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PubMed2001

Race, ethnicity and preventive services: no gains for Hispanics.

Three years ago, the Clinton administration initiated multiple efforts to identify and eliminate health disparities among various populations, including ethnic minority groups. Recent findings from the Community Tracking Study Household Survey show that between 1997 and 1999 there was an increase in the percentage of white and African American persons receiving preventive care-such as mammography screening among women and physicians counseling cigarette smokers to quit-but that there was no such increase in preventive measures for Hispanics. If policy makers want to remove disparities in health status based on race and ethnicity, they need to promote preventive care for minorities and monitor progress by regularly measuring preventive care indicators. This Issue Brief focuses on change in key preventive care indicators between 1997 and 1999.

Black or African American↗
PubMed2001

HIV services for a new generation.

Expanded treatment capabilities, supportive services, and education are available to control the AIDS epidemic as it spreads among new, harder-to-reach populations. Unfortunately, disparities in health status among these groups often prevent them from getting preventive care and treatment. To build awareness among today's at-risk population, health care marketers must address the needs of their target audience. With a well-planned and sensitive approach, they can work with practitioners to bring these services to the people who need them most.

Adolescent↗
PubMed2002

Health and peace.

Health and peace are closely linked. One cannot have one without the other. Although health and peace are desirable conditions, we human beings often thwart our best intentions to achieve and maintain them. War has profound impacts on human health. In addition to direct consequences, including the fact that 90% of all deaths related to recent wars were among civilians, war has several indirect consequences, including long-term physical and psychological adverse health effects, damage to the social fabric and infrastructure of society, displacement of people, damage to the environment, drainage of human, financial, and other resources away from public health and other socially productive activities, and fostering of a culture of violence. Many public health issues can be both a consequence and a cause of war, including infectious diseases, mental health disorders, vulnerability of population groups, disparities in health status within and among countries, and weakening of human rights. We, health professionals, can promote peace in many ways and facilitate this work by demonstrating our values, vision, and leadership.

Croatia↗
PubMed2002

Contributing to Balkan public health: a school for Skopje.

The absence of social well-being and growing vulnerability are alarming for a large portion of people living in the Balkan countries. The Stability Pact is currently targeting the issue of social cohesion, which holds out promise for as yet unrealized development. Both the World Health Organization and the Council of Europe have called attention to the population vulnerability and growing disparity in health status between that region and Europe. Reversal of present trends demands the support of the international community and the strengthening of all public health institutions, human resource training, and population health research. Given the severity of the problem space of population vulnerability, these actions are more than ever indispensable to the health sector of the region. The paper describes an encouraging dialogue for Balkan health conducted by the National School of Public Health in Athens, Greece over the past decade and emphasizes the work of the newly created Public Health in South Eastern Europe (PH-SEE) Network (www.snz.hr/ph-see), which provides new opportunities for engagement in regional public health through Public Health Schools and Institutes. There is a need for public health curricula development and a closer linkage of all Schools with the Association of Schools of Public Health in the European Region. A curriculum for peace and public health is already under development in institutions in Athens, Greece; Mostar, Bosnia and Herzegovina; and Zagreb, Croatia. Soon to be added to the group of regional institutions is the School of Public Health in Skopje. It is a policy response to considerable need in a country showing pre-conflict conditions in the heart of the South Eastern Europe. Within the general framework of public health development, a School of Public Health in Skopje can be of great national benefit. Suggestions are made for its function under an umbrella of interdisciplinarity and autonomy, and the need to steer a path clear of medical dominance. According to a related mission statement, the School is to be implemented as an academic center of excellence and innovation, with the worthy purpose of improving the health of the population, with particular attention to the disadvantaged, underserved, and vulnerable. It can aid policy enactment, capacity building, and vulnerability research, promote the development of new training curricula for human rights and public health, and contribute to regional public health. The implementation of the School has a symbolism attached to it as a Balkan response for the elimination of the causes for political violence.

Education, Professional↗
PubMed2003

Ethnicity/race, ethics, and epidemiology.

