Disparities

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.

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.

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.

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.

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.

At the turn of the 21st century, several important reports and events designed to raise awareness of health disparities and to describe initial efforts to reduce health disparities took place. The Surgeon General's office released several reports that showed dramatic disparities in tobacco use and access to mental health services by race and ethnicity. The first real legislation focused on reducing health disparities was signed into law, creating the National Center for Minority Health and Health Disparities within the NIH. In 2001, the IOM released its landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, highlighting the importance of a focus on health care quality rather than a focus on only access and cost issues. Building upon these reports and events, the IOM held a workshop on April 8, 2010, that discussed progress to address health disparities and focused on the success of various federal initiatives to reduce health disparities. How Far Have We Come in Reducing Health Disparities? summarizes the workshop and explains the progress in the field since 2000.

Inequality is one of the major problems of the contemporary world. Significant geographical disparities exist within nations of the developed world, as well as between these countries and those referred to as the ‘South’ in the Bruntland Report. Issues of equity and deprivation must be addressed in view of sustainable development. However, before policymakers can remove the obstacles to a fairer world, it is essential to understand the nature of inequality, both in terms of its spatial and socio-demographic characteristics. This second volume in the series contains population studies that examine the disparities evident across geographical space in the UK and between different individuals or groups. Topics include demographic and social change, deprivation, happiness, cultural consumption, ethnicity, gender, employment, health, religion, education and social values. These topics and the relationships between them are explored using secondary data from censuses, surveys or administrative records. In volume 1 the findings of research on fertility, living arrangements, care and mobility are examined. Volume 3 will focus on ethnicity and integration.

Eliminating Race-Based Mental Health Disparities offers concrete guidelines and evidence-based best practices for addressing racial inequities and biases in clinical care. Perhaps there is no subject more challenging than the intricacies of race and racism in American culture. More and more, it has become clear that simply teaching facts about cultural differences between racial and ethnic groups is not adequate to achieve cultural competence in clinical care. One must also consider less “visible” constructs—including implicit bias, stereotypes, white privilege, intersectionality, and microaggressions—as potent drivers of behaviors and attitudes. In this edited volume, three leading experts in race, mental health, and contextual behavior science explore the urgent problem of racial inequities and biases, which often prevent people of color from seeking mental health services—leading to poor outcomes if and when they do receive treatment. In this much-needed resource, you’ll find evidence-based recommendations for addressing problems at multiple levels, and best practices for compassionately and effectively helping clients across a range of cultural groups and settings. As more and more people gain access to services that have historically been unavailable to them, guidelines for cultural competence in clinical care are needed. Eliminating Race-Based Mental Health Disparities offers a comprehensive road map to help you address racial health disparities and improve treatment outcomes in your practice.