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)
Nonelderly lawfully present and undocumented immigrants are more likely to be uninsured than nonelderly U.S. citizens. Kaiser Family Foundation, 2017
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:
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.
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.
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.
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.
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.
Cultural Competence in Health Education and Health Promotion by
Cultural Competence in Health Education and Health Promotion, 2nd edition, examines the importance of ethnic and cultural factors for community health practice. Edited and written by a stellar list of contributors who are experts in field, this book describes essential theories, models, and practices for working with race, ethnicity, gender, and social issues. The authors cover a wide range of topics including demographics, disparities, complementary and alternative medicine, spiritually grounded approaches, multicultural populations, culturally competent needs assessment and planning, communication, workforce, program planning, aging, sexual orientation, and future challenges. This edition has substantially expanded coverage on working with diverse groups, social determinants of health, spirituality, theoretical models for multicultural populations, planning and program evaluation, and aging, with new content includes coverage of disability and health literacy. This edition also reflects the latest standards for Certified Health Education Specialist certification and national standards on Culturally and Linguistically Appropriate Services (CLAS), from Department of Health and Human Services, Office of Minority Health
Delivering Health Care in America: A Systems Approach by
Given the recent and rapid developments in the delivery of health care in the United States, never has it been more important to have the most up-to-date resources for teaching students about this complex and dynamic industry. Now in its Fifth Edition, Delivering Health Care in America offers the most current and comprehensive overview of the basic structures and operations of the U.S. health system--from its historical origins and resources, to its individual services, cost, and quality. Using a unique "systems" approach, this bestselling text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance, while presenting a solid overview of how the various components fit together.
Health and Wellness Concerns for Racial, Ethnic, and Sexual Minorities by
Minority status in the United States often accompanies diminished access to education, employment, and subsequently health care. This volume explores factors that have contributed to health disparities among racial, ethnic, and sexual minorities. Focused on developing strategies for understanding these disparities and promoting wellness in minority communities, the authors highlight social forces such as racism, ethnocentrism, sexism, and homophobia, which continue to influence not only access to and quality of care but also perception and trust of health care professionals. The authors identify several common themes, including the importance of communication, intentional and unintentional discriminatory structures, and perhaps most significantly, the role of culturally relevant learning sites. This is the 142nd volume of the Jossey Bass series New Directions for Adult and Continuing Education. Noted for its depth of coverage, it explores issues of common interest to instructors, administrators, counselors, and policymakers in a broad range of education settings, such as colleges and universities, extension programs, businesses, libraries, and museums.
Issues in Health and Health Care Related to Race/Ethnicity, Immigration, SES and Gender by
The 30th Anniversary volume of Research in the Sociology of Health Care looks at the important links between major social factors and health and health care. The four main factors examined in the book are race/ethnicity, immigration, Socioeconomic Status (SES) and gender. Starting with an introductory chapter which reviews some of the important sociological literature on these social factors as linked to health, the book goes on to cover various key issues, including obesity, ageing, immigration and racial segregation.
Making the Mexican Diabetic by
This innovative ethnographic study animates the racial politics that underlie genomic research into type 2 diabetes, one of the most widespread chronic diseases and one that affects ethnic groups disproportionately. Michael J. Montoya follows blood donations from "Mexican-American" donors to laboratories that are searching out genetic contributions to diabetes. His analysis lays bare the politics and ethics of the research process, addressing the implicit contradiction of undertaking genetic research that reinscribes race's importance even as it is being demonstrated to have little scientific validity. In placing DNA sampling, processing, data set sharing, and carefully crafted science into a broader social context, Making the Mexican Diabetic underscores the implications of geneticizing disease while illuminating the significance of type 2 diabetes research in American life.
