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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.
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.
In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable's first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on July 31, 2007, and examined (1) the importance of differences in life expectancy within the United States, (2) the reasons for those differences, and (3) the implications of this information for programs and policy makers.
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.
In this edited volume, three leading experts in race, mental health, and contextual behavior science address the urgent problem of racial inequities and biases, whichoften prevent people of color from seeking mental health services--leading to poor outcomes if and when they do receive treatment. This critical and timely guide provides clinicians and educators with evidence-based recommendations for addressing inequities at multiple levels, as well as best practices for compassionately and effectively helping clients across a range of cultural groups and settings.
Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information. These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, heath disparities could increase. But if technologies can be developed and implemented in such a way to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all. To explore the potential for further insights into, and opportunities to address, disparities in underserved populations the National Academies of Sciences, Engineering, and Medicine held a workshop in October 2014. The workshop focused on (1) how communities are using digital health technologies to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) on models of successful technology-based strategies to reduce health disparities. This report summarizes the presentations and discussions at the workshop.
The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data. Race, Ethnicity, and Language Data identifies current models for collecting and coding race, ethnicity, and language data; reviews challenges involved in obtaining these data, and makes recommendations for a nationally standardized approach for use in health care quality improvement.
The decade ahead will test the nation's nearly 4 million nurses in new and complex ways. Nurses live and work at the intersection of health, education, and communities. Nurses work in a wide array of settings and practice at a range of professional levels. They are often the first and most frequent line of contact with people of all backgrounds and experiences seeking care and they represent the largest of the health care professions. A nation cannot fully thrive until everyone - no matter who they are, where they live, or how much money they make - can live their healthiest possible life, and helping people live their healthiest life is and has always been the essential role of nurses. Nurses have a critical role to play in achieving the goal of health equity, but they need robust education, supportive work environments, and autonomy. Accordingly, at the request of the Robert Wood Johnson Foundation, on behalf of the National Academy of Medicine, an ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine conducted a study aimed at envisioning and charting a path forward for the nursing profession to help reduce inequities in people's ability to achieve their full health potential. The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise. By leveraging these attributes, nursing will help to create and contribute comprehensively to equitable public health and health care systems that are designed to work for everyone. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity explores how nurses can work to reduce health disparities and promote equity, while keeping costs at bay, utilizing technology, and maintaining patient and family-focused care into 2030. This work builds on the foundation set out by The Future of Nursing: Leading Change, Advancing Health (2011) report.
Most public health students, academicians, and practitioners recognize the association between racial/ethnic minority status and the disproportionate burden of preventable disease in the United States. Much less attention has been directed, however, toward health disparities that affect gay and bisexual men. These disparities affect the lives of an estimated 5.3-7.4 million American men, and are an important concern for public health. Until very recently, the relative invisibility of this group and a paucity of empirical data have hampered attempts to identify health disparities experienced by gay and bisexual men. This book proposes to review and synthesize evidence of health disparities among gay and bisexual men, identify individual and community factors that contribute to these disparities, and articulate strategies for public health efforts to eliminate disparities. To date, these disparities have been largely discussed in isolation in the research literature in a manner that does not permit a comprehensive examination of these problems, their underlying causes, and potential solutions. Thus, a primary emphasis of the book will be to document health disparities among gay and bisexual men while also describing public health solutions to these challenges.
Health Equity: A Solutions-Focused Approach is a comprehensive textbook that illustrates existing conditions of health disparities across a range of populations in the United States, positions those disparities within the broader sociopolitical framework that leads to their existence, and most importantly, presents specific ways in which health equity solutions can be designed and implemented. Presenting current theoretical foundations, cultural context, and evidence-based models and interventions all in one, this textbook provides students with the basis to achieve greater health equity in their communities. Edited by award-winning authors and featuring contributions from diverse experts in public health, sociology, psychology, and medicine, this groundbreaking text goes beyond a traditional approach to risk factors and disparities and emphasizes the central role that health equity initiatives must play in public health research and practice. The book is divided into three sections, with Section I focusing on providing the context of health equity research and practice. Chapters are structured in such a way that both new and experienced students in the field will develop a deeper understanding of topics such as prejudice and discrimination; frameworks and theories; and research and collaboration approaches. Section II addresses the current knowledge of specific populations impacted by issues related to health equity, including African American, Latinx and Hispanic, Asian, American Indian and Alaska Native, Native Hawaiian and Pacific Islander, LGBTQ, Veteran, People with Disabilities, and many more. Authored or co-authored by members of the community being discussed, each of these chapters summarizes how health disparities impact the group, ongoing population-specific models of disparities and equity, emerging programs for achieving health equity, coverage of the most relevant aspects of intersectionality, and concluding exercises such as case studies and current events. Section III then highlights the role of cultural humility in achieving health equity. With its solutions-focused and community-affirming approach, Health Equity provides graduate and undergraduate students of public health with evidence-based models to help advance health through diversity, inclusion, and social justice. Key Features: Origins and Theories – Discusses the sociocultural and political origins of health disparities and the major theories that underlie an understanding of health equity Solutions-Focused – Describes emerging models and gives best practices in designing new programs Diverse Population Coverage – Provides historical context, sociocultural dynamics, and population-specific evidence-based programs from the voices of the communities being discussed Intersectionality Perspective – Highlights the role that overlapping and interdependent identities play in promoting health equity and the interventions that build from this perspective Case Studies and Real-World Examples – Demonstrates how to apply health equity improvement approaches in different contexts eBook access –Included with print purchase for use on most mobile devices or computers Instructor’s Packet – With an Instructor’s Manual, PowerPoint slides, Test Bank, and a Sample Syllabus