Health disparities, health care inequality, and policy - Research Guide

Contributions by Richard D. deShazo, John Dittmer, Keydron K. Guinn, Lucius M. Lampton, Wilson F. Minor, Rosemary Moak, Sara B. Parker, Wayne J. Riley, Leigh Baldwin Skipworth, Robert Smith, and William F. Winter The Racial Divide in American Medicine documents the struggle for equity in health and health care by African Americans in Mississippi and the United States and the connections between what happened there and the national search for social justice in health care. Dr. Richard D. deShazo and the contributors to the volume trace the dark journey from a system of slave hospitals in the state, through Reconstruction, Jim Crow, and the civil rights era, to the present day. They substantiate that current health disparities are directly linked to America's history of separation, neglect, struggle, and disparities. Contributors reveal details of individual physicians' journeys for recognition both as African Americans and as professionals in Mississippi. Despite discrimination by their white colleagues and threats of violence, a small but fearless group of African American physicians fought for desegregation of American medicine and society. For example, T. R. M. Howard, MD, in the all-black city of Mound Bayou led a private investigation of the Emmett Till murder that helped trigger the civil rights movement. Later, other black physicians risked their lives and practices to provide care for white civil rights workers during the civil rights movement. Dr. deShazo has assembled an accurate account of the lives and experiences of black physicians in Mississippi, one that gives full credit to the actions of these pioneers. Dr. deShazo's introduction and the essays address ongoing isolation and distrust among black and white colleagues. This book will stimulate dialogue, apology, and reconciliation, with the ultimate goal of improving disparities in health and health care and addressing long-standing injustices in our country.

This book shows how living in a highly racialized society affects health through multiple social contexts, including neighborhoods, personal and family relationships, and the medical system. Black-white disparities in health, illness, and mortality have been widely documented, but most research has focused on single factors that produce and perpetuate those disparities, such as individual health behaviors and access to medical care. This is the first book to offer a comprehensive perspective on health and sickness among African Americans, starting with an examination of how race has been historically constructed in the US and in the medical system and the resilience of racial ideologies and practices. Racial disparities in health reflect racial inequalities in living conditions, incarceration rates, family systems, and opportunities. These racial disparities often cut across social class boundaries and have gender-specific consequences. Bringing together data from existing quantitative and qualitative research with new archival and interview data, this book advances research in the fields of families, race-ethnicity, and medical sociology.

A guide to a holistic approach to healthcare measurement aimed at improving access and outcomes Healthcare System Access is an important resource that bridges two areas of research--access modeling and healthcare system engineering. The book's mathematical modeling approach highlights fundamental approaches on measurement of and inference on healthcare access. This mathematical modeling facilitates translating data into knowledge in order to make data-driven estimates and projections about parameters, patterns, and trends in the system. The complementary engineering approach uses estimates and projections about the system to better inform efforts to design systems that will yield better outcomes. The author--a noted expert on the topic--offers an in-depth exploration of the concepts of systematic disparities, reviews measures for systematic disparities, and presents a statistical framework for making inference on disparities with application to disparities in access. The book also includes information health outcomes in the context of prevention and chronic disease management. In addition, this text: Integrates data and knowledge from various fields to provide a framework for decision making in transforming access to healthcare Provides in-depth material including illustrations of how to use state-of-art methodology, large data sources, and research from various fields Includes end-of-chapter case studies for applying concepts to real-world conditions Written for health systems engineers, Healthcare System Access: Measurement, Inference, and Intervention puts the focus on approaches to measure healthcare access and addresses important enablers of such change in healthcare towards improving access and outcomes.

A physician reveals how right-wing backlash policies have mortal consequences -- even for the white voters they promise to help Named one of the most anticipated books of 2019 by Esquire and the Boston Globe In the era of Donald Trump, many lower- and middle-class white Americans are drawn to politicians who pledge to make their lives great again. But as Dying of Whiteness shows, the policies that result actually place white Americans at ever-greater risk of sickness and death. Physician Jonathan M. Metzl's quest to understand the health implications of "backlash governance" leads him across America's heartland. Interviewing a range of everyday Americans, he examines how racial resentment has fueled progun laws in Missouri, resistance to the Affordable Care Act in Tennessee, and cuts to schools and social services in Kansas. And he shows these policies' costs: increasing deaths by gun suicide, falling life expectancies, and rising dropout rates. White Americans, Metzl argues, must reject the racial hierarchies that promise to aid them but in fact lead our nation to demise.

