Communities in Action

Communities in Action
Author: National Academies of Sciences, Engineering, and Medicine
Publisher: National Academies Press
Total Pages: 583
Release: 2017-04-27
Genre: Medical
ISBN: 0309452961

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.

Unequal Treatment

Unequal Treatment
Author: Institute of Medicine
Publisher: National Academies Press
Total Pages: 781
Release: 2009-02-06
Genre: Medical
ISBN: 030908265X

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.

Understanding Racial and Ethnic Differences in Health in Late Life

Understanding Racial and Ethnic Differences in Health in Late Life
Author: National Research Council
Publisher: National Academies Press
Total Pages: 184
Release: 2004-09-08
Genre: Social Science
ISBN: 0309165865

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.

Urban Injustice

Urban Injustice
Author: David Hilfiker
Publisher: Seven Stories Press
Total Pages: 141
Release: 2011-01-04
Genre: Social Science
ISBN: 1609800346

David Hilfiker has committed his life, both as a writer and a doctor, to people in need, writing about the urban poor with whom he’s spent all his days for the last two decades. In Urban Injustice, he explains in beautiful and simple language how the myth that the urban poor siphon off precious government resources is contradicted by the facts, and how most programs help some of the people some of the time but are almost never sufficiently orchestrated to enable people to escape the cycle of urban poverty. Hilfiker is able to present a surprising history of poverty programs since the New Deal, and shows that many of the biggest programs were extremely successful at attaining the goals set out for them. Even so, Hilfiker reveals, most of the best and biggest programs were "social insurance" programs, like Medicare and Social Security, that primarily assisted the middle class, not the poor. Whereas, "public assistance" programs, directed specifically towards the poor, were often extremely effective as far as they went, but were instituted with far less ambitious goals. In a book that is short, sweet, and completely without academic verboseness or pretension, Hilfiker makes a clear path through the complex history of societal poverty, the obvious weaknesses and surprising strengths of societal responses to poverty thus far, and offers an analysis of models of assistance from around the world that might perhaps assist us in making a better world for our children once we decide that is what we must do.

Urban Inequality

Urban Inequality
Author: Alice O'Connor
Publisher: Russell Sage Foundation
Total Pages: 564
Release: 2001-03-08
Genre: Social Science
ISBN: 1610444310

Despite today's booming economy, secure work and upward mobility remain out of reach for many central-city residents. Urban Inequality presents an authoritative new look at the racial and economic divisions that continue to beset our nation's cities. Drawing upon a landmark survey of employers and households in four U.S. metropolises, Atlanta, Boston, Detroit, and Los Angeles, the study links both sides of the labor market, inquiring into the job requirements and hiring procedures of employers, as well as the skills, housing situation, and job search strategies of workers. Using this wealth of evidence, the authors discuss the merits of rival explanations of urban inequality. Do racial minorities lack the skills and education demanded by employers in today's global economy? Have the jobs best matched to the skills of inner-city workers moved to outlying suburbs? Or is inequality the result of racial discrimination in hiring, pay, and housing? Each of these explanations may provide part of the story, and the authors shed new light on the links between labor market disadvantage, residential segregation, and exclusionary racial attitudes. In each of the four cities, old industries have declined and new commercial centers have sprung up outside the traditional city limits, while new immigrant groups have entered all levels of the labor market. Despite these transformations, longstanding hostilities and lines of segregation between racial and ethnic communities are still apparent in each city. This book reveals how the disadvantaged position of many minority workers is compounded by racial antipathies and stereotypes that count against them in their search for housing and jobs. Until now, there has been little agreement on the sources of urban disadvantage and no convincing way of adjudicating between rival theories. Urban Inequality aims to advance our understanding of the causes of urban inequality as a first step toward ensuring that the nation's cities can prosper in the future without leaving their minority residents further behind. A Volume in the Multi-City Study of Urban Inequality

Race and the Politics of Welfare Reform

Race and the Politics of Welfare Reform
Author: Sanford F. Schram
Publisher: University of Michigan Press
Total Pages: 391
Release: 2010-03-10
Genre: Political Science
ISBN: 0472025511

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.

Social Epidemiology

Social Epidemiology
Author: Lisa F. Berkman
Publisher: Oxford University Press
Total Pages: 428
Release: 2000-03-09
Genre: Language Arts & Disciplines
ISBN: 9780195083316

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.