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Race, Ethnicity and Health, Second Edition, is a new and critical selection of hallmark articles that address health disparities in America. It effectively documents the need for equal treatment and equal health status for minorities. Intended as a resource for faculty and students in public health as well as the social sciences, it will be also be valuable to public health administrators and frontline staff who serve diverse racial and ethnic populations. The book brings together the best peer reviewed research literature from the leading scholars and faculty in this growing field, providing a historical and political context for the study of health, race, and ethnicity, with key findings on disparities in access, use, and quality. This volume also examines the role of health care providers in health disparities and discusses the issue of matching patients and doctors by race. There has been considerable new research since the original manuscript's preparation in 2001 and publication in 2002, and reflecting this, more than half the book is new content. New chapters cover: reflections on demographic changes in the US based on the current census; metrics and nomenclature for disparities; theories of genetic basis for disparities; the built environment; residential segregation; environmental health; occupational health; health disparities in integrated communities; Latino health; Asian populations; stress and health; physician/patient relationships; hospital treatment of minorities; the slavery hypertension hypothesis; geographic disparities; and intervention design.
Thomas A. La Veist is associate professor of health policy and management and director of the Center for Health Disparities Studies, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland.
During the twentieth century there was a literal and figurative change in the "face of America." At the beginning of the century racial issues were essentially concerns with relations between black and white Americans. However, by the end of the century the relative sizes of American racial and ethnic groups had changed, and Latinos and Asian Americans made up a sizable proportion of the U.S. population. According to projections from the U.S. Census Bureau (summarized in Figure 1.1), this pattern is part of a long-term trend. During the twenty-first century U.S. racial and ethnic minorities are expected to constitute a steadily larger minority and eventually a majority of the U.S. population.
Another important trend that has unfolded during the twentieth century is the steadily improving health profile of Americans. As Figure 1.2 shows, early in the century the average white American lived fewer than fifty years. Life expectancy for African Americans was around thirty-five years. By the end of the century, life expectancy for all Americans exceeded sixty-five years, yet the disparities among racial and ethnic groups remained generally constant. As racial and ethnic minorities come to make up a larger percentage of the total population, the overall health statistics in the United Stateswill increasingly reflect the health status of those minorities. Consequently, it is becoming increasingly important to monitor the health status of racial and ethnic minorities, and finding ways to improve minority health has taken on heightened urgency.
There are substantial differences among the health profiles of U.S. racial and ethnic groups. Researchers have demonstrated this fact for centuries. Figure 1.3 shows mortality rates for U.S. racial and ethnic groups for the year 2000. African Americans have the worst health profile, and Asian Americans have the fewest health problems. Such disparities in health status are well documented and widely known. However, research on race, ethnicity, and health is controversial, probably owing in part to the thorny role that race has played in U.S. history and contemporary culture. Because of this history, race engenders emotion, and emotion is often the antidote to rational thought. Some have called for an end to research on race and health. Medical journal editors now discourage the use of the term race in submitted manuscripts. In fact, physical anthropologists no longer recognize race as a valid concept. Other disciplines have also begun to debate the viability of the concept of race.
The argument against continuing to conduct research on race and health goes like this:
Proposition 1. Race is not a valid biological concept, therefore
Proposition 2. Race is not a valid scientific concept, therefore
Proposition 3. Continuing to document racial differences in health bolsters pseudoscientific and even racist arguments about the existence of biological differences between what we call races and thus about the genetic inferiority of certain groups.
Although it is easy to be sympathetic to propositions one and three, it is at the second proposition that the reasoning goes astray. The problem is in using biology as the arbiter of what is scientific. As knowledge of human genomic makeup has unfolded, it has become increasingly clear that the widely held belief that there are biological differences between racial groups is incorrect. However, even though race may be a biological fiction, it is nevertheless-as the articles in this reader demonstrate-a profoundly important determinant of health status and health care quality.
THE PURPOSE OF THIS BOOK
So what is race, and why do racial disparities exist? These are the central questions this book is designed to address by bringing together a set of articles and chapters previously published in scientific journals and books. Together, these materials provide an overview of our current state of knowledge as we attempt to answer these questions.
The chapters in this book address race, ethnicity, and health only in the United States. I set this limitation because different cultures and countries respond differently to race and ethnicity. This being the case, I felt it best to address the broader international context in a separate volume. Moreover, this compilation is not intended to be merely a listing of the "best" articles in minority health. My goal has been to compile a set of articles with range and depth that will provide an overview and a strong foundation for those interested in learning about health disparities that reflect race and ethnicity.