The first sustained social and political inquiry of metabolic syndrome, this provocative and timely book is a crucial contribution to the emerging literature on race and medicine. It will engage those who seek to understand how unjust power relations shape population health inequalities and the production of medical knowledge and biotechnologies.

In less than four months, beginning with a staff of five, an obscure office buried deep within the federal bureaucracy transformed the nation's hospitals from our most racially and economically segregated institutions into our most integrated. These powerful private institutions, which had for a half century selectively served people on the basis of race and wealth, began equally caring for all on the basis of need. The book draws the reader into the struggles of the unsung heroes of the transformation, black medical leaders whose stubborn courage helped shape the larger civil rights movement. They demanded an end to federal subsidization of discrimination in the form of Medicare payments to hospitals that embraced the "separate but equal" creed that shaped American life during the Jim Crow era. Faced with this pressure, the Kennedy and Johnson Administrations tried to play a cautious chess game, but that game led to perhaps the biggest gamble in the history of domestic policy. Leaders secretly recruited volunteer federal employees to serve as inspectors, and an invisible army of hospital workers and civil rights activists to work as agents, making it impossible for hospitals to get Medicare dollars with mere paper compliance. These triumphs did not come without casualties, yet the story offers lessons and hope for realizing this transformational dream. This book is the recipient of the Norman L. and Roselea J. Goldberg Prize from Vanderbilt University Press for the best book in the area of medicine.

A troubling study of the role that medical racism plays in the lives of black women who have given birth to premature and low birth weight infants Black women have higher rates of premature birth than other women in America. This cannot be simply explained by economic factors, with poorer women lacking resources or access to care. Even professional, middle-class black women are at a much higher risk of premature birth than low-income white women in the United States. Dána-Ain Davis looks into this phenomenon, placing racial differences in birth outcomes into a historical context, revealing that ideas about reproduction and race today have been influenced by the legacy of ideas which developed during the era of slavery. While poor and low-income black women are often the "mascots" of premature birth outcomes, this book focuses on professional black women, who are just as likely to give birth prematurely. Drawing on an impressive array of interviews with nearly fifty mothers, fathers, neonatologists, nurses, midwives, and reproductive justice advocates, Dána-Ain Davis argues that events leading up to an infant's arrival in a neonatal intensive care unit (NICU), and the parents' experiences while they are in the NICU, reveal subtle but pernicious forms of racism that confound the perceived class dynamics that are frequently understood to be a central factor of premature birth. The book argues not only that medical racism persists and must be considered when examining adverse outcomes--as well as upsetting experiences for parents--but also that NICUs and life-saving technologies should not be the only strategies for improving the outcomes for black pregnant women and their babies. Davis makes the case for other avenues, such as community-based birthing projects, doulas, and midwives, that support women during pregnancy and labor are just as important and effective in avoiding premature births and mortality.

Millions of low-income African Americans in the United States lack access to health care. How do they treat their health care problems? In Health Care Off the Books, Danielle T. Raudenbush provides an answer that challenges public perceptions and prior scholarly work. Informed by three and a half years of fieldwork in a public housing development, Raudenbush shows how residents who face obstacles to health care gain access to pharmaceutical drugs, medical equipment, physician reference manuals, and insurance cards by mobilizing social networks that include not only their neighbors but also local physicians. However, membership in these social networks is not universal, and some residents are forced to turn to a robust street market to obtain medicine. For others, health problems simply go untreated. Raudenbush reconceptualizes U.S. health care as a formal-informal hybrid system and explains why many residents who do have access to health services also turn to informal strategies to treat their health problems. While the practices described in the book may at times be beneficial to people's health, they also have the potential to do serious harm. By understanding this hybrid system, we can evaluate its effects and gain new insight into the sources of social and racial disparities in health outcomes.  