Ethnicity/race is a much-studied variable in epidemiology. There has been little consensus about what self-reported ethnicity/race represents, but it is a measure of some combination of genetic, socioeconomic, and cultural factors. The present article will attempt to: 1.) Elucidate the limitations of contemporary discourse on ethnicity/race that emphasizes the genetic and socioeconomic dimensions as competing explanatory frameworks; 2.) Demonstrate how considerable attention to the cultural dimension facilitates understanding of race differences in health-related outcomes; and 3.) Discuss interpretations of disparities in health status of African Americans versus European Americans from an ethical perspective. A major challenge to the discourse on ethnicity/race and health being limited to socioeconomic and genetic considerations is the lack of attention to the third alternative of a cultural perspective. The combined cultural ideologies of individualism and racism undermine the utility of epidemiologic research in health promotion and disease prevention campaigns aimed at reducing the racial gaps in health status. An ethical analysis supplements the cultural perspective. Ethics converge with culture on the notion of values influencing the study of ethnicity/race in epidemiology. A cultural approach to the use of ethnicity/race in epidemiologic research addresses methodological limitations, public health traditions, and ethical imperatives.

Attitude to Health↗
PubMed2003

A history of child health equity legislation in the United States.

The mission of the Maternal and Child Health Bureau (MCHB) is comprehensive in scope and establishes the capacity, structure, and function for the MCHB to continually improve the health and well-being of pregnant women and children. The MCHB works in partnership with states and has broad authority to improve access to care and ensure the provision of quality preventive and primary care services. Specific provisions of legislation establish the framework for accomplishing this mission. With the increasing recognition of the social, economic, and environmental determinants of child health and the inequities that exist in access and quality of care for children, the Maternal and Child Health Bureau (MCHB) has set the following 3 goals for year 2003: 1) To eliminate disparities in health status outcomes through the removal of economic, social, and cultural barriers to receiving comprehensive, timely, and appropriate health care; 2) To ensure the highest quality of care through the development of practice guidance and data monitoring and evaluation tools; the use of evidence-based research; and the availability of a well-trained, culturally diverse workforce; and 3) To facilitate access to care through the development and improvement of the maternal and child health infrastructure and systems of care to enhance the provision of necessary, coordinated, quality health care. Priority MCHB strategies to accomplish these goals include improving and expanding 1) the cultural competence of providers (in particular to decrease sudden infant death syndrome [SIDS] among minorities), 2) emergency medical services for children, 3) health and safety in child care, 4) quality of primary pediatric care, and 5) the providing of every child with a medical home.

Child↗
PubMed2006

Hypertension prevalence awareness, treatment and control in North Nashville.

North Nashville is a largely African-American community known to suffer from increased cardiovascular mortality compared with whites in the same area of Davidson County. The burden of hypertension, a well-known risk factor for cardiovascular death, has not been fully described for this population. To quantify the prevalence, awareness, treatment and control of hypertension in the North Nashville community, we screened 132 patients aged 18 and older at the 2005 Juneteenth festival on Jefferson Street. We compared our results to data for African-Americans from the most recent NHANES survey. Compared to the national survey, our study population had a higher prevalence of hypertension (52.3 percent versus 33.5 percent) and lower awareness (68.1 percent versus 73.9 percent), treatment (46.4 percent versus 63.0 percent) and control of hypertension (13.0 percent versus 28.1 percent) despite comparable age. This study adds to a growing literature on the racial and geographic disparities in health status in the Unites States and cautions that data from national surveys may not be representative of individual communities.

Adult↗
PubMedDate not supplied

The need for black specialists in preventive medicine.

The disparity in health status between black and white Americans exists chiefly because of an excess of preventable disease in blacks. This situation calls for an increase in preventive services for blacks, services which might best be implemented or directed by black specialists in preventive medicine. However, there exists both an absolute shortage of preventive medicine specialists (of all races) and a relative shortage of black preventive medicine specialists. The immediate need for additional black specialists exceeds the total U.S. preventive medicine residency corps.

