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This study adds to the small but growing literature on Black health history--the rise of hospital care and hospital services provided to Blacks from the antebellum era to the integration era, a period of some 150 years. The work examines the political, policy, legal, and philanthropic forces that helped to define the rise, development, and decline of Black hospitals in the United States. Particular discussion is given to the federal Hill-Burton Act of 1946 and the extent to which the legislation impacted Black hospital development. The roles of the Freedman's Bureau, National Medical Association, National Hospital Association, and the U.S. Commission on Civil Rights in the development of Black hospitals is highlighted.
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.
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 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.
Sick and Tired of Being Sick and Tired moves beyond the depiction of African Americans as mere recipients of aid or as victims of neglect and highlights the ways black health activists created public health programs and influenced public policy at every opportunity. Smith also sheds new light on the infamous Tuskegee syphilis experiment by situating it within the context of black public health activity, reminding us that public health work had oppressive as well as progressive consequences.
Plagued by geographic isolation, poverty, and acute shortages of health professionals and hospital beds, the South was dubbed by Surgeon General Thomas Parran "the nation's number one health problem." The improvement of southern, rural, and black health would become a top priority of the U.S. Public Health Service during the Roosevelt and Truman administrations. Karen Kruse Thomas details how NAACP lawsuits pushed southern states to equalize public services and facilities for blacks just as wartime shortages of health personnel and high rates of draft rejections generated broad support for health reform. Southern Democrats leveraged their power in Congress and used the war effort to call for federal aid to uplift the South. The language of regional uplift, Thomas contends, allowed southern liberals to aid blacks while remaining silent on race. Reformers embraced, at least initially, the notion of "deluxe Jim Crow"--support for health care that maintained segregation. Thomas argues that this strategy was, in certain respects, a success, building much-needed hospitals and training more black doctors. By the 1950s, deluxe Jim Crow policy had helped to weaken the legal basis for segregation. Thomas traces this transformation at the national level and in North Carolina, where "deluxe Jim Crow reached its fullest potential." This dual focus allows her to examine the shifting alliances--between blacks and liberal whites, southerners and northerners, activists and doctors--that drove policy. Deluxe Jim Crow provides insight into a variety of historical debates, including the racial dimensions of state building, the nature of white southern liberalism, and the role of black professionals during the long civil rights movement.
This unique contribution to the literature represents an important adjunct in developing comprehensive policies that will meet the health care needs of underserved communities in American society. The book is readable and contains useful documentation. Recommended as an important reference for all academic audiences interested in the politics and delivery of health care. Choice Editors Woodrow Jones, Jr., and Mitchell F. Rice present a thorough analysis of the problems of health and health care particular to black Americans. The contributors to this work analyze the factor of race as it influences the availability, accessibility, and quality of health care. They focus on barriers to health care encountered by blacks, and attempt to differentiate the problems of the black community from those of other disadvantaged groups. Using epidemiological data, the initial chapters evaluate the general health of the black population. In subsequent chapters, the contributors examine particular problems of groups within the black community, problems which are based both on behavior and environment. The work concludes by assessing the adequacy of governmental response to the problems identified.
Offers an innovative plan to eliminate inequalities in American health care and save the lives they endanger Over 84,000 black and brown lives are needlessly lost each year due to health disparities: the unfair, unjust, and avoidable differences between the quality and quantity of health care provided to Americans who are members of racial and ethnic minorities and care provided to whites. Health disparities have remained stubbornly entrenched in the American health care system—and in Just Medicine Dayna Bowen Matthew finds that they principally arise from unconscious racial and ethnic biases held by physicians, institutional providers, and their patients. Implicit bias is the single most important determinant of health and health care disparities. Because we have missed this fact, the money we spend on training providers to become culturally competent, expanding wellness education programs and community health centers, and even expanding access to health insurance will have only a modest effect on reducing health disparities. We will continue to utterly fail in the effort to eradicate health disparities unless we enact strong, evidence-based legal remedies that accurately address implicit and unintentional forms of discrimination, to replace the weak, tepid, and largely irrelevant legal remedies currently available. Our continued failure to fashion an effective response that purges the effects of implicit bias from American health care, Matthew argues, is unjust and morally untenable. In this book, she unites medical, neuroscience, psychology, and sociology research on implicit bias and health disparities with her own expertise in civil rights and constitutional law. In a time when the health of the entire nation is at risk, it is essential to confront the issues keeping the health care system from providing equal treatment to all.