Communities in Action


Book Description

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.




Racial and Ethnic Differences in the Health of Older Americans


Book Description

Older Americans, even the oldest, can now expect to live years longer than those who reached the same ages even a few decades ago. Although survival has improved for all racial and ethnic groups, strong differences persist, both in life expectancy and in the causes of disability and death at older ages. This book examines trends in mortality rates and selected causes of disability (cardiovascular disease, dementia) for older people of different racial and ethnic groups. The determinants of these trends and differences are also investigated, including differences in access to health care and experiences in early life, diet, health behaviors, genetic background, social class, wealth and income. Groups often neglected in analyses of national data, such as the elderly Hispanic and Asian Americans of different origin and immigrant generations, are compared. The volume provides understanding of research bearing on the health status and survival of the fastest-growing segment of the American population.




Critical Perspectives on Racial and Ethnic Differences in Health in Late Life


Book Description

In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.




Education Gradients in Mortality Trends by Gender and Race


Book Description

We examine gender and race differences in education-mortality trends among 25-64 year olds in the United States from 2001-2018. The data indicate that the relationships are heterogeneous with larger mortality reductions for less educated non-Hispanic blacks than other races and mixed results at higher levels of schooling. We also investigate the causes of death associated with changes in overall mortality rates and identify key differences across race groups and education quartiles. Drug overdoses represent the single most important contributor to increased death rates for all groups, but the sizes of these effects vary sharply. Cardiovascular disease, cancer, and HIV are the most significant sources of mortality rate reductions, with the patterns again heterogeneous across sex, race, and educational attainment. These results suggest the limitations of focusing on all-cause mortality rates when attempting to determine the sources of positive and negative health shocks affecting population subgroups. Examining specific causes of death can provide a more nuanced understanding of these trends.




Education Gradients in Mortality Trends by Gender and Race


Book Description

We examine gender and race differences in education-mortality trends among 25-64 year olds in the United States from 2001-2018. The data indicate that the relationships are heterogeneous with larger mortality reductions for less educated non-Hispanic blacks than other races and mixed results at higher levels of schooling. We also investigate the causes of death associated with changes in overall mortality rates and identify key differences across race groups and education quartiles. Drug overdoses represent the single most important contributor to increased death rates for all groups, but the sizes of these effects vary sharply. Cardiovascular disease, cancer, and HIV are the most significant sources of mortality rate reductions, with the patterns again heterogeneous across sex, race, and educational attainment. These results suggest the limitations of focusing on all-cause mortality rates when attempting to determine the sources of positive and negative health shocks affecting population subgroups. Examining specific causes of death can provide a more nuanced understanding of these trends.













Death, Gender and Ethnicity


Book Description

Death, Gender and Ethnicity examines the ways in which gender and ethnicity shape the experiences of dying and bereavement, taking as its focus the diversity of ways through which the universal event of death is encountered. It brings together accounts of how these experiences are actually managed with analyses of a range of representations of dying and grieving in order to provide a more theoretical approach to the relationship between death, gender and ethnicity. Though death and dying have been an increasingly important focus for academics and clinicians over the last thirty years, much of this work provides little insight into the impact of gender and ethnicity on the experience. The result is often a universalising representation which fails to take account of the personally unique and culturally specific experiences associated with a death. Drawing on a range of detailed case studies, Death, Gender and Ethnicity develops a more sensitive theoretical approach which will be invaluable reading for students and practitioners in health studies, sociology, social work and medical anthropology.




Unequal Treatment


Book Description

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.