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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.
Hispanics and the Future of America presents details of the complex story of a population that varies in many dimensions, including national origin, immigration status, and generation. The papers in this volume draw on a wide variety of data sources to describe the contours of this population, from the perspectives of history, demography, geography, education, family, employment, economic well-being, health, and political engagement. They provide a rich source of information for researchers, policy makers, and others who want to better understand the fast-growing and diverse population that we call "Hispanic." The current period is a critical one for getting a better understanding of how Hispanics are being shaped by the U.S. experience. This will, in turn, affect the United States and the contours of the Hispanic future remain uncertain. The uncertainties include such issues as whether Hispanics, especially immigrants, improve their educational attainment and fluency in English and thereby improve their economic position; whether growing numbers of foreign-born Hispanics become citizens and achieve empowerment at the ballot box and through elected office; whether impending health problems are successfully averted; and whether Hispanics' geographic dispersal accelerates their spatial and social integration. The papers in this volume provide invaluable information to explore these issues.
Reshaping Health Care in Latin America: A Comparative Analysis of Health Care Reform in Argentina, Brazil, and Mexico
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.
The struggle of Mexicans to secure quality health care is the focal point of this study. Large-scale transformations in Mexico's national health care system have resulted in budget cuts, increased user fees and decreased public services. At the local level community-based health groups that practice popular medicine are addressing the challenge by training health promoters in a variety of preventive and healing practices and offering low-cost services in community clinics. Their health care approach integrates local and global practices ranging from Mexican herbalism to Chinese medicine. Suzanne Schneider's ethnographic study of grassroots health groups in Morelos, Mexico, addresses the lives of the participants and the groups' contributions to community health. What draws women to these groups? Are they reacting to their experiences with formal health care? To what extent are the groups' teachings applied in the household and accepted throughout the community? Does group participation offer women new sources of empowerment or avenues to income generation? Does the government support these groups? How do they fit into larger trends of health care reform and the shift toward privatization? Taking a political economic approach, Schneider examines the conditions under which community-based health groups are emerging and explores the ways different constituencies address health dilemmas. She delineates future roles for new participants in health care, new models of community health, and a new medical pluralism.
Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.