Mapping Race by
Researchers commonly ask subjects to self-identify their race from a menu of preestablished options. Yet if race is a multidimensional, multilevel social construction, this has profound methodological implications for the sciences and social sciences. Race must inform how we design large-scale data collection and how scientists utilize race in the context of specific research questions. This landmark collection argues for the recognition of those implications for research and suggests ways in which they may be integrated into future scientific endeavors. It concludes on a prescriptive note, providing an arsenal of multidisciplinary, conceptual, and methodological tools for studying race specifically within the context of health inequalities. Contributors: John A. Garcia, Arline T. Geronimus, Laura E. Gómez, Joseph L. Graves Jr., Janet E. Helms, Derek Kenji Iwamoto, Jonathan Kahn, Jay S. Kaufman, Mai M. Kindaichi, Simon J. Craddock Lee, Nancy López, Ethan H. Mereish, Matthew Miller, Gabriel R. Sanchez, Aliya Saperstein, R. Burciaga Valdez, Vicki D. Ybarra
Medical Apartheid by
From the era of slavery to the present day, the first full history of black America’s shocking mistreatment as unwilling and unwitting experimental subjects at the hands of the medical establishment. Medical Apartheidis the first and only comprehensive history of medical experimentation on African Americans. Starting with the earliest encounters between black Americans and Western medical researchers and the racist pseudoscience that resulted, it details the ways both slaves and freedmen were used in hospitals for experiments conducted without their knowledge—a tradition that continues today within some black populations. It reveals how blacks have historically been prey to grave-robbing as well as unauthorized autopsies and dissections. Moving into the twentieth century, it shows how the pseudoscience of eugenics and social Darwinism was used to justify experimental exploitation and shoddy medical treatment of blacks, and the view that they were biologically inferior, oversexed, and unfit for adult responsibilities. Shocking new details about the government’s notorious Tuskegee experiment are revealed, as are similar, less-well-known medical atrocities conducted by the government, the armed forces, prisons, and private institutions. The product of years of prodigious research into medical journals and experimental reports long undisturbed,Medical Apartheidreveals the hidden underbelly of scientific research and makes possible, for the first time, an understanding of the roots of the African American health deficit. At last, it provides the fullest possible context for comprehending the behavioral fallout that has caused black Americans to view researchers—and indeed the whole medical establishment—with such deep distrust. No one concerned with issues of public health and racial justice can afford not to readMedical Apartheid, a masterful book that will stir up both controversy and long-needed debate.
Multicultural Medicine and Health Disparities by
An essential guide to clinical issues encountered during management of patients of varied cultural and economic backgrounds This essential text assists health care students and practitioners in delivering skilled and appropriate care to all patients, no matter their ethnicity, country of origin, cultural history, or access to services. Presenting need-to-know and often hard to find information on differences in access to heath care, immunization histories, disease prevalence, attitudes about health and provision of care, and much more, this resource provides practical, authoritative, and specific guidance.
Precarious Prescriptions by
In "Precarious Prescriptions," Laurie B. Green, John Mckiernan-Gonzilez, and Martin Summers bring together essays that place race, citizenship, and gender at the center of questions about health and disease. Exploring the interplay between disease as a biological phenomenon, illness as a subjective experience, and race as an ideological construct, this volume weaves together a complicated history to show the role that health and medicine have played throughout the past in defining the ideal citizen. By creating an intricate portrait of the close associations of race, medicine, and public health, "Precarious Prescriptions" helps us better understand the long and fraught history of health care in America. Contributors: Jason E. Glenn, U of Texas Medical Branch at Galveston; Mark Allan Goldberg, U of Houston; Jean J. Kim; Gretchen Long, Williams College; Vernica Mart nez-Matsuda, Cornell U; Lena McQuade-Salzfass, Sonoma State U; Natalia Molina, U of California, San Diego; Susan M. Reverby, Wellesley College; Jennifer Seltz, Western Washington U. "
Race, Ethnicity, and Health by
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.
Unequal Treatment by
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. Patientsâe(tm) and providersâe(tm) 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 providerâe"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.