Black or African American↗
PubMed1989

Comparisons of black and white smoking-attributable mortality, morbidity, and economic costs in the District of Columbia.

Cigarette smoking is generally considered to be the most important preventable cause of death in the United States. To determine the public health impact of smoking in the District of Columbia, the DC Commission of Public Health calculated smoking-attributable mortality, morbidity, and economic costs in this predominantly black population. In 1985, an estimated 933 district residents died from smoking-related diseases, resulting in 3535 years of potential life lost. Cigarette smoking contributed to approximately 13.5% of all District deaths in 1985 (N = 6921) and accounted for 30% of all deaths of persons over age 20, far exceeding the affect of other potentially preventable causes of mortality. Black residents, especially black men, shared a disproportionately greater burden of smoking-attributable mortality when compared with white residents. These smoking-attributable deaths resulted in over $110 million in direct medical and indirect morbidity and mortality costs to District of Columbia residents. The results indicate that cigarette smoking is a major contributing cause of the black-white disparity in health status in the District of Columbia.

Black or African American↗
PubMedDate not supplied

Why we should continue to study race...but do a better job: an essay on race, racism and health.

For at least a century, American medical and public health researchers have used race as a marker for biology, and have documented race-associated differences in health and illness behavior. The research has often been inappropriate and has led to abuses and erroneous conclusions about the role played by race in the production of disparities in health status. Consequently, some researchers have begun to advocate the abolition of medical and public health research using race. In this essay, I argue that, although the arguments against continuing to study race have some merit, more rather than fewer studies of race are needed. Researchers should be more careful in the use of race and more conscious of the limitations of the race concept.

Culture↗
PubMedDate not supplied

National Black Nurses Association community collaboration model.

In 1991, the National Black Nurses Association was awarded a contract from the Division of Nursing, United States Department of Health and Human Services to develop a community education program addressing eight Healthy People 2000 objectives. Healthy People 2000 is the United States Public Health Services's statement of national priorities for improving the health of all Americans. It provides a framework to reduce preventable deaths and disabilities, and equalize disparities in health status for specific populations. The NBNA Board of Directors chose to address five priority areas: infant mortality, HIV/AIDS, cardiovascular disease, cancer, and recruitment and retention of Blacks in nursing. For each area, specific nursing responsibilities were identified: health promotion, health protection, disease prevention, preventive clinical services, and surveillance and data requirements. The authors developed a model for implementation of the NBNA's Healthy America Report recommendations. The model and data from program implementation are presented with commentary on the efficacy of community partnership models to achieve preventive health goals.

Black or African American↗
PubMed2005

Both clinical epidemiology and population health perspectives can define the role of health care in reducing health disparities.

OBJECTIVE: To compare and contrast clinical epidemiology and population health perspectives on the role of health care in reducing socioeconomic disparities in health. STUDY DESIGN AND SETTING: A review of concepts outlined in selected articles on population health and clinical epidemiology and a systematic literature search for randomized controlled trials (RCTs) of therapeutic interventions for cardiovascular disease that contained analysis of outcomes by socioeconomic status. RESULTS: Population health has a focus on health disparities, particularly disparities related to socioeconomic status, and many of its proponents have a pessimistic view of the degree to which health care can reduce these disparities. Clinical epidemiology has a focus on the production of valid evidence on the impact of health care interventions; however, RCTs rarely report the impact of interventions across socioeconomic strata. Both population health and clinical epidemiology share the view that efficacy, effectiveness, and cost-effectiveness are all important in defining the impact of health care on health disparities. CONCLUSION: Principles drawn from both population health and clinical epidemiology could be used to provide a clearer picture of the role that health care interventions can have on socioeconomic disparities in health and to identify implications for policy, research, and clinical practice.

Epidemiologic Methods↗
PubMedDate not supplied

Cardiovascular health among African-Americans: a review of the health status, risk reduction, and intervention strategies.

