The Men’s Health Forum: An Initiative to Address Health Disparities in the Community

Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men's Health Forum, currently referred to as the Men's Health Forum. The African American Men's Health Forum was the result of the community's desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men's Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men's Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.     

Building on leadership and social capital to create change in 2 urban communities

There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud/Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital. We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration.     

Race, health, and the African Diaspora

Health inequalities exist throughout the African Diaspora and are viewed in this article as largely color-coded. In developed, developing, and undeveloped nations today, "racial" stratification is consistently reflected in an inability to provide adequate health regardless of national policy or ideology. For instance, African Americans experience less than adequate health care very similar to Blacks in Britain, in spite of each nations differing health systems. Latin America's Africana Negra communities experience poorer health similar to Blacks throughout the Caribbean. The African continent itself is arguably the poorest on earth. A common history of racism correlates with health disparities across the African Diaspora.     

Community Health Centers and racial/ethnic disparities in healthy life.

This study examined disparities in health status among individuals of different racial and ethnic groups cared for by the nation's community health centers (CHCs) and compared these results with the findings for individuals using non-CHC sites as their usual source of care. The sample consisted of CHC users from the 1994 CHC User Survey and non-CHC users from the 1994 National Health Interview Survey. Bivariate comparisons were made between individuals' race/ethnicity and their experience of healthy life, an integrated measure that incorporates both activity limitation and self-perceived health status. Multiple regressions were followed to examine the independent association of race/ethnicity with healthy life experience for both CHC and non-CHC users while controlling for sociodemographic correlates of health. Among CHC users, racial and ethnic minorities did not have worse health than whites, but among non-CHC users there were significant racial and ethnic disparities: whites experienced significantly healthier life than both blacks and non-white Hispanics. These findings persisted after controlling for sociodemographic correlates of health. The results indicate that while racial/ethnic disparities in health persist nationally, these disparities do not exist within CHCs, safety-net providers with an explicit mission to serve vulnerable populations.     

Using popular education for community empowerment: perspectives of Community Health Workers in the Poder es Salud/Power for Health program

Empowerment has been advanced as a strategy for eliminating remaining health disparities. Popular education promotes community empowerment by increasing individuals’ and communities’ awareness of their capacity and providing a framework and strategies through which participants can identify and resolve problems. Poder es Salud/Power for Health, a community-based participatory research project, sought to improve health and decrease disparities in African American and Latino communities in Multnomah County, Oregon, through the intervention of Community Health Workers (CHWs) who used popular education. In-depth interviews were conducted with five CHWs involved in the project to explore their perceptions of the effects of the use of popular education on the CHWs and their communities. Results suggested that CHWs possessed a shared understanding of popular education. Effects on the CHWs included increases in community participation and identification, desire to advocate for the community, and sense of personal potential. Similarly, among communities, CHWs observed increases in level of participation in community events, quality and quantity of leadership, and sense of community solidarity. These results suggest that popular education, when used consistently throughout a health promotion program, can promote empowerment and thus contribute to eliminating health disparities.     

Findings from a Community-based Participatory Prevention Research Intervention Designed to Increase Social Capital in Latino and African American Communities

A community-based participatory research intervention, Poder es Salud/Power for Health, employed Community Health Workers who used popular education to identify and address health disparities in Latino and African American communities in a metropolitan area in the United States. We assessed participants’ social capital, self-rated health, and depressive symptoms at baseline and the end of the intervention. Social support and self-rated health improved while depressive symptoms decreased. Public health interventions involving diverse communities that are designed to build upon assets, such as existing levels of social capital, may improve health in those communities.     

The African American Wellness Village in Portland, Ore

More than 80% of African Americans in Oregon reside in the Portland metropolitan area; African Americans comprise 1.7% of the state's population. Although relatively small, the African American population in the state experiences substantial health disparities. The African American Health Coalition, Inc was developed to implement initiatives that would reduce these disparities and to promote increased communication and trust between the African American community and local institutions and organizations. One of these initiatives is an annual Wellness Week featuring an African American Wellness Village. The Wellness Village uses a model of cultural sensitivity to provide access to free health screenings, links between health care organizations and African American community members, and health education and information.

The African American Health Coalition, Inc obtained a Racial and Ethnic Approaches to Community Health (REACH) 2010 grant to sustain this programming. The Wellness Village is supported by five major sponsors; annual attendance has ranged from 700 to 900 participants. The African American Health Coalition's evaluation of the event indicates that more than 50% of respondents identify the Wellness Village as the only place that they receive health screenings. Participants with access to screenings elsewhere report that a culturally sensitive environment that inspires trust is the reason they prefer the screenings offered at the Wellness Village.

Culturally sensitive health fairs such as the Wellness Village may play an important role in bringing preventive health screenings to African American communities. Collaboration between black and white health care providers is critical in this effort. Partnerships must be built at multiple levels, including institutions to provide financial resources and in-kind donations, community members to assist with outreach and recruitment, and health care professionals to conduct screenings and services.