An advisory committee and an editorial board, made up of experts in minority health, were kind enough to provide me with valuable feedback during the selection process. However, the final selections were my own, and any omissions should be attributed to my judgment (or misjudgment) alone.
ORGANIZATION OF THIS BOOK
Race, Ethnicity, and Health is divided into seven parts. The chapters in Part One provide a historical and political context for the study of research on race, ethnicity, and health. Nancy Krieger addresses the history of the ways in which race has been used as a political tool in health and public policy. Vanessa Gamble's classic article on the Tuskegee Syphilis Study details the long-term consequences of mistrust resulting from that experience. William Vega and Hortensia Amaro offer a profile of the health of the Latino population, noting once-ignored differences from other minority populations. Thomas LaVeist addresses political aspects of minority status and health, demonstrating the interrelationships among political power, racial segregation, poverty, and health.
In Part Two we move to discussions of the theoretical and conceptual underpinnings of race and ethnicity. These chapters address the questions, what is race, and how should it be used in health research? Richard Cooper looks at the social forces that give rise to racial differences; Thomas LaVeist describes the caution and skepticism required of researchers who employ race as a variable; Carles Mutaner, F. Javier Nieto, and Patricia O'Campo address the methodological, empirical, and ethical weaknesses of arguments for a biological basis for certain racial differences; and David Hayes-Bautista and Jorge Chapa offer a conceptual analysis of the terminology used in the United States for persons of Latin American origin.
The two chapters in Part Three, by Robert Mayberry, Fatima Mili, and Elizabeth Ofili and by Kevin Fiscella and colleagues, summarize findings on disparities in health care access, utilization, and quality. The chapters in Part Four then seek to explain why racial and ethnic variations in health status exist. These chapters address a variety of hypotheses, including Arline Geronimus's weathering hypothesis and Sherman James's John Henryism theory. Chapters by W. Parker Frisbie, Youngtae Cho, and Robert Hummer; Richard David and James Collins; Gopal Singh and Stella Yu; and Luisa Franzini, John Ribble, and Arlene Keddie examine the interrelationships among immigration, assimilation, and acculturation. A well-known paradox in the health literature is that although Latinos (especially Mexican Americans) have a generally worse health profile than white Americans, Mexican immigrants have better health than white and Mexican Americans. However, as their time in the United States extends, their health status begins to approximate that of Mexican Americans. As Singh and Yu demonstrate, similar findings exist for African and Asian immigrants.
Another possible explanation for health disparities is exposure to racism. The chapters by Camara Jones and by Rodney Clark et al. describe the theoretical basis for this hypothesis, and David Williams and Chiquita Collins and also Elizabeth Klonoff and Hope Landrine discuss empirical tests. The final chapters in Part Four explore the idea that disparities among the racial and ethnic groups are caused by differential exposure to health risks. Michelle Pearl, Paula Braveman, and Barbara Abrams and also Williams and Collins examine socioeconomic status. Kimberly Morland et al. demonstrate that food stores are less available in minority communities, and R. Sean Morrison et al. demonstrate that pharmacies in those communities are less likely to carry pain medication. Limited availability of products that sustain good health is typically accompanied by overavailability of products injurious to health, as discussed by Robert Bullard (solid waste sites), Thomas LaVeist and John Wallace (liquor stores), and Marsha Lillie-Blanton, James Anthony, and Charles Schuster (crack cocaine).
In Part Five we turn to the health care system and examine the role of health care providers in producing health disparities. Knox Todd and colleagues demonstrate that African American patients were less likely than white patients to receive pain medication when they came to a hospital emergency room. Schulman and colleagues show that African American women were less likely than white men to be referred for heart surgery. Betsy Sleath, Bonnie Svarstad, and Debra Roter discuss the racial differences they found in the prescribing of psychotropic medications. And Michelle van Ryn and Jane Burke explore physicians' attitudes toward African American and white patients.
Part Six of this reader presents two views of patient factors in health care disparities. Numerous studies have found (as, for example, Schulman et al. did) that there are racial differences in the receipt of heart surgery. Most of these studies have speculated that the difference is caused by patient preferences, that is, African American patients prefer not to have the procedure. Jeff Whittle et al. provide a good test of the patient preference hypothesis. Then Chamberlain Diala and colleagues study racial differences in patients' attitudes toward use of mental health services.
