The changing landscape for the elimination of racial/ethnic health status disparities

The elimination of racial/ethnic health status disparities is a compelling national health objective. It was etched in sharp relief by the 1985 report of the U.S. Department of Health and Human Services Secretary's Task Force on Black and Minority Health and considerable attention has been devoted to the problem since that report. But the problem persists, disparities are not fully explained and effective policies to reduce them have been elusive, a situation presenting both opportunities and challenges. Important advances towards reducing racial/ethnic health disparities may be made by better understanding the complex bidirectional relationship between and among the multiple factors, biological and non-biological, influencing morbidity and mortality. The landscape in which these influences are felt is anything but static. In this paper selected components of the landscape that are critical to the elimination of racial/ethnic health status disparities are reviewed. These factors underscore the importance of adopting and maintaining a perspective on health disparities that encompasses a broad array of health determinants.     

The changing role of rural women: Nursing and health implications

Rural women in America represent a rapidly changing group with unique characteristics and health concerns. A review of the available literature reveals that rural women present unique health care needs, especially related to health promotion. Based on the scant data available, identifiable strengths among rural women include their pride in rural heritage and culture, tradition of self‐care, strong family attachment, and community involvement and support. Potential threats include insufficient data and research, isolation, inadequate support services, and potential sex‐role conflicts. Based on these strengths and potential weaknesses, health implications are drawn using the Neuman Systems Model. Specific implications for nursing practice, education and research are presented based on the review of literature and conceptual analysis.     

Tracking the changing provider landscape: implications for health policy and practice

Throughout the 1990s health care providers were interested in developing organized delivery systems. However, industry observers have increasingly questioned the sense of these efforts. Using an established taxonomy of health networks and systems, we examined whether there was a nationwide trend away from the vertical and horizontal arrangements that serve as the backbone to organized delivery systems. Studying 1994-1998, we found that both health networks and systems became less centralized in their hospital services, physician arrangements, and insurance product development. We did not find a general pathway to disintegration but instead found considerable experimentation in organizational form.     

The changing medical profession: implications for medical education

Summary. Reproduced with kind permission of the Pan American Health Organization, Regional Office of the World Health Organization and the Pan American Federation of Associations of Medical Schools     

Changing dietary habits of ethnic groups in Europe and implications for health

A systematic review of the literature suggests the dietary habits of some ethnic groups living in Europe are likely to become less healthy as individuals increase consumption of processed foods that are energy dense and contain high levels of fat, sugar, and salt. Such products often replace healthy dietary components of the native diet, such as fruits, vegetables, nuts, and grains. Mixed food habits are emerging mainly amongst younger people in the second and third generations, most likely due to acculturation and adoption of a Western lifestyle. Age and immigrant generation are the major factors accounting for changes in dietary habits, whilst income, level of education, dietary laws, religion, and food beliefs are also important factors. Obesity, cardiovascular disease, diabetes, and hypertension present major problems for the mainstream European population. However, the risk of chronic disease is reported to be higher in ethnic populations, particularly South Asians, African Caribbeans, and Mexicans.     

The changing face of death: Implications for public health

Palliative care and bereavement care attempt to foster greater dignity in death and loss. Yet the former has been criticised for ‘creeping medicalisation’ and the latter for individualising grief and loss to the ‘talking therapies’. In a broad sense, amongst the dying, their communities and advocates, there is growing recognition of the positive aspects of more collective responses to death to integrate the dying, public health and community. In response to Kellehear's call for public health to consider the above issues as a matter of priority, this essay describes the changing way death has been experienced and managed in empirical, conceptual, and theoretical terms. It then moves on to explore the implications for public health.     

Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health

We use the Metropolitan Community Information Center-Metro Survey-a serial cross section of adults residing in the City of Chicago, USA, conducted from 1991 through 1999-in combination with 1990 census data to simultaneously examine the extent to which self-rated health varies across Chicago neighborhoods and across time. Three-level hierarchical logit models are employed to decompose individual, spatial, and temporal variance in self-rated health. Results indicate that variation in self-rated health across neighborhoods is explained, in part, by variation in the level of neighborhood affluence. Neighborhood level poverty, however, is not a significant predictor of self-rated health. Community level affluence, moreover, accounts for a substantial proportion of the residual health deficit experienced by African-Americans when compared with Whites (after controlling for individual level SES). The effects of affluence hold when controlling for spatial autocorrelation and when considered in primarily African-American neighborhoods. Findings also indicate that individuals living in the City of Chicago became significantly healthier over the decade of the 1990s, and that this improvement in health is explained largely by the increasing education and income levels of Chicago residents.     

New evidence regarding racial and ethnic disparities in mental health: policy implications

Minorities have, in general, equal or better mental health than white Americans, yet they suffer from disparities in mental health care. This paper reviews the evidence for mental health and mental health care disparities, comparing them to patterns in health. Strategies for addressing disparities in health care, such as improving access to and quality of care, should also work to eliminate mental health care disparities. In addition, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities.     

Variations in associations of health risk behaviors among ethnic minority early adolescents

PurposeTo investigate patterns of vulnerability and protection factors associated with risk behaviors and the co-occurrence of risk behaviors in minority ethnicity early adolescents.MethodsAnalysis of data from the Research with East London Adolescents Community Health Survey (RELACHS), a school-based study of a representative sample of 2789 adolescents age 11–14 in 2001 (sample 73% non-Caucasian, 21% born outside the United Kingdom). Questionnaire data were obtained on sociodemographic variables, ethnicity, smoking, drinking, drug use, psychological well-being, physical health, and social support from family and peers. Models of associations for each behavior and co-occurrence of risk behaviors (defined as engaging in ≥ 2 behaviors) were developed by hierarchical stepwise logistic regression.ResultsTwo hundred ninety-two (10.9%) reported 1 risk behavior, 84 (3.1%) reported 2, and 25 (0.9%) reported 3 behaviors. In multivariate models, psychological morbidity was associated with higher risk of all behaviors and co-occurrence, while higher family support was associated with lower risk in all models. Non-Caucasian ethnicity was associated with lower risk of regular smoking and co-occurrence but not drinking or drugs. Birth outside the United Kingdom was associated with lower risk for individual behaviors but not co-occurrence. Religion and religious observance were associated with lower risk of smoking and drinking but not drug use or co-occurrence. Peer connectedness was associated with drug use, but with increased risk. Socioeconomic status was associated only with smoking.ConclusionsPatterns of associations of personal, family, and environmental factors appear to differ between smoking, drinking, lifetime drug use, and the co-occurrence of these behaviors. Hypotheses regarding common factors related to health risk behaviors may be misleading in ethnic minorities and immigrants. Co-occurrence may represent a distinct behavioral domain of risk that is partly culturally determined.     

Africa: The changing environment and health

Like other developing areas of the world, Africa is undergoing social, political, and economic changes. These developmental changes have provided important benefits, but have also produced significant impacts on the environment. Industrialization and agricultural mechanization have introduced new environmental hazards to the African environment. Rapid population growth and development have produced significant impact on the environment and health. This paper reviews the literature on the impact of development on the African environment and health and suggests feasible solutions that can be initiated to decrease degradation and pollution of the environment to minimize resulting risks to health.