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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.
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.
'Punchily written ... He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement 'Splendid and necessary' Henry Marsh, author of Do No Harm, New Statesman There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.
New Horizons in Health discusses how the National Institutes of Health (NIH) can integrate research in the social, behavioral, and biomedical sciences to better understand the causes of disease as well as interventions that promote health. It outlines a set of research priorities for consideration by the Office of Behavioral and Social Sciences Research (OBSSR), with particular attention to research that can support and complement the work of the National Institutes of Health. By addressing the range of interactions among social settings, behavioral patterns, and important health concerns, it highlights areas of scientific opportunity where significant investment is most likely to improve nationalâ€"and globalâ€"health outcomes. These opportunities will apply the knowledge and methods of the behavioral and social sciences to contemporary health needs, and give attention to the chief health concerns of the general public.
Good health is a key component of people's well-being. It is a value in itself but - through its influence on social, education and labour market outcomes - being in good or bad health has also wider implications on people's chances of leading a fulfilling and productive life. Yet, even in the OECD countries, health inequality persists with severe consequences on the goal of promoting inclusive growth. This report documents a comprehensive range of inequalities in health and health systems to the detriment of disadvantaged population groups in a large set of OECD and EU countries. It assesses the gaps in health outcomes and risk factors between different socio-economic groups. When it comes to health systems, the report measures inequalities in health care utilisation, unmet needs and the affordability of health care services. For each of these different domains, the report identifies groups of countries that display higher, intermediate, and low levels of inequality. The report makes a strong case for addressing health-related inequalities as a key component of a policy strategy to promote inclusive growth and reduce social inequalities. It also provides a framework for more in-depth analyses on how to address these inequalities at country level.
During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages-cancer and cardiovascular disease-available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which-unlike randomized controlled trials-are subject to many biases.
An essential text for courses in public health, health policy, and sociology, this compelling book is a vital teaching tool and a comprehensive reference for social science and medical professionals.
Inequality in income, earnings, and wealth has risen dramatically in the United States over the past three decades. Most research into this issue has focused on the causes—global trade, new technology, and economic policy—rather than the consequences of inequality. In Social Inequality, a group of the nation's leading social scientists opens a wide-ranging inquiry into the social implications of rising economic inequality. Beginning with a critical evaluation of the existing research, they assess whether the recent run-up in economic inequality has been accompanied by rising inequality in social domains such as the quality of family and neighborhood life, equal access to education and health care, job satisfaction, and political participation. Marcia Meyers and colleagues find that many low-income mothers cannot afford market-based child care, which contributes to inequality both at the present time—by reducing maternal employment and family income—and through the long-term consequences of informal or low-quality care on children's educational achievement. At the other end of the educational spectrum, Thomas Kane links the growing inequality in college attendance to rising tuition and cuts in financial aid. Neil Fligstein and Taek-Jin Shin show how both job security and job satisfaction have decreased for low-wage workers compared with their higher-paid counterparts. Those who fall behind economically may also suffer diminished access to essential social resources like health care. John Mullahy, Stephanie Robert, and Barbara Wolfe discuss why higher inequality may lead to poorer health: wider inequality might mean increased stress-related ailments for the poor, and it might also be associated with public health care policies that favor the privileged. On the political front, Richard Freeman concludes that political participation has become more stratified as incomes have become more unequal. Workers at the bottom of the income scale may simply be too hard-pressed or too demoralized to care about political participation. Social Inequality concludes with a comprehensive section on the methodological problems involved in disentangling the effects of inequality from other economic factors, which will be of great benefit to future investigators. While today's widening inequality may be a temporary episode, the danger is that the current economic divisions may set in motion a self-perpetuating cycle of social disadvantage. The most comprehensive review of this quandary to date, Social Inequality maps out a new agenda for research on inequality in America with important implications for public policy.
Health, Food and Social Inequality investigates how vast amounts of consumer data are used by the food industry to enable the social ranking of products, food outlets and consumers themselves, and how this influences food consumption patterns. This book supplies a fresh social scientific perspective on the health consequences of poor diet. Shifting the focus from individual behaviour to the food supply and the way it is developed and marketed, it discusses what is known about the shaping of food behaviours by both social theory and psychology. Exploring how knowledge of social identities and health beliefs and behaviours are used by the food industry, Health, Food and Social Inequality outlines, for example, how commercial marketing firms supply food companies with information on where to locate snack and fast foods whilst also advising governments on where to site health services for those consuming such foods disproportionately. Giving a sociological underpinning to Nudge theory while simultaneously critiquing it in the context of diet and health, this book explores how social class is an often overlooked factor mediating both individual dietary practice and food marketing strategies. This innovative volume provides a detailed critique of marketing and food industry practices and places class at the centre of diet and health. It is suitable for scholars in the social sciences, public health and marketing.
This book raises questions and provides a starting point for health practitioners ready to reorient public health practice to address the root causes of health inequities.