Finally, Part Seven presents three important discussions about provider-patient interaction. Lisa Cooper-Patrick et al. and Somnath Saha et al. test whether matching patients and doctors by race has a benefit in terms of patients' perception of their health care experience. And Jersey Chen and colleagues test whether matching patients and doctors by race has an effect on the racial disparity in the receipt of heart surgery.
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Introduction: The Ethnic Demographic Transition 1 Thomas A. LaVeist
Chapter 1 Defi ning Health and Health Care Disparities and Examining Disparities Across the Life Span 11 Lydia A. Isaac
PART 1 HISTORICAL AND POLITICAL CONSIDERATIONS
Chapter 2 The Color Line: Race Matters in the Elimination of Health Disparities 35 Stephen B. Thomas
Chapter 3 Health Care Disparities—Science, Politics, and Race 41 M. Gregg Bloche
PART 2 CONCEPTUALIZING RACE AND ETHNICITY
Chapter 4 Why Genes Don’t Count (for Racial Differences in Health) 49 Alan H. Goodman
Chapter 5 Using “Socially Assigned Race” to Probe White Advantages in Health Status 57 Camara Phyllis Jones, Benedict I. Truman, Laurie D. Elam-Evans, Camille A. Jones, Clara Y. Jones, Ruth Jiles, Susan F. Rumisha, Geraldine S. Perry
PART 3 EXPLAINING RACIAL AND ETHNIC DISPARITIES PSYCHOSOCIAL AND INDIVIDUAL-LEVEL DETERMINANTS 77
Chapter 6 Racism as a Stressor for African Americans: A Biopsychosocial Model 79 Rodney Clark, Norman B. Anderson, Vernessa R. Clark, David R. Williams
Chapter 7 A Systematic Review of Empirical Research on Self-Reported Racism and Health 105 Yin Paradies
Chapter 8 Stress, Coping, and Health Outcomes Among African-Americans: A Review of the John Henryism Hypothesis 139
Gary G. Bennett, Marcellus M. Merritt, John J. Sollers III, Christopher L. Edwards, Keith E. Whitfield, Dwayne T. Brandon, Reginald D. Tucker-Seeley
Chapter 9 Race and Unhealthy Behaviors: Chronic Stress, the HPA Axis, and Physical and Mental Health Disparities Over the Life Course 159 James S. Jackson, Katherine M. Knight, Jane A. Rafferty
Chapter 10 Epigenetics and the Embodiment of Race: Developmental Origins of U.S. Racial Disparities in Cardiovascular Health 175 Christopher W. Kuzawa, Elizabeth Sweet
THE EFFECTS OF CULTURE 213
Chapter 11 Acculturation and Latino Health in the United States: A Review of the Literature and Its Sociopolitical Context 215 Marielena Lara, Cristina Gamboa, M. Iya Kahramanian, Leo S. Morales, David E. Hayes Bautista
Chapter 12 Measuring Culture: A Critical Review of Acculturation and Health in Asian Immigrant Populations 253 Talya Salant, Diane S. Lauderdale
Chapter 13 Racial Influences Associated with Weight-Related Beliefs in African American and Caucasian Women 291 Christie Z. Malpede, Lori F. Greene, Stephanie L. Fitzpatrick, Wendy K. Jefferson, Richard M. Shewchuk, Monica L. Baskin, Jamy D. Ard
Chapter 14 Adverse Pregnancy Outcomes: Differences Between U.S.- and Foreign-Born Women in Major U.S. Racial and Ethnic Groups 303 Gopal K. Singh, Stella M. Yu
SOCIAL DETERMINANTS 321
Chapter 15 Levels of Racism: A Theoretic Framework and a Gardener’s Tale 323 Camara Phyllis Jones
Chapter 16 Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health 331 David R. Williams, Chiquita Collins
Chapter 17 Life Course Theories of Race Disparities: A Comparison of the Cumulative Dis/Advantage Theory Perspective and the Weathering Hypothesis 355 Roland J. Thorpe Jr., Jessica A. Kelley-Moore
Chapter 18 U.S. Socioeconomic and Racial Differences in Health: Patterns and Explanations 375 David R. Williams, Chiquita Collins
Chapter 19 Exploring Health Disparities in Integrated Communities 419 Thomas A. LaVeist
ENVIRONMENTAL DETERMINANTS 437
Chapter 20 Race/Ethnicity, the Social Environment, and Health 439 Marsha Lillie-Blanton, Thomas A. LaVeist
Chapter 21 Built Environments and Obesity in Disadvantaged Populations 455 Gina S. Lovasi, Malo A. Hutson, Monica Guerra, Kathryn M. Neckerman
Chapter 22 Health Risk and Inequitable Distribution of Liquor Stores in African American Neighborhoods 485
Thomas A. LaVeist, John M. Wallace Jr.