     

Approaching health disparities from a population perspective: the National Institutes of Health Centers for Population Health and Health Disparities

Addressing health disparities has been a national challenge for decades. The National Institutes of Health-sponsored Centers for Population Health and Health Disparities are the first federal initiative to support transdisciplinary multilevel research on the determinants of health disparities. Their novel research approach combines population, clinical, and basic science to elucidate the complex determinants of health disparities. The centers are partnering with community-based, public, and quasi-public organizations to disseminate scientific findings and guide clinical practice in communities. In turn, communities and public health agents are shaping the research. The relationships forged through these complex collaborations increase the likelihood that the centers' scientific findings will be relevant to communities and contribute to reductions in health disparities.     

Using multilevel, multisource needs assessment data for planning community interventions

African Americans and Latinos share higher rates of cardiovascular disease (CVD) and diabetes compared with Whites. These diseases have common risk factors that are amenable to primary and secondary prevention. The goal of the Chicago REACH 2010-Lawndale Health Promotion Project is to eliminate disparities related to CVD and diabetes experienced by African Americans and Latinos in two contiguous Chicago neighborhoods using a community-based prevention approach. This article shares findings from the Phase 1 participatory planning process and discusses the implications these findings and lessons learned may have for programs aiming to reduce health disparities in multiethnic communities. The triangulation of data sources from the planning phase enriched interpretation and led to more creative and feasible suggestions for programmatic interventions across the four levels of the ecological framework. Multisource data yielded useful information for program planning and a better understanding of the cultural differences and similarities between African Americans and Latinos.     

Sexual and behavioral health disparities among African American sexual minority men and women

ABSTRACT

Introduction: Sexual and behavioral health disparities have been consistently demonstrated between African American and White adults and between sexual minority and heterosexual communities in the United States; however, few studies using nationally representative samples have examined disparities between sexual minority and heterosexual adults within African American populations. The purpose of this study was to examine the prevalence of sexual and behavioral health outcomes between sexual minority and heterosexual African American adults and to examine whether there were different patterns of disparities for African American sexual minority men and women, respectively.

Methods: We analyzed data from 4502 African American adults who participated in the 2001–2015 waves of the National Health and Nutrition Examination Survey. Using multivariable analyses, we examined differences in HIV, sexually transmitted infections, mental health, and substance use among African American sexual minority and heterosexual men and women.

Results: After adjusting for sociodemographic variables, African American sexual minority men had significantly higher odds of HIV, sexually transmitted infections, and poor mental health compared to their heterosexual male counterparts, whereas African American sexual minority women had significantly higher odds of Hepatitis C, poor mental health, and substance use compared to their heterosexual female counterparts.

Conclusions: These findings demonstrate notable sexual orientation disparities among African American adults. Disparities persisted beyond the role of sociodemographic factors, suggesting that further research utilizing an intersectional approach is warranted to understand the social determinants of adverse health outcomes among African American sexual minority men and women.     

Evidence to support church-based health promotion programmes for African Canadians at risk for cardiovascular disease

High quality management of cardiovascular disease is a critical health issue for people of African descent as this group is more likely than the general population to have greater coexisting cardiovascular comorbidities. The higher than average rates of cardiovascular conditions among Black populations are a cause for concern. In an effort to combat the disproportionate number of African Americans experiencing cardiovascular conditions a significant number of churches within the African American community have initiated health promotion programmes and/or services. Health organisations and agencies in the United States are keen to support and encourage these programmes for cardiovascular disease risk populations (i.e. African Americans and other minority groups, such as the Hispanic community). Indeed these health organisations and agencies recognise the need to promote healthier habits among African Americans and other minority groups as statistics continue to show health disparities among these populations within the US health care system. This paper attempts to encourage Canadian health agencies, organizations and practitioners to support similar CBHPPs initiatives for the African Canadian population. The historical significance of the church in Black Canadian communities is also examined.     

Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women’s Heart & Health Study

Maternal and Child Health Journal - Health disparities research has demonstrated a negative relationship between racial discrimination and African American women’s maternal health outcomes....     

Using community-based participatory approaches to mobilize communities for policy change

The Racial and Ethnic Approaches to Community Health (REACH) Alabama Breast and Cervical Cancer Coalition used community-based participatory research principles to address breast and cervical cancer disparities among Alabama's most vulnerable African American communities. With funding from the Centers for Disease Control and Prevention, the Alabama Breast and Cervical Cancer Coalition implemented a multilevel action plan, which entailed disseminating evidence-based strategies to community organizations interested in addressing cancer and other health disparities. Based on the Alabama Breast and Cervical Cancer Coalition's technical assistance on advocacy, an independent, community-led coalition was formed. This article uses a case study approach to document the steps taken by this empowered coalition to mobilize their community to impact cancer disparities using community-based participatory research principles as a tool to change tobacco and breast and cervical cancer legislation.     

