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This unique text explores health disparities in the United States and their implications from the perspective of a health care administration The book begins with a broad overview of health disparities including definitions from local, state, and federal legislation, as well as alternative definitions. The authors examine current and past frameworks of analysis regarding the causes of disparities and provide a statistical overview of death rates and their implications for health care administrators. In the final section of the book, each chapter looks at health disparities within each type of health care environment such as physician practices, hospitals, pharmaceutical products, Medicare/Medicaid, long-term care, insurance markets, and more.
In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable's first workshop, Challenges and Successes in Reducing Health Disparities, was held in St. Louis, Missouri, on July 31, 2007, and examined (1) the importance of differences in life expectancy within the United States, (2) the reasons for those differences, and (3) the implications of this information for programs and policy makers.
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.
How can we all work together to eliminate the avoidable injustices that plague our health care system and society? Health is determined by far more than a person's choices and behaviors. Social and political conditions, economic forces, physical environments, institutional policies, health care system features, social relationships, risk behaviors, and genetic predispositions all contribute to physical and mental well-being. In America and around the world, many of these factors are derived from a lingering history of unequal opportunities and unjust treatment for people of color and other vulnerable communities. But they aren't the only ones who suffer because of these disparities—everyone is impacted by the factors that degrade health for the least advantaged among us. In Why Are Health Disparities Everyone's Problem? Dr. Lisa Cooper shows how we can work together to eliminate the injustices that plague our health care system and society. The book follows Cooper's journey from her childhood in Liberia, West Africa, to her thirty-year career working first as a clinician and then as a health equity researcher at Johns Hopkins University. Drawing on her experiences, it explores how differences in communication and the quality of relationships affect health outcomes. Through her work as the founder and director of the Johns Hopkins Center for Health Equity, it details the actions and policies needed to reduce and eliminate the conditions that are harming us all. Cooper reveals with compelling detail how health disparities are crippling our health care system and society, driving up health care costs, leading to adverse health outcomes and ultimately an enormous burden of human suffering. Why Are Health Disparities Everyone's Problem? demonstrates the ways in which everyone's health is interconnected, both within communities and across the globe. Cooper calls for a new kind of herd immunity, when a sufficiently high proportion of people, across race and social class, become immune to harmful social conditions through "vaccination" with solidarity among groups and opportunities created by institutional and societal practices and policies. By acknowledging and acting upon that interconnectedness, she believes everyone can help to create a healthier world. Features • Raises readers' health care inequities literacy through an approachable narrative with specific examples • Introduces the concept of "herd immunity" as it applies to building communal awareness of systemic injustices • Features sections that underscore key takeaways • Includes contributions from the world's leading minds through their research findings and quotations • Guides readers on what can be done at an individual level as a patient, public health professional, and community member • Includes inspiring stories of effective health equity studies and practices around the world, from Ghana's ADHINCRA Project addressing hypertension control to Baltimore's BRIDGE Study for depression in African Americans and the Maryland and Pennsylvania–based RICH LIFE Project for hypertension, diabetes, and other medical conditions Johns Hopkins Wavelengths In classrooms, field stations, and laboratories in Baltimore and around the world, the Bloomberg Distinguished Professors of Johns Hopkins University are opening the boundaries of our understanding of many of the world's most complex challenges. The Johns Hopkins Wavelengths book series brings readers inside their stories, illustrating how their pioneering discoveries benefit people in their neighborhoods and across the globe in artificial intelligence, cancer research, food systems' environmental impacts, health equity, science diplomacy, and other critical arenas of study. Through these compelling narratives, their insights will spark conversations from dorm rooms to dining rooms to boardrooms.
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.
