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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.
The eleven essays that comprise this book offer an integrated perspective on Nazi policies of mass murder. Drawing heavily on primary sources from European and American archives, the collection of essays provides novel interpretations of Nazi policies vis-à-vis ethnic, religious, and sexual minorities in the German-occupied territories, specifically Eastern Europe. The essays printed in this volume advance two main theses, drawing a line under the Functionalist-Intentionalist debate regarding the origins of Nazi genocide. In their dealing with the “lesser races,” the Nazis proved more flexible and less single-minded than has been conventionally believed. Faced with what they saw as a temporary military setback, the Nazis were willing to renegotiate their murderous policies, granting certain concessions to the minority groups otherwise slated for destruction. In the long run, however, the Nazis never abandoned the ideology of racial exclusiveness, which had contributed to their ultimate defeat. Another thesis concerns the complex ethno-political landscape of Eastern Europe that came under Nazi domination. German occupation authorities encouraged ethnic rivalries and grievances, which trace back to the Austro-Hungarian and Russian Empires and beyond. Hobbesian war of all against all that had ensued made it easier for the Nazis to apply a divide-and-rule policy. It also provided a fertile ground for collaboration, specifically in the mass murder of Jews. The book will appear to both academic and non-academic audiences interested in the subjects as diverse as genocide, ethno-nationalism, and minority studies.
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.
Mental health practitioners are most effective when their services respond to the client's lifestyle, cultural and linguistic heritage, and life circumstances. Thus, an essential component of evidence-based psychological practice (EBPP) is attending to the ethnocultural background of the client. A significant challenge in using EBPP to guide treatment interventions with ethnic minority clients is that relatively little applicable research has been conducted, especially research that satisfies rigorous methodological criteria. In this book, experts in the field of ethnic minority mental health treatment discuss why research on culturally informed EBPP has not made more progress and suggest tangible strategies for conducting more meaningful and impactful studies in this area. The chapters address measurement issues such as test translation and adaptation, and research design issues such as meta-analytic strategies and mixed-method approaches. Inspiring examples show how EBPP can be tailored to meet the specific needs of ethnic minorities. This volume is an important step in reducing disparities and promoting effective mental health treatment for underserved populations.
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.
#1 NEW YORK TIMES BESTSELLER • OPRAH’S BOOK CLUB PICK • “An instant American classic and almost certainly the keynote nonfiction book of the American century thus far.”—Dwight Garner, The New York Times The Pulitzer Prize–winning, bestselling author of The Warmth of Other Suns examines the unspoken caste system that has shaped America and shows how our lives today are still defined by a hierarchy of human divisions—now with a new Afterword by the author. #1 NONFICTION BOOK OF THE YEAR: Time ONE OF THE BEST BOOKS OF THE YEAR: The Washington Post, The New York Times, Los Angeles Times, The Boston Globe, O: The Oprah Magazine, NPR, Bloomberg, The Christian Science Monitor, New York Post, The New York Public Library, Fortune, Smithsonian Magazine, Marie Claire, Slate, Library Journal, Kirkus Reviews Winner of the Carl Sandberg Literary Award • Winner of the Los Angeles Times Book Prize • National Book Award Longlist • National Book Critics Circle Award Finalist • Dayton Literary Peace Prize Finalist • PEN/John Kenneth Galbraith Award for Nonfiction Finalist • PEN/Jean Stein Book Award Longlist • Kirkus Prize Finalist “As we go about our daily lives, caste is the wordless usher in a darkened theater, flashlight cast down in the aisles, guiding us to our assigned seats for a performance. The hierarchy of caste is not about feelings or morality. It is about power—which groups have it and which do not.” In this brilliant book, Isabel Wilkerson gives us a masterful portrait of an unseen phenomenon in America as she explores, through an immersive, deeply researched, and beautifully written narrative and stories about real people, how America today and throughout its history has been shaped by a hidden caste system, a rigid hierarchy of human rankings. Beyond race, class, or other factors, there is a powerful caste system that influences people’s lives and behavior and the nation’s fate. Linking the caste systems of America, India, and Nazi Germany, Wilkerson explores eight pillars that underlie caste systems across civilizations, including divine will, bloodlines, stigma, and more. Using riveting stories about people—including Martin Luther King, Jr., baseball’s Satchel Paige, a single father and his toddler son, Wilkerson herself, and many others—she shows the ways that the insidious undertow of caste is experienced every day. She documents how the Nazis studied the racial systems in America to plan their outcasting of the Jews; she discusses why the cruel logic of caste requires that there be a bottom rung for those in the middle to measure themselves against; she writes about the surprising health costs of caste, in depression and life expectancy, and the effects of this hierarchy on our culture and politics. Finally, she points forward to ways America can move beyond the artificial and destructive separations of human divisions, toward hope in our common humanity. Original and revealing, Caste: The Origins of Our Discontents is an eye-opening story of people and history, and a reexamination of what lies under the surface of ordinary lives and of American life today.
Contention has surrounded the status of minorities throughout Indonesian history. Two broad polarities are evident: one inclusive of minorities, regarding them as part of the nation’s rich complexity and a manifestation of its “Unity in Diversity” motto; the other exclusive, viewing with suspicion or disdain those communities or groups that differ from the perceived majority. State and community attitudes towards minorities have fluctuated over time. Some periods have been notable for the acceptance of minorities and protection of their rights, while others have been marked by anti-minority discrimination, marginalisation and sometimes violence. This book explores the complex historical and contemporary dimensions of Indonesia’s religious, ethnic, LGBT and disability minorities from a range of perspectives, including historical, legal, political, cultural, discursive and social. It addresses fundamental questions about Indonesia’s tolerance and acceptance of difference, and examines the extent to which diversity is embraced or suppressed.