The Role of Social Context in Racial Disparities in Self-Rated Health

Race disparities in self-rated health in the USA are well-documented, such that African Americans rate their health more poorly than whites. However, after adjusting for health status, socioeconomic status (SES), and health behaviors, residual race differences are observed. This suggests the importance of unmeasured variables. Because African Americans and whites tend to live in differing social contexts, it is possible that accounting for social and environmental conditions may reduce racial disparities in self-rated health. Differences in self-rated health among whites and African Americans were assessed in a low-income, urban integrated community (Exploring Health Disparities in Integrated Communities (EHDIC)) and compared with a national sample (National Health Interview Survey (NHIS)). Controlling for demographics, SES, health insurance, status, and behaviors, African Americans in NHIS had higher odds of reporting fair or poor health (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.18–1.66) than whites. In EHDIC, there was no race difference in self-rated health (OR = 0.83, 95% CI = 0.63–1.11). These results demonstrate the importance of social context in understanding race disparities in self-rated health.     

Reducing disparities for African Americans with diabetes: progress made by the REACH 2010 Charleston and Georgetown Diabetes Coalition

Racial and Ethnic Approaches to Community Health (REACH 2010) is a U.S.Centers for Disease Control and Prevention demonstration program that responds to the U.S. Department of Health and Human Services' goal to eliminate racial and ethnic disparities in health status by the year 2010. As part of REACH 2010, community projects were funded to develop, implement, and evaluate community action plans to improve health care and outcomes for racial and ethnic populations. This article describes the program and details the progress of the REACH 2010: Charleston and Georgetown Diabetes Coalition in reducing disparities in care. Approaches employed by the Coalition included community development, empowerment, and education related to diabetes; health systems change associated with access, care, and education; and coalition advocacy. Racial disparities were identified for 12,000 African Americans with diabetes in this urban/rural South Carolina community. After 24 months, significant differences that initially ranged from 11% to 28% in African Americans (when compared with whites/others) were not observed on 270 chart audits for A1C, lipid and kidney testing, eye examinations, and blood pressure control. Future efforts will focus on maintaining progress, eliminating other disparities, and identifying the contributions of each intervention in eliminating racial disparities.     

Health Disparities Between Appalachian and Non-Appalachian Counties in Virginia USA

The examination of health disparities among people within Appalachian counties compared to people living in other counties is needed to find ways to strategically target improvements in community health in the United States of America (USA). Methods: A telephone survey of a random sample of adults living in households within communities of all counties of the state of Virginia (VA) in the USA was conducted. Findings: Health status was poorer among those in communities within Appalachian counties in VA and health insurance did not make a difference. Health perception was significantly worse in residents within communities in Appalachian counties compared to non-Appalachian community residents (30.5 vs. 17.4% rated their health status as poor/fair), and was worse even among those with no chronic diseases. Within communities in Appalachian counties, black residents report significantly better health perception than do white residents. Conclusion: Residents living in communities in Appalachian counties in VA are not receiving adequate health care, even among those with health insurance. More research with a larger ethnic minority sample is needed to investigate the racial/ethnic disparities in self-reported health and health care utilization within communities.     

The insurance gap and minority health care, 1997-2001

Gaps in access to medical care among working-age white Americans, African Americans and Latinos failed to improve between 1997 and 2001, despite a booming economy and increased national attention to narrowing and eliminating minority health disparities. African Americans and Latinos continue to have less access to a regular health care provider, see a doctor less often and lag behind whites in seeing specialists, according to recent findings from the Center for Studying Health System Change (HSC). Ethnic and racial disparities in access among uninsured Americans are much greater than disparities among the insured. Uninsured whites' greater financial resources may explain why they have fewer problems accessing care. Eliminating disparities in minority health care will be difficult without first eliminating these gaps in minority health insurance.     

Health status of African Americans

The health status of African Americans identifies a higher prevalence of cardiovascular diseases, cancer, hypertension, diabetes, obesity, and sexually transmitted infections when compared with Whites. However, more research is needed to identify socioeconomic variables and to establish needed health programs. The vestiges of early 20th century traditions of substandard housing and inadequate nutrition for African Americans are still apparent in many communities today. Most health care professionals are not educated and trained to be culturally sensitive. The struggle against the prevalence of diseases in African Americans must incorporate cultural sensitivity, community organization and empowerment. The need for a universal system of health insurance coverage is of utmost importance. The elimination of health disparities among African Americans requires a national effort, the involvement of public and private sectors, individuals and communities.     

Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-based Research Network (SNW-PBRN)

In 2001, community health center (CHC) leaders in Oregon established an organization to facilitate the integration of health information technology, including a shared electronic health record (EHR), into safety net clinics. The Oregon Community Health Information Network (shortened to OCHIN as other states joined) became a CHC information technology hub, supporting a network-wide EHR with one master patient index, now linked across >40 safety net organizations serving >900,000 patients with nearly 800,000 distinct CHC visits. Recognizing the potential of OCHIN's multiclinic network and comprehensive EHR database for conducting safety net-based research, OCHIN leaders and local researchers formed the Safety Net West practice-based research network (PBRN). The Safety Net West "community- based laboratory," based at OCHIN, is positioned to become an important resource for many studies including: evaluation of the real-time impact of health care reform on uninsured populations; development of new models of primary care delivery; dissemination and translation of interventions from other EHR-based systems (e.g., Kaiser Permanente) into the community health setting; and analyses of factors influencing disparities in health and health care access. We describe the founding of Safety Net West, its infrastructure development, current projects, and the future goals of this community-based PBRN with a common EHR.