Per the CDC's 2015 Health Report, "race is a social construct influenced by a complex set of factors. Because of the complexity and difficulty in conceptualizing and defining race, as well as the increasing representation of racial and ethnic subgroups in the United States, racial classification and data collection systems continue to evolve and expand." For that reason, this guide cannot fully explore and delineate the many changing facets of race and ethnicity in American healthcare systems. Racial dynamics are intersectional and often blurry in their own right, and this is increased when viewed through the frames of ethnicity, gender, age, ability, and geography.
This guide does affirm the complexities of race in the United States, but attempts a balance between complexity and usability by dividing up racial and ethnic health care disparities into explicit categories, being: Asian Americans, Indian Americans and Arabic Americans, Black Americans, Hispanic Americans, Native & Alaskan Native Americans. There is also a page dedicated to the specific healthcare disparities experienced by persons with an immigrant status.
Each category includes healthcare resources that address disparities relevant to the corresponding racial/ethnic group. Because all persons who belong to a racial/ethnic minority group experience some level of disparity in health and healthcare, some resources will be similar, and others will vary. Taking into account the inadequacies of a guide like this, it is still vital to understand the interplay between healthcare and race/ethnicity in the United States because all racial and ethnic minorities in America share characteristics "associated with health risk factors, disease prevalence, and access to care, which in turn drive health care utilization and expenditures." (CDC.gov, 2015)
HSRIC is an information repository sponsored by NLM, the Healthcare Disparities page includes information relevant to: search queries using NLM resources, news, data, health education, grants, legislation, guidelines, key organizations, and conferences.
"The Office of Minority Health is dedicated to improving the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities."
"REACH is a national program administered by the Centers for Disease Control and Prevention (CDC) to reduce racial and ethnic health disparities. Through REACH, awardee partners plan and carry out local, culturally appropriate programs to address a wide range of health issues among African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders."
Lack of access to health insurance and healthcare is a key issue for lawfully present and undocumented immigrants to the United States. However, immigrants also forego or miss out on treatment for mental illness as well as preventative care along with a number of other important facets of healthcare (RWFJ, 2018). Factors include:
fear of deportation
Children are particularly negatively affected by these factors, even if they are permanent citizens while their parents or relatives are not. In terms of outlook, it is possible that immigrant health care disparities will increase alongside diminishing coverage options, expanding cultural stressors, and cutbacks to community health centers and programs (KFF, 2017). The following list of resources covers all of these domains in order to give providers, communities, and policy makers information that can decrease the disparities faced by immigrants in the United States.
This report details the proceedings of the 2011 National Children's Study Symposium, Health Disparities Among Children of Immigrants that summarize key findings of health differences, sources of change, and at risk populations.
This article examines ID policies and their slow encroachment into American life such that a government-issued ID is now required to access goods and services, records, community services (such as libraries), and some forms of healthcare.
This comprehensive public health and health policy guide from the CDC addresses medical examination, guidelines for refugee health, laws and regulations, adoption resources, and responses to outbreaks.
A 2014 paper that argues that "immigrants’ political, social and economic incorporation experiences, which are embedded in individual life-course trajectories and heavily influenced by governmental policies, play an important role in producing diverse health outcomes among older U.S. foreign-born persons."
This site describes mental health and other psychological/psychiatric disparities that correlate with immigration status.
Disparities in Asian-American populations
The Model-Minority Myth describes a pervasive misunderstanding that Asian Americans are more likely to succeed in most areas of American life, including healthcare. This has resulted in approaches to health and healthcare which play down and/or ignore Asian American healthcare needs and the disparities that arise from those needs. For instance, Asian Americans experience high rates of diabetes, stomach cancers, smoking-related illnesses, and mental health issues, while often failing to receive care in these areas (Trinh-Shevrin, 2017). In order to push back against the model-minority myth and the inequities that arise, it's important to consider the complex needs of Asian Americans.
From the description: "This special issue focuses attention on physical and mental health disparities within the Asian American community and the work done by researchers and affiliates of the Asian American Center for Disparities Research to understand and alleviate these disparities."
Information pertinent for patients and providers. Includes community health resources for Himilayan, Arab, Bangladeshi, Chinese, Filipino, Indian, Indo-Caribbean, Japanese, Korean, Pakistani, Vietnamese, and Cambodian healthcare needs.
The NYU CSAAH is the result of a partnership with the NIH Office on Minority Health and Health Disparities, and is the oldest and most prominent resource for navigating Asian American health and health disparities in the United States.