Chapter 23 Environmental Health Disparities: A Framework Integrating Psychosocial and Environmental Concepts 493 Gilbert C. Gee, Devon C. Payne-Sturges
Chapter 24 Sick and Tired of Being Sick and Tired: Scientific Evidence, Methods, and Research Implications for Racial and Ethnic Disparities in Occupational Health 523 Linda Rae Murray
PART 4 HEALTH SERVICES AND HEALTH SYSTEM EFFECTS PATIENTS 539
Chapter 25 Attitudes About Racism, Medical Mistrust, and Satisfaction with Care Among African American and White Cardiac Patients 541 Thomas A. LaVeist, Kim J. Nickerson, Janice V. Bowie
Chapter 26 The Legacy of Tuskegee and Trust in Medical Care: Is Tuskegee Responsible for Race Differences in Mistrust of Medical Care? 557 Dwayne T. Brandon, Lydia A. Isaac, Thomas A. LaVeist
Chapter 27 Patient Race/Ethnicity and Quality of Patient–Physician Communication During Medical Visits 569 Rachel L. Johnson, Debra Roter, Neil R. Powe, Lisa A. Cooper
Chapter 28 Implicit Bias Among Physicians and Its Prediction of Thrombolysis Decisions for Black and White Patients 589 Alexander R. Green, Dana R. Carney, Daniel J. Pallin, Long H. Ngo, Kristal L. Raymond, Lisa I. Iezzoni, Mahzarin R. Banaji
Chapter 29 The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients 607 Michelle van Ryn, Jane Burke
Chapter 30 Ethnicity and Analgesic Practice 637 Knox H. Todd, Christi Deaton, Anne P. D’Adamo, Leon Goe
Chapter 31 The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization 647
Kevin A. Schulman, Jesse A. Berlin, William Harless, Jon F. Kerner, Shyrl Sistrunk, Bernard J. Gersh, Ross Dubé, Christopher K. Taleghani, Jennifer E. Burke, Sankey Williams, John M. Eisenberg, José J. Escarce
Chapter 32 Advancing Health Disparities Research Within the Health Care System: A Conceptual Framework 667 Amy M. Kilbourne, Galen Switzer, Kelly Hyman, Megan Crowley-Matoka, Michael J. Fine
Chapter 33 Linking Cultural Competence Training to Improved Health Outcomes: Perspectives from the Field 689 Joseph R. Betancourt, Alexander R. Green
Chapter 34 “We Don’t Carry That”—Failure of Pharmacies in Predominantly Nonwhite Neighborhoods to Stock Opioid Analgesics 697 R. Sean Morrison, Sylvan Wallenstein, Dana K. Natale, Richard S. Senzel, Lo-Li Huang
Chapter 35 Do Hospitals Provide Lower-Quality Care to Minorities Than to Whites? 707 Darrell J. Gaskin, Christine S. Spencer, Patrick Richard, Gerard F. Anderson, Neil R. Powe, Thomas A. LaVeist
PART 5 HEALTH DISPARITIES SOLUTIONS
Chapter 36 Linking Science and Policy Through Community-Based Participatory Research to Study and Address Health Disparities 723 Meredith Minkler
Chapter 37 The National Health Plan Collaborative to Reduce Disparities and Improve Quality 741 Nicole Lurie, Allen Fremont, Stephen A. Somers, Kathryn Coltin, Andrea Gelzer, Rhonda Johnson, Wayne Rawlins, Grace Ting, Winston Wong, Donna Zimmerman
Chapter 38 Interventions to Reduce Racial and Ethnic Disparities in Health Care 761 Marshall H. Chin, Amy E. Walters, Scott C. Cook, Elbert S. Huang
A very comprehensive overview of the issues around minority health in the United States. Does not deal with international issues, but the topic of race, ethnitity and health in the US is big enough. You are interested in learning about the topic, this is a very good place to start. You will be depressed after reading some of this. The studies described in the book are convincing and you can't help but conclude that we have a serious problem with regard to minority health.
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