BACKGROUND: This article reviews the literature of African-American risk and identifies the disparity in cardiovascular health status, particularly hypertension, hypercholesterolemia, and cigarette smoking, and mortality rates between African-Americans and whites. METHODS: Data on African-Americans' knowledge and attitudes toward preventing hypertension and heart disease are summarized and compared to that of whites. RESULTS: Program implementation details such as communication channels, activities, and health outcomes in cardiovascular risk reduction programs in African-American communities are summarized. DISCUSSION: Promising approaches to program planning and implementation for cardiovascular risk reduction among African-Americans are recommended.

Adult↗
PubMed2005

Disparities in indigenous health: a cross-country comparison between New Zealand and the United States.

OBJECTIVES: We compared the health statuses of the indigenous populations of New Zealand and the United States with those of the numerically dominant populations of these countries. METHODS: Health indicators compared included health outcome measures, preventive care measures, modifiable risk factor prevalence, and treatment measures. RESULTS: In the case of nearly every health status indicator assessed, disparities (both absolute and relative) were more pronounced for Maoris than for American Indians/Alaska Natives. Both indigenous populations suffered from disparities across a range of health indicators. However, no disparities were observed for American Indians/Alaska Natives in regard to immunization coverage. CONCLUSIONS: Ethnic health disparities appear to be more pronounced in New Zealand than in the United States. These disparities are not necessarily intractable. Although differences in national health sector responses exist, New Zealand may be well placed in the future to evaluate the effectiveness of new strategies to reduce these disparities given the extent and quality of Maori-specific health information available.

Adult↗
PubMed1990

An evolving agenda for the AAMC's second century.

The author presents a discussion of current problems in health care delivery and considers potential solutions. He notes that in the United States there is a wide disparity in health care status between the white population and the poor and minority communities, and that this disparity exists in virtually every health care category. Inadequate access to health care services, perpetuated by the high cost of health care, is part of the problem. The author analyzes many legislative and administrative steps that have been taken to address these issues, and many more that should be carefully examined. More emphasis on health promotion and disease prevention is vital. Another solution is to further enhance the biomedical research enterprise and work to prepare the regulatory system to quickly, safely, and effectively infuse this knowledge into the health care delivery system. Another solution is for physicians to be adequately prepared for this practice of medicine in the years to come.

Delivery of Health Care↗
PubMed2003

Disparities in adolescent health and health care: does socioeconomic status matter?

DATA COLLECTION/EXTRACTION METHODS: National household survey. DATA SOURCES/STUDY SETTING: We analyzed data on 12,434 adolescents (10 through 18 years old) included in the 1999 and 2000 editions of the National Health Interview Survey. STUDY DESIGN: We assessed the presence of income gradients using four income groups. Outcome variables included health status, health insurance coverage, access to and satisfaction with care, utilization, and unmet health needs. PRINCIPAL FINDINGS: After adjustment for confounding variables using multivariate analysis, statistically significant disparities were found between poor adolescents and their counterparts in middle- and higher-income families for three of four health status measures, six of eight measures of access to and satisfaction with care, and for six of nine indicators of access to and use of medical care, dental care, and mental health care. CONCLUSION: Our analyses indicate adolescents in low-income families remain at a disadvantage despite expansions of the Medicaid program and the comparatively new State Children's Health Insurance Program (SCHIP). Additional efforts are needed to ensure eligible adolescents are enrolled in these programs. Nonfinancial barriers to care must also be addressed to reduce inequities.

Adolescent↗
PubMed1998

Health care needs of medically underserved women of color: The role of the Bureau of Primary Health Care.

The Bureau of Primary Health Care (BPHC) was developed to increase access to comprehensive primary and preventive health care and to improve the health status of medically underserved populations. Approximately 43 million Americans fall into this category, and the majority are poor, female, young, and uninsured. Under the Public Health Services Act, BPHC does not provide direct services, but rather assist local communities in identifying populations at risk of poor health outcomes and helps these communities through various programs. One of the newest initiatives of BPHC is the Office of Minority and Women's Health, developed with a mission to help reduce the disparities in the health status of women of racial and ethnic minority populations. This article outlines these disparities and discusses proposals for reducing them.

Ethnicity↗