This supplementary special issue published by the Journal of Health Care for the Poor and Underserved includes original research, opinions, and reports covering a wide range of health issues prevalent among Asian Americans, Native Hawaiians, and Pacific Islanders.
Disparities in Black/African American Populations:
Black Americans experience higher mortality rates than any other racial/ethnic group in the United States for 8 of the top 10 causes of death. (AHRQ.gov, 2015) And while overall health has improved among Black Americans in the past two decades, Growth is slower and often lacking when compared to the overall health of other racial/ethnic groups. (CDC.gov, 2018) Further, social constraints and inherent racism tied to poverty, incarceration, and geographical location often cause Black Americans (especially Black American men) to age at a more rapid pace than other Americans, which requires more extensive healthcare sooner in life and longer across the lifespan. Additionally, Black Americans are most likely to contract HIV/AIDS than other racial groups. It is imperative for providers, communities, and policy makers to not only push for increased literacy concerning each of these trends, but community organizations such as churches and cultural centers should be employed as allies that promote health literacy. Finally, healthcare disparities for Black Americans cannot be eliminated without changes to laws and organizational structures, which must be another priority, especially for policy makers and legislators.
From the abstract: "The weathering hypothesis, an explanation for race disparities in the USA, asserts that the health of African Americans begin to deteriorate prematurely compared to whites as a consequence of long-term exposure to social and environmental risk factors. Using data from 2000–2009 National Health Interview Surveys (NHIS), we sought to describe differences in age-related health outcomes in 619,130 African Americans and whites."
From the about page: "The Black Church & HIV initiative was established to form a national network of faith leaders, religious institutions, and community members committed to making change and ending the HIV epidemic in Black America. There is an immediate need for faith leaders to take action for what is happening with HIV in the Black community."
This document provides a brief overview of racial and ethnic health disparities and unveils a Department of Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities (“HHS Disparities Action Plan”).
From the abstract, the authors "discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA."
features information, continuing education opportunities, resources, and more for health and health care professionals to learn about culturally and linguistically appropriate services, or CLAS. Launched in 2004, Think Cultural Health is sponsored by the Office of Minority Health.
The Office of Minority Health addresses disease prevention, health promotion, risk reduction, healthier lifestyle choices, use of health care services and barriers to health care for racial and ethnic minorities.
Disparities in Hispanic/Latinx Populations:
Hispanic Americans, though the largest racial/ethnic minority in the United States, continue to experience "poor conditions of daily life, shaped by structural and social position factors (such as macroeconomics, cultural values, income, education, occupation, and social support systems, including health services)". (Velasco-Mondragon, et al., 2016) This conflux of forces results in higher likelihood to experience trauma, chronic stress/anxiety, sedentary behavior, and substance abuse, as well as lack of sleep. (Velasco-Mondragon, et al., 2016) These factors, along with higher risks for non-communicable diseases (arising from obesity, alcohol abuse, tobacco use, etc.) and lack of affordable healthcare and insurance, result in increased health and healthcare disparities for Hispanic Americans. Hispanic Americans are also more likely to experience healthcare needs that arise from occupation and geography, especially in farming and agricultural communities. For Hispanic American health, it is particularly important to target these societal and structural factors because compounded, they result in higher rates of diabetes, cardiovascular diseases, cancers, liver disease, and occupational injuries.
From the abstract: "This report estimates the extent and severity of food insecurity across diverse groups of Hispanic households using 2011-2014 data from the Current Population Survey’s Food Security Supplement. Food insecure households have difficulty at some time during the year in providing enough food for all their members due to a lack of resources. In 2014, 14.0 percent of all U.S. households were food insecure, versus 22.4 percent of Hispanic households."
By breaking down social determinants of health for Hispanic/Latinx Americans, this review provides an in-depth summary and analysis of health-related research, areas for growth, data/statistics, and current trends in Hispanic/Latinx health in America.
From the abstract: "Latino men experience health disparities in STI/HIV, diabetes, hypertension, and cancer. Gender roles likely play a role in risk behaviors and outcomes; however, there has been little focus on masculinity in Latino men. We conducted 20 semi-structured interviews with Latino men living in North Carolina. The interviews, conducted by a trained bilingual/bicultural Latino male, prompted discussion around work, family, and stress."
LULAC is a public advocacy initiative lobbying for increased awareness toward Hispanic/Latinx populations in the United States. This page describes health disparities commonly affecting Hispanic/Latinx Americans, and can be easily disseminated in community health settings.