"Over 84,000 black and brown lives are needlessly lost each year due to health disparities, the unfair, unjust, and avoidable differences between the quality and quantity of health care provided to Americans who are members of racial and ethnic minorities and care provided to whites. Health disparities have remained stubbornly entrenched in the American health care system--and in Just Medicine, Dayna Bowen Matthew finds that they principally arise from unconscious racial and ethnic biases held by physicians, institutional providers, and their patients. Implicit bias is the single most important determinant of health and health care disparities. Because we have missed this fact, the money we spend on training providers to become culturally competent, expanding wellness education programs and community health centers, and even expanding access to health insurance will have only a modest effect on reducing health disparities. We will continue to utterly fail in the effort to eradicate health disparities unless we enact strong, evidence-based legal remedies that accurately address implicit and unintentional forms of discrimination, to replace the weak, tepid, and largely irrelevant legal remedies currently available. Our continued failure to fashion an effective response that purges the effects of implicit bias from American health care, Matthew argues, is unjust and morally untenable.

This timely volume serves as a comprehensive and much-needed update to the literature on Latinx health. As both the United States and Latinx subgroups experience and anticipate demographic shifts, it is critical to examine the current epidemiology of Latinx health, as well as the factors influencing this population's health and well-being. Chapters in this book, written by highly respected experts, illuminate the diversity of the Latinx population and provide strategies to mitigate many of the challenges faced by them, including challenges related to migrating to new destinations. The book is designed to enrich dialogue around the multilevel determinants of Latinx health, and concludes with a call to action for both increased culturally congruent and sound Latinx-focused research and the mentorship of Latinx early-career investigators.

Racial and ethnic minority youth have less access to health care and experience health disparities that are linked to social determinants that impact their health and well-being. This book is a practical reference for clinicians caring for racially and ethnically diverse adolescents seeking to effectively identify and address the social structures and factors that influence their health and well-being to promote health equity. It provides an overview of key health equity, population health and cultural competency principles and highlights clinical, teaching, and research skills critical to promoting health equity. Clinically oriented chapters provide guidance on strength-based approaches and strategies that clinicians can integrate in their encounters with diverse youth and feature clinical vignettes, clinical pearls and reflection questions to promote the application of concepts to practice.

This book addresses the unique sociocultural and historical systems of oppression that have alienated African-American and other racial minority patients within the mental healthcare system. This text aims to build a novel didactic curriculum addressing racism, justice, and community mental health as these issues intersect clinical practice. Unlike any other resource, this guide moves beyond an exploration of the problem of racism and its detrimental effects, to a practical, solution-oriented discussion of how to understand and approach the mental health consequences with a lens and sensitivity for contemporary justice issues. After establishing the historical context of racism within organized medicine and psychiatry, the text boldly examines contemporary issues, including clinical biases in diagnosis and treatment, addiction and incarceration, and perspectives on providing psychotherapy to racial minorities. The text concludes with chapters covering training and medical education within this sphere, approaches to supporting patients coping with racism and discrimination, and strategies for changing institutional practices in mental healthcare.

This first-of-its-kind textbook marks a revolutionary effort to reform medical education nationally by providing a comprehensive, high-quality resource to serve as a foundation for lesbian, gay, bisexual, transgender, and queer (LGBTQ) health education across multiple disciplines. Addressing the decades-long unequal weight of medical education generally offered about the care of LGBTQ people, The Equal Curriculum was created to advance clinicians' competencies in optimizing the health of LGBTQ people. This textbook is designed to be integrated into health sciences curricula and offers pointed strategies to evaluate the integration of LGBTQ health topics.

This handbook examines the effects and influences on child and youth development of prejudice, discrimination, and inequity as well as other critical contexts, including implicit bias, explicit racism, post immigration processes, social policies, parenting and media influences. It traces the impact of bias and discrimination on children, from infancy through emerging adulthood with implications for later years. The handbook explores ways in which the expanding social, economic, and racial inequities in society are linked to increases in negative outcomes for children through exposure to adverse childhood experiences (ACEs). Chapters examine a range of ACEs - low income, separation/divorce, family substance abuse and mental illness, exposure to neighborhood and/or domestic violence, parental incarceration, immigration and displacement, and parent loss through death. Chapters also discuss discrimination and prejudice within the adverse experiences of African American, Asian American, European American, Latino, Native American, Arab American, and Sikh as well as LGBTQ youth and non-binary children. Additionally, the handbook elevates dynamic aspects of resilience, adjustment, and the daily triumphs of children and youth faced with issues related to prejudice and differential treatment.