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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.
It's hard to imagine discussing welfare policy without discussing race, yet all too often this uncomfortable factor is avoided or simply ignored. Sometimes the relationship between welfare and race is treated as so self-evident as to need no further attention; equally often, race in the context of welfare is glossed over, lest it raise hard questions about racism in American society as a whole. Either way, ducking the issue misrepresents the facts and misleads the public and policy-makers alike. Many scholars have addressed specific aspects of this subject, but until now there has been no single integrated overview. Race and the Politics of Welfare Reform is designed to fill this need and provide a forum for a range of voices and perspectives that reaffirm the key role race has played--and continues to play--in our approach to poverty. The essays collected here offer a systematic, step-by-step approach to the issue. Part 1 traces the evolution of welfare from the 1930s to the sweeping Clinton-era reforms, providing a historical context within which to consider today's attitudes and strategies. Part 2 looks at media representation and public perception, observing, for instance, that although blacks accounted for only about one-third of America's poor from 1967 to 1992, they featured in nearly two-thirds of news stories on poverty, a bias inevitably reflected in public attitudes. Part 3 discusses public discourse, asking questions like "Whose voices get heard and why?" and "What does 'race' mean to different constituencies?" For although "old-fashioned" racism has been replaced by euphemism, many of the same underlying prejudices still drive welfare debates--and indeed are all the more pernicious for being unspoken. Part 4 examines policy choices and implementation, showing how even the best-intentioned reform often simply displaces institutional inequities to the individual level--bias exercised case by case but no less discriminatory in effect. Part 5 explores the effects of welfare reform and the implications of transferring policy-making to the states, where local politics and increasing use of referendum balloting introduce new, often unpredictable concerns. Finally, Frances Fox Piven's concluding commentary, "Why Welfare Is Racist," offers a provocative response to the views expressed in the pages that have gone before--intended not as a "last word" but rather as the opening argument in an ongoing, necessary, and newly envisioned national debate. Sanford Schram is Visiting Professor of Social Work and Social Research, Bryn Mawr Graduate School of Social Work and Social Research. Joe Soss teaches in the Department of Government at the Graduate school of Public Affairs, American University, Washington, D.C. Richard Fording is Associate Professor in the Department of Political Science, University of Kentucky.
This volume examines existing research documenting racial disproportionality and disparities in child welfare systems, the underlying factors that contribute to these phenomena and the harms that result at both the individual and community levels. It reviews multiple forms of interventions designed to prevent and reduce disproportionality, particularly in states and jurisdictions that have seen meaningful change. With contributions from authorities and leaders in the field, this volume serves as the authoritative volume on the complex issue of child maltreatment and child welfare. It offers a central source of information for students and practitioners who are seeking understanding on how structural and institutional racism can be addressed in public systems.
Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.
An enlarged edition of Thomas Sowell's brilliant examination of the origins of economic disparities Economic and other outcomes differ vastly among individuals, groups, and nations. Many explanations have been offered for the differences. Some believe that those with less fortunate outcomes are victims of genetics. Others believe that those who are less fortunate are victims of the more fortunate. Discrimination and Disparities gathers a wide array of empirical evidence to challenge the idea that different economic outcomes can be explained by any one factor, be it discrimination, exploitation, or genetics. This revised and enlarged edition also analyzes the human consequences of the prevailing social vision of these disparities and the policies based on that vision--from educational disasters to widespread crime and violence.
Many racial and ethnic groups in the United States, including blacks, Hispanics, Asians, American Indians, and others, have historically faced severe discriminationâ€"pervasive and open denial of civil, social, political, educational, and economic opportunities. Today, large differences among racial and ethnic groups continue to exist in employment, income and wealth, housing, education, criminal justice, health, and other areas. While many factors may contribute to such differences, their size and extent suggest that various forms of discriminatory treatment persist in U.S. society and serve to undercut the achievement of equal opportunity. Measuring Racial Discrimination considers the definition of race and racial discrimination, reviews the existing techniques used to measure racial discrimination, and identifies new tools and areas for future research. The book conducts a thorough evaluation of current methodologies for a wide range of circumstances in which racial discrimination may occur, and makes recommendations on how to better assess the presence and effects of discrimination.
Thirty years after Lyndon Johnson declared a War on Poverty, the United States still lags behind most Western democracies in national welfare systems, lacking such basic programs as national health insurance and child care support. Some critics have explained the failure of social programs by citing our tradition of individual freedom and libertarian values, while others point to weaknesses within the working class. In The Color of Welfare, Jill Quadagno takes exception to these claims, placing race at the center of the "American Dilemma," as Swedish economist Gunnar Myrdal did half a century ago. The "American creed" of liberty, justice, and equality clashed with a history of active racial discrimination, says Quadagno. It is racism that has undermined the War on Poverty, and America must come to terms with this history if there is to be any hope of addressing welfare reform today. From Reconstruction to Lyndon Johnson and beyond, Quadagno reveals how American social policy has continually foundered on issues of race. Drawing on extensive primary research, Quadagno shows, for instance, how Roosevelt, in need of support from southern congressmen, excluded African Americans from the core programs of the Social Security Act. Turning to Lyndon Johnson's "unconditional war on poverty," she contends that though anti-poverty programs for job training, community action, health care, housing, and education have accomplished much, they have not been fully realized because they became inextricably intertwined with the civil rights movement of the 1960s, which triggered a white backlash. Job training programs, for instance, became affirmative action programs, programs to improve housing became programs to integrate housing, programs that began as community action to upgrade the quality of life in the cities were taken over by local civil rights groups. This shift of emphasis eventually alienated white, working-class Americans, who had some of the same needs--for health care, subsidized housing, and job training opportunities--but who got very little from these programs. At the same time, affirmative action clashed openly with organized labor, and equal housing raised protests from the white suburban middle-class, who didn't want their neighborhoods integrated. Quadagno shows that Nixon, who initially supported many of Johnson's programs, eventually caught on that the white middle class was disenchanted. He realized that his grand plan for welfare reform, the Family Assistance Plan, threatened to undermine wages in the South and alienate the Republican party's new constituency--white, southern Democrats--and therefore dropped it. In the 1960s, the United States embarked on a journey to resolve the "American dilemma." Yet instead of finally instituting full democratic rights for all its citizens, the policies enacted in that turbulent decade failed dismally. The Color of Welfare reveals the root cause of this failure--the inability to address racial inequality.
This book shows the important links between social conditions and health and begins to describe the processes through which these health inequalities may be generated. It reviews a range of methodologies that could be used by health researchers in this field and proposes innovative future research directions.