From the abstract: "This article provides findings of a pilot test of Yo Veo Salud (I See Health), an intervention designed to positively modify attitudes toward Latinos among medical trainees. The research question was: Compared to the comparison group, did the intervention group show lower levels of implicit bias against Latinos versus Whites, and higher levels of ethnocultural empathy, healthcare empathy, and patient-centeredness?"
From the abstract: "We examine Latino citizen children in mixed-status families and how their physical health status compares to their U.S. citizen, co-ethnic counterparts. We also examine Latino parents' perceptions of state immigration policy and its implications for child health status...We find that mixed-status families report worse physical health for their children as compared to their U.S. citizen co-ethnics. We also find that parental perceptions of their states' immigration status further exacerbate health disparities between families."
Disparities in American Indian/Alaskan Native Populations:
Health and healthcare disparities are ever-present and unyielding across many American Indian and Alaskan Native communities. Even as overall health has increased for much of the U.S. population, American Indian and Alaskan Natives continue to have lower life expectancy that is 5.5 years less than all other ethnic/racial groups in the United States. (IHS.gov, 2018) These rates are partially due to American Indian and Alaskan Natives experiencing higher rates of liver disease, cirrhosis, diabetes, mental health, chronic trauma, unintentional injuries, assault, suicide, and lower respiratory diseases, compounded by a lack of access to healthcare and affordable coverage. (IHS.gov, 2018) Many of these epidemiologies are the result of social determinants produced by "structural violence" that "shapes the health" of American Indian and Alaskan Natives and results in widespread inequities in housing, employment, food/water, transportation, and safety. (Browne, et al., 2016).
Providers, communities, and policy makers should take all of these factors into account when considering the health and healthcare of American Native populations.
Resources for American Indian/Alaskan Native Populations:
"Native American Connections offers substance use treatment and general mental health services including psychiatric evaluation, medication management, counseling and case management. We also offer residential treatment for substance use and co-occurring disorders. Licensed by the Arizona Department of Health Services in 1978, NAC has partnerships with State Regional Behavioral Health Authority (RBHA), Tribal RBHAs, Tribes, and Indian Health Services (IHS)."
From the abstract: "Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural impacts. As a result, both quantity and quality of culturally important subsistence resources are diminished, contributing to poor nutrition and obesity, and overall reductions in quality of life and life expectancy."
While this paper focuses on healthcare needs of indigenous communities in Canada, it's exploration of health disparities across all indigenous populations can help inform how providers work with American Indian and Alaskan Native patients and communities.
From the ITCA, list and descriptions of various community health services for Arizona's American Indian populations, including: aging/senior services, research, dental support, STI awareness, cancer, teen pregnancy, epidemiology, health policy, and WIC.
From the abstract: "Health disparities exact a devastating toll upon Indigenous people in the USA. However, there has been scant research investment to develop strategies to address these inequities in Indigenous health. We present a case for increased health promotion, prevention, and treatment research with Indigenous populations, providing context to the recent NIH investment in the Intervention Research to Improve Native American Health (IRINAH) network."
MedlinePlus is a primary source for consumer health information. This page covers various facets of Native American (Alaska Native, American Indian) health, including: genetics, environmental risks, access to car, cultural factors of wellbeing, research, and links to further resources.
Native Health provides a full range of medical services to Arizona's American Indian and Alaska Native populations. This includes primary care, dental, behavioral, WID, community health, and wellness programs.
"he objectives of the Navajo Nation Special Diabetes Project are to provide prevention education to reduce new cases among the Navajo people; to identify individuals who are in pre-diabetes stage to reduce new developments; and provide diabetes management to reduce complications and disabilities. These objectives are being met by healthy lifestyle promotions, improvement in nutrition and diet, and exercise on a daily basis by our staff as they go out into the community."
Abstract Objective: "To estimate obesity and overweight prevalence in American Indian and Alaska Native (AI/AN) children across genders, ages, and geographic regions in the Indian Health Service active clinical population."
"The mission of the Southwest Hub for American Indian Youth Suicide Prevention Research (Southwest Hub) is to establish a collaborative network of tribal leaders, investigators, interventionists, service providers, and service users in the Southwest region. Facilitated by Johns Hopkins Center for American Indian Health, this hub will bring together intellectual resources, cultural assets, and experiences to overcome the suicide disparity among American Indian youth."
Provides research and health support for American Indians and Alaska Natives throughout the United States, with assistance for cancer, chronic disease, communicable disease, health data, health policy, and WIC.