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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.
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.
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.
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.
Making a Place for Ourselves examines an important but not widely chronicled event at the intersection of African-American history and American medical history--the black hospital movement. A practical response to the racial realities of American life, the movement was a "self-help" endeavor--immediate improvement of separate medical institutions insured the advancement and health of African Americans until the slow process of integration could occur. Recognizing that their careers depended on access to hospitals, black physicians associated with the two leading black medical societies, the National Medical Association (NMA) and the National Hospital Association (NHA), initiated the movement in the 1920s in order to upgrade the medical and education programs at black hospitals. Vanessa Northington Gamble examines the activities of these physicians and those of black community organizations, local and federal governments, and major health care organizations. She focuses on three case studies (Cleveland, Chicago, and Tuskegee) to demonstrate how the black hospital movement reflected the goals, needs, and divisions within the African-American community--and the state of American race relations. Examining ideological tensions within the black community over the existence of black hospitals, Gamble shows that black hospitals were essential for the professional lives of black physicians before the emergence of the civil rights movement. More broadly, Making a Place for Ourselves clearly and powerfully documents how issues of race and racism have affected the development of the American hospital system.
"The claim of The Black Poets to being... an anthology is that it presents the full range of Black-American poetry, from the slave songs to the present day. It is important that folk poetry be included because it is the root and inspiration of later, literary poetry. Not only does this book present the full range of Black poetry, but it presents most poets in depths, and in some cases presents aspects of a poet neglected or overlooked before. Gwendolyn Brooks is represented not only by poems on racial and domestic themes, but is revealed as a writer of superb love lyrics. Tuming away from White models and retuming to their roots has freed Black poets to create a new poetry. This book records their progress."--from the Introduction by Dudley Randall
Florida Historical Society Harry T. and Harriette V. Moore Award Highlighting the long unacknowledged role of a group of pioneering professional women, The Public Health Nurses of Jim Crow Florida tells the story of healthcare workers who battled racism in a state where white supremacy formed the bedrock of society. They aimed to serve those people out of reach of modern medical care. In the era of Jim Crow discrimination, their marginalization in medical facilities—along with the overall medical neglect to address their health—meant that many African Americans in rural communities rarely saw doctors. Christine Ardalan shows how Florida’s public health nurses took up the charge, traveling into the Florida scrub to deliver health improvement information to the homes of Black and white residents, many of whom were illiterate. Drawing on a rich body of public health and nursing records, Ardalan draws attention to the innovative ways nurses bridged the gap between these communities and government policies that addressed threats of infection and high rates of infant and maternal mortality. From the progressive era to the civil rights movement, Florida’s public health nurses worked to overcome the constraints of segregation. Their story is echoed by the experiences of today’s community health nurses, who are keenly aware that maintaining healthy lives for all Americans requires tackling the nation’s deep-rooted cultural challenges.
How do policy and politics influence the social conditions that generate health outcomes? Reduced life expectancy, worsening health outcomes, health inequity, and declining health care options—these are now realities for most Americans. However, in a country of more than 325 million people, addressing everyone's issues is challenging. How can we effect beneficial change for everyone so we all can thrive? What is the great equalizer? In this book, Daniel E. Dawes argues that political determinants of health create the social drivers—including poor environmental conditions, inadequate transportation, unsafe neighborhoods, and lack of healthy food options—that affect all other dynamics of health. By understanding these determinants, their origins, and their impact on the equitable distribution of opportunities and resources, we will be better equipped to develop and implement actionable solutions to close the health gap. Dawes draws on his firsthand experience helping to shape major federal policies, including the Affordable Care Act, to describe the history of efforts to address the political determinants that have resulted in health inequities. Taking us further upstream to the underlying source of the causes of inequities, Dawes examines the political decisions that lead to our social conditions, makes the social determinants of health more accessible, and provides a playbook for how we can address them effectively. A thought-provoking and evocative account that considers both the policies we think of as "health policy" and those that we don't, The Political Determinants of Health provides a novel, multidisciplinary framework for addressing the systemic barriers preventing the United States from becoming the healthiest nation in the world.
A physician's "provocative" (Boston Globe) and "timely" (Ibram X. Kendi, New York Times Book Review) account of how right-wing backlash policies have deadly consequences -- even for the white voters they promise to help. In election after election, conservative white Americans have embraced politicians who pledge to make their lives great again. But as physician Jonathan M. Metzl shows in Dying of Whiteness, the policies that result actually place white Americans at ever-greater risk of sickness and death. Interviewing a range of everyday Americans, Metzl examines how racial resentment has fueled progun laws in Missouri, resistance to the Affordable Care Act in Tennessee, and cuts to schools and social services in Kansas. He shows these policies' costs: increasing deaths by gun suicide, falling life expectancies, and rising dropout rates. Now updated with a new afterword, Dying of Whiteness demonstrates how much white America would benefit by emphasizing cooperation rather than chasing false promises of supremacy. Winner of the Robert F. Kennedy Book Award