence to adulthood. According to this report, young adults should be considered as a separate group from adolescents and older adults. Investing in The Health and Well-Being of Young Adults makes the case that increased efforts to improve high school and college graduate rates and education and workforce development systems that are more closely tied to high-demand economic sectors will help this age group achieve greater opportunity and success. The report also discusses the health status of young adults and makes recommendations to develop evidence-based practices for young adults for medical and behavioral health, including preventions. What happens during the young adult years has profound implications for the rest of the life course, and the stability and progress of society at large depends on how any cohort of young adults fares as a whole. Investing in The Health and Well-Being of Young Adults will provide a roadmap to improving outcomes for this age group as they transition from adolescence to adulthood.
This book shows the important links between social conditions and health and begins to describe the processes through which these health inequalities may be generated. It reviews a range of methodologies that could be used by health researchers in this field and proposes innovative future research directions.
Analyzing Oppression presents a new, integrated theory of social oppression, which tackles the fundamental question that no theory of oppression has satisfactorily answered: if there is no natural hierarchy among humans, why are some cases of oppression so persistent? Cudd argues that the explanation lies in the coercive co-opting of the oppressed to join in their own oppression. This answer sets the stage for analysis throughout the book, as it explores the questions of how and why the oppressed join in their oppression. Cudd argues that oppression is an institutionally structured harm perpetrated on social groups by other groups using direct and indirect material, economic, and psychological force. Among the most important and insidious of the indirect forces is an economic force that operates through oppressed persons' own rational choices. This force constitutes the central feature of analysis, and the book argues that this force is especially insidious because it conceals the fact of oppression from the oppressed and from others who would be sympathetic to their plight. The oppressed come to believe that they suffer personal failings and this belief appears to absolve society from responsibility. While on Cudd's view oppression is grounded in material exploitation and physical deprivation, it cannot be long sustained without corresponding psychological forces. Cudd examines the direct and indirect psychological forces that generate and sustain oppression. She discusses strategies that groups have used to resist oppression and argues that all persons have a moral responsibility to resist in some way. In the concluding chapter Cudd proposes a concept of freedom that would be possible for humans in a world that is actively opposing oppression, arguing that freedom for each individual is only possible when we achieve freedom for all others.
Many racial and ethnic groups in the United States, including blacks, Hispanics, Asians, American Indians, and others, have historically faced severe discriminationâ€"pervasive and open denial of civil, social, political, educational, and economic opportunities. Today, large differences among racial and ethnic groups continue to exist in employment, income and wealth, housing, education, criminal justice, health, and other areas. While many factors may contribute to such differences, their size and extent suggest that various forms of discriminatory treatment persist in U.S. society and serve to undercut the achievement of equal opportunity. Measuring Racial Discrimination considers the definition of race and racial discrimination, reviews the existing techniques used to measure racial discrimination, and identifies new tools and areas for future research. The book conducts a thorough evaluation of current methodologies for a wide range of circumstances in which racial discrimination may occur, and makes recommendations on how to better assess the presence and effects of discrimination.
Introduction -- Theoretical and methodological foundations -- A theoretical overview of the impact of racism on people of color / Alex Pieterse and Shantel Powell -- Applying intersectionality theory to research on perceived racism / Jioni A. Lewis and Patrick R. Grzanka -- Improving the measurement of perceived racial discrimination : challenges and opportunities / David R. Williams -- Moderators and mediators of the experience of perceived racism / Alvin Alvarez, Christopher T.H. Liang, Carin Molenaar, and David Nguyen -- Context and costs -- Racism and mental health : examining the link between racism and depression from a social-cognitive perspective / Elizabeth Brondolo, Wan Ng, Kristy-Lee J. Pierre, and Robert Lane -- Racism and behavioral outcomes over the life course / Gilbert C. Gee and Angie Denisse Otiniano Verissimo -- Racism and physical health disparities / Joseph Keaweaimoku Kaholokula -- The impact of racism on education and the educational experiences of students of color / Adrienne D. Dixson, Dominique Clayton, Leah Peoples, and Rema Reynolds -- The costs of racism on workforce entry and work adjustment / Justin C. Perry and Lela L. Pickett -- The impact of racism on communities of color : historical contexts and contemporary issues / Azara L. Santiago Rivera, Hector Y. Adames, Nayeli Y. Chavez-Dueñas, and Gregory Benson-Flórez -- Interventions and future directions -- Racial trauma recovery : a race-informed therapeutic approach to racial wounds / Lillian Comas-Díaz -- Critical race, psychology and social policy : refusing damage, cataloguing oppression, and documenting desire / Michelle Fine and William E. Cross -- Educational interventions for reducing racism / Elizabeth Vera, Daniel Camacho, Megan Polanin, and Manuel Salgado -- Toward a relevant psychology of prejudice, stereotyping and discrimination : linking science and practice to develop interventions that work in community settings / Ignacio D. Acevedo-Polakovich, Kara L. Beck, Erin Hawks, and Sarah E. Ogdie
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.