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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.
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.
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 world’s urban populations grow, cities become spaces where increasingly diverse peoples negotiate such differences as language, citizenship, ethnicity and race, class and wealth, and gender. Using a comparative framework, Urban Diversity examines the multiple meanings of inclusion and exclusion in fast-changing urban contexts. The contributors identify specific areas of contestation, including public spaces and facilities, governmental structures, civil society institutions, cultural organizations, and cyberspace. The contributors also explore the socioeconomic and cultural mechanisms that can encourage inclusive pluralism in the world’s cities, seeking approaches that view diversity as an asset rather than a threat. Exploring old and new public spaces, practices of marginalized urban dwellers, and actions of the state, the contributors to Urban Diversity assess the formation and reformation of processes of inclusion, whether through deliberate actions intended to rejuvenate democratic political institutions or the spontaneous reactions of city residents.
This book provides an expert examination and comparison of housing segregation in major population centers in the United States and Western Europe and analyzes successes and failures of government policies and desegregation programs in the United States, the United Kingdom, the Netherlands, Sweden, France, and West Germany. The collection begins with a review of the historical development of housing segregation in these countries, describing current housing conditions, concentration of housing in each country's leading cities, minority populations and the housing they occupy--specifically public, nonprofit, and owner-occupied dwellings. When focusing on the United States, the contributors assess housing segregation, antisegregation measures, and institutional racism toward blacks in the Midwest and South, and toward Mexican-Americans throughout American cities. Chapters dealing with Western Europe include housing segregation of South Asian and West Indian immigrants in Britain, immigrants in Sweden, Turkish, and Yugoslav "guest workers" in West Germany, and Algerian and other Arab groups in France. The book concludes with discussions of public housing policies; suburban desegregation, resegregation, and integration maintenance programs; specific integration stabilization programs; and desegregation efforts in one specific place. Contributors. Elizabeth Huttman, Michal Arend, Cihan Arin, Maurice Blanc, Wim Blauw, Ger Mik, Clyde McDaniels, Jürgen Friedrichs, Hannes Alpheis, John M. Goering, Len Gordon, Albert Mayer, Rosemary Helper, Barry V. Johnston, Terry Jones, Valerie Karn, Göran Lindberg, Anna Lisa Lindén, Deborah Phillips, Dennis Keating, Juliet Saltman, Alan Murie
"Provides a rich prism through which to explore the social, economic, and political development of black Cincinnati. These studies offer insight into both the dynamics of racism and a community's changing responses to it." -- Peter Rachleff, author of Black Labor in Richmond
On Melbenan Drive just west of Atlanta, sunlight falls onto a long row of well-kept lawns. Two dozen homes line the street; behind them wooden decks and living-room windows open onto vast woodland properties. Residents returning from their jobs steer SUVs into long driveways and emerge from their automobiles. They walk to the front doors of their houses past sculptured bushes and flowers in bloom. For most people, this cozy image of suburbia does not immediately evoke images of African Americans. But as this pioneering work demonstrates, the suburbs have provided a home to black residents in increasing numbers for the past hundred years—in the last two decades alone, the numbers have nearly doubled to just under twelve million. Places of Their Own begins a hundred years ago, painting an austere portrait of the conditions that early black residents found in isolated, poor suburbs. Andrew Wiese insists, however, that they moved there by choice, withstanding racism and poverty through efforts to shape the landscape to their own needs. Turning then to the 1950s, Wiese illuminates key differences between black suburbanization in the North and South. He considers how African Americans in the South bargained for separate areas where they could develop their own neighborhoods, while many of their northern counterparts transgressed racial boundaries, settling in historically white communities. Ultimately, Wiese explores how the civil rights movement emboldened black families to purchase homes in the suburbs with increased vigor, and how the passage of civil rights legislation helped pave the way for today's black middle class. Tracing the precise contours of black migration to the suburbs over the course of the whole last century and across the entire United States, Places of Their Own will be a foundational book for anyone interested in the African American experience or the role of race and class in the making of America's suburbs. Winner of the 2005 John G. Cawelti Book Award from the American Culture Association. Winner of the 2005 Award for Best Book in North American Urban History from the Urban History Association.
Winner of the 2009 Book Award in Social Sciences, Association for Asian American Studies This innovative work provides a new model for the analysis of ethnic and racial settlement patterns in the United States and Canada. Ethnoburbs—suburban ethnic clusters of residential areas and business districts in large metropolitan areas—are multiracial, multiethnic, multicultural, multilingual, and often multinational communities in which one ethnic minority group has a significant concentration but does not necessarily constitute a majority. Wei Li documents the processes that have evolved with the spatial transformation of the Chinese American community of Los Angeles and that have converted the San Gabriel Valley into ethnoburbs in the latter half of the twentieth century, and she examines the opportunities and challenges that occurred as a result of these changes. Traditional ethnic and immigrant settlements customarily take the form of either ghettos or enclaves. Thus the majority of scholarly publications and mass media covering the San Gabriel Valley has described it as a Chinatown located in Los Angeles’ suburbs. Li offers a completely different approach to understanding and analyzing this fascinating place. By conducting interviews with residents, a comparative spatial examination of census data and other statistical sources, and fieldwork—coupled with her own holistic view of the area—Li gives readers an effective and fine-tuned socio-spatial analysis of the evolution of a new type of racially defined place. The San Gabriel Valley tells a unique story, but its evolution also speaks to those experiencing a similar type of ethnic and racial conurbation. In sum, Li sheds light on processes that are shaping other present (and future) ethnically and racially diverse communities. The concept of the ethnoburb has redefined the way geographers and other scholars think about ethnic space, place, and process. This book will contribute significantly to both theoretical and empirical studies of immigration by presenting a more intensive and thorough "take" on arguments about spatial and social processes in urban and suburban America.
In the 1960s, many believed that the civil rights movement’s successes would foster a new era of racial equality in America. Four decades later, the degree of racial inequality has barely changed. To understand what went wrong, Patrick Sharkey argues that we have to understand what has happened to African American communities over the last several decades. In Stuck in Place, Sharkey describes how political decisions and social policies have led to severe disinvestment from black neighborhoods, persistent segregation, declining economic opportunities, and a growing link between African American communities and the criminal justice system. As a result, neighborhood inequality that existed in the 1970s has been passed down to the current generation of African Americans. Some of the most persistent forms of racial inequality, such as gaps in income and test scores, can only be explained by considering the neighborhoods in which black and white families have lived over multiple generations. This multigenerational nature of neighborhood inequality also means that a new kind of urban policy is necessary for our nation’s cities. Sharkey argues for urban policies that have the potential to create transformative and sustained changes in urban communities and the families that live within them, and he outlines a durable urban policy agenda to move in that direction.