Chronic diseases are common and costly, yet they are also among the most preventable health problems. Comprehensive and accurate disease surveillance systems are needed to implement successful efforts which will reduce the burden of chronic diseases on the U.S. population. A number of sources of surveillance data-including population surveys, cohort studies, disease registries, administrative health data, and vital statistics-contribute critical information about chronic disease. But no central surveillance system provides the information needed to analyze how chronic disease impacts the U.S. population, to identify public health priorities, or to track the progress of preventive efforts. A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases outlines a conceptual framework for building a national chronic disease surveillance system focused primarily on cardiovascular and chronic lung diseases. This system should be capable of providing data on disparities in incidence and prevalence of the diseases by race, ethnicity, socioeconomic status, and geographic region, along with data on disease risk factors, clinical care delivery, and functional health outcomes. This coordinated surveillance system is needed to integrate and expand existing information across the multiple levels of decision making in order to generate actionable, timely knowledge for a range of stakeholders at the local, state or regional, and national levels. The recommendations presented in A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases focus on data collection, resource allocation, monitoring activities, and implementation. The report also recommends that systems evolve along with new knowledge about emerging risk factors, advancing technologies, and new understanding of the basis for disease. This report will inform decision-making among federal health agencies, especially the Department of Health and Human Services; public health and clinical practitioners; non-governmental organizations; and policy makers, among others.
This uniquely accessible volume challenges professionals to understand—and help correct—health disparities, both at the patient level and in their larger social contexts. Dedicated to eradicating this ongoing injustice, contributors focus on marginalized populations, the role of healthcare systems in perpetuating inequities, the need for deeper engagement and listening by professionals, and the need for advocacy within professional education and the political/policy arena. The compelling case narratives at the core of the book illustrate the interrelated biopsychosocial components of patients’ health problems and the gradations of learning needed for practitioners to address them effectively. The book’s tools for developing a health disparities curriculum include a selection of workshop exercises, facilitator resources, and a brief guide to writing effective case narratives. A sampling of the narratives: “Finding the Person in Patient-Centered Health Care” (race/ethnicity/culture). “The Annual Big Girl / Big Boy Exchange” (gender). “Just Give Me Narcan and Let Me Go” (poverty/addiction). “Everyone Called Him Crazy” (immigration). “Adrift in the System” (disability). “Aging out of Pediatrics” (mental illness and stigma). “Time to Leave” (LGBT) A work of profound compassion, Health Disparities will be of considerable interest to researchers and practitioners interested in public health, population health, health disparities, and related fields such as sociology, social work, and narrative medicine. Its wealth of educational features also makes it a quality training text. "I was impressed when I read Health Disparities: Weaving a New Understanding through Case Narratives. As a patient who has experienced unpleasant situations in health care, I was moved to see that it was emotional and personal for the writers. The book confirms for me that the time is now for change to take place in our health care systems. I see this book as a light that can shine bright in the darkest places of health care. The editors have assembled a powerful book that provides all health professionals with specific steps they can take towards addressing and then eventually eliminating health disparities. A few steps that I really connected with were improving critical awareness, delivering quality care, listening and empathizing with patients and families, and advocating for changes. I recommend that anyone interested in working to improve health care obtain a copy of this book—it’s filled with useful information that every medical professional should know. The book reminds me of a quote by Wayne Dyer, 'When you change the way you look at things, the things you look at change.'" -Delores Collins, Founder and Executive Director, A Vision of Change Incorporated, Certified Community Health Worker. Founder of The Greater Cleveland Community Health Workers Association.
The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.
Researchers commonly ask subjects to self-identify their race from a menu of preestablished options. Yet if race is a multidimensional, multilevel social construction, this has profound methodological implications for the sciences and social sciences. Race must inform how we design large-scale data collection and how scientists utilize race in the context of specific research questions. This landmark collection argues for the recognition of those implications for research and suggests ways in which they may be integrated into future scientific endeavors. It concludes on a prescriptive note, providing an arsenal of multidisciplinary, conceptual, and methodological tools for studying race specifically within the context of health inequalities. Contributors: John A. Garcia, Arline T. Geronimus, Laura E. Gómez, Joseph L. Graves Jr., Janet E. Helms, Derek Kenji Iwamoto, Jonathan Kahn, Jay S. Kaufman, Mai M. Kindaichi, Simon J. Craddock Lee, Nancy López, Ethan H. Mereish, Matthew Miller, Gabriel R. Sanchez, Aliya Saperstein, R. Burciaga Valdez, Vicki D. Ybarra
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