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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.
Evidence indicates that actions within four main themes (early child development fair employment and decent work social protection and the living environment) are likely to have the greatest impact on the social determinants of health and health inequities. A systematic search and analysis of recommendations and policy guidelines from intergovernmental organizations and international bodies identified practical policy options for action on social determinants within these four themes. Policy options focused on early childhood education and care; child poverty; investment strategies for an inclusive economy; active labour market programmes; working conditions; social cash transfers; affordable housing; and planning and regulatory mechanisms to improve air quality and mitigate climate change. Applying combinations of these policy options alongside effective governance for health equity should enable WHO European Region Member States to reduce health inequities and synergize efforts to achieve the United Nations Sustainable Development Goals.
The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.
Today the United States has one of the highest poverty rates among the world's rich industrial democracies. The Failed Welfare Revolution shows us that things might have turned out differently. During the 1960s and 1970s, policymakers in three presidential administrations tried to replace the nation's existing welfare system with a revolutionary program to guarantee Americans basic economic security. Surprisingly from today's vantage point, guaranteed income plans received broad bipartisan support in the 1960s. One proposal, President Nixon's Family Assistance Plan, nearly passed into law in the 1970s, and President Carter advanced a similar bill a few years later. The failure of these proposals marked the federal government's last direct effort to alleviate poverty among the least advantaged and, ironically, sowed the seeds of conservative welfare reform strategies under President Reagan and beyond. This episode has largely vanished from America's collective memory. Here, Brian Steensland tells the whole story for the first time--from why such an unlikely policy idea first developed to the factors that sealed its fate. His account, based on extensive original research in presidential archives, draws on mainstream social science perspectives that emphasize the influence of powerful stakeholder groups and policymaking institutions. But Steensland also shows that some of the most potent obstacles to guaranteed income plans were cultural. Most centrally, by challenging Americans' longstanding distinction between the "deserving" and "undeserving" poor, the plans threatened the nation's cultural, political, and economic status quo.
The shame experienced by people living in poverty has long been recognised. Nobel laureate and economist, Amartya Sen, has described shame as the irreducible core of poverty. However, little attention has been paid to the implications of this connection in the making and implementation of anti-poverty policies. This important volume rectifies this critical omission and demonstrates the need to take account of the psychological consequences of poverty for policy to be effective. Drawing on pioneering empirical research in countries as diverse as Britain, Uganda, Norway, Pakistan, India, South Korea and China, it outlines core principles that can aid policy makers in policy development. In so doing, it provides the foundation for a shift in policy learning on a global scale and bridges the traditional distinctions between North and South, and high-, middle- and low-income countries. This will help students, academics and policy makers better understand the reasons for the varying effectiveness of anti-poverty policies.
The Other Welfare offers the first comprehensive history of Supplemental Security Income (SSI), from its origins as part of President Nixon's daring social reform efforts to its pivotal role in the politics of the Clinton administration. Enacted into law in 1972, Supplemental Security Income (SSI) marked the culmination of liberal social and economic policies that began during the New Deal. The new program provided cash benefits to needy elderly, blind, and disabled individuals. Because of the complex character of SSI-marking both the high tide of the Great Society and the beginning of the retrenchment of the welfare state-it provides the perfect subject for assessing the development of the American state in the late twentieth century. SSI was launched with the hope of freeing welfare programs from social and political stigma; it instead became a source of controversy almost from its very start. Intended as a program that paid uniform benefits across the nation, it ended up replicating many of the state-by-state differences that characterized the American welfare state. Begun as a program intended to provide income for the elderly, SSI evolved into a program that served people with disabilities, becoming a primary source of financial aid for the de-institutionalized mentally ill and a principal support for children with disabilities. Written by a leading historian of America's welfare state and the former chief historian of the Social Security Administration, The Other Welfare illuminates the course of modern social policy. Using documents previously unavailable to researchers, the authors delve into SSI's transformation from the idealistic intentions of its founders to the realities of its performance in America's highly splintered political system. In telling this important and overlooked history, this book alters the conventional wisdom about the development of American social welfare policy.