Minority Health and Health Equity Archive

Permanent URI for this collectionhttp://hdl.handle.net/1903/21769

Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.

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Author: search.filters.author.Braveman, Paula

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Now showing 1 - 7 of 7
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    What is health equity? What are health disparities? And why do the definitions matter?
    (Center on Social Disparities in Health, 2013) Braveman, Paula
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    A health disparities perspective on obesity research.
    (2009) Braveman, Paula
    Obesity is a major risk factor for chronic disease and can decrease longevity, quality of life, and economic productivity. Compelling ethical, human rights, and practical reasons exist for addressing social disparities in obesity, which requires systematically applying a disparities perspective to obesity research and relevant policy. A disparities perspective guides us to consider multiple dimensions and levels of social advantage and disadvantage and how those advantages and disadvantages produce disparities in obesity and its consequences.
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    Health disparities and health equity: concepts and measurement.
    (2006) Braveman, Paula
    There is little consensus about the meaning of the terms "health disparities," "health inequalities," or "health equity." The definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity. This paper aims to clarify the concepts of health disparities/inequalities (used interchangeably here) and health equity, focusing on the implications of different definitions for measurement and hence for accountability. Health disparities/inequalities do not refer to all differences in health. A health disparity/inequality is a particular type of difference in health (or in the most important influences on health that could potentially be shaped by policies); it is a difference in which disadvantaged social groups-such as the poor, racial/ethnic minorities, women, or other groups who have persistently experienced social disadvantage or discrimination-systematically experience worse health or greater health risks than more advantaged social groups. ("Social advantage" refers to one's relative position in a social hierarchy determined by wealth, power, and/or prestige.) Health disparities/inequalities include differences between the most advantaged group in a given category-e.g., the wealthiest, the most powerful racial/ethnic group-and all others, not only between the best- and worst-off groups. Pursuing health equity means pursuing the elimination of such health disparities/inequalities.
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    Social conditions, health equity, and human rights.
    (2010) Braveman, Paula
    The fields of health equity and human rights have different languages, perspectives, and tools for action, yet they share several foundational concepts. This paper explores connections between human rights and health equity, focusing particularly on the implications of current knowledge of how social conditions may influence health and health inequalities, the metric by which health equity is assessed. The role of social conditions in health is explicitly addressed by both 1) the concept that health equity requires equity in social conditions, as well as in other modifiable determinants, of health; and 2) the right to a standard of living adequate for health. The indivisibility and interdependence of all human rights--civil and political as well as economic and social--together with the right to education, implicitly but unambiguously support the need to address the social (including political) determinants of health, thus contributing to the conceptual basis for health equity. The right to the highest attainable standard of health strengthens the concept and guides the measurement of health equity by implying that the reference group for equity comparisons should be one that has optimal conditions for health. The human rights principles of non-discrimination and equality also strengthen the conceptual foundation for health equity by identifying groups among whom inequalities in health status and health determinants (including social conditions) reflect a lack of health equity; and by construing discrimination to include not only intentional bias, but also actions with unintentionally discriminatory effects. In turn, health equity can make substantial contributions to human rights 1) insofar as research on health inequalities provides increasing understanding and empiric evidence of the importance of social conditions as determinants of health; and, more concretely, 2) by indicating how to operationalize the concept of the right to health for the purposes of measurement and accountability, which have been elusive. Human rights laws and principles and health equity concepts and technical approaches can be powerful tools for mutual strengthening, not only by contributing toward building awareness and consensus around shared values, but also by guiding analysis and strengthening measurement of both human rights and health equity.
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    ‘‘It’s The Skin You’re In’’: African-American Women Talk About Their Experiences of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies
    (2008) Nuru-Jeter, Amani; Dominguez, Tyan Parker; Hammond, Wizdom Powell; Leu, Janxin; Skaff, Marilyn; Egerter, Susan; Jones, Camara P.; Braveman, Paula
    Objectives: Stress due to experiences of racism could contribute to African-American women’s adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research. Methods: Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities. Results Women reported experiencing racism (1) throughout the lifecourse, with childhood experiences seeming particularly salient and to have especially enduring effects (2) directly and vicariously, particularly in relation to their children; (3) in interpersonal, institutional, and internalized forms; (4) across different life domains; (5) with active and passive responses; and (6) with pervasive vigilance, anticipating threats to themselves and their children. Conclusions This exploratory study’s findings support the need for measures reflecting the complexity of childbearing African-American women’s racism experiences. In addition to discrete, interpersonal experiences across multiple domains and active/passive responses, which have been measured, birth outcomes research should also measure women’s childhood experiences and their potentially enduring impact, perceptions of institutionalized racism and internalized negative stereotypes, vicarious experiences related to their children, vigilance in anticipating future racism events, as well as the pervasiveness and chronicity of racism exposure, all of which could be sources of ongoing stress with potentially serious implications for birth outcomes. Measures of racism addressing these issues should be developed and formally tested.
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    Overcoming Obstacles to Health
    (2008) Braveman, Paula; Egerter, Susan
    Social differences in health can be reduced, but only if solutions can be identified to address their root causes. The greatest potential lies in solutions that will help people choose health. That means both strengthening individuals’ ability to make healthy choices and removing obstacles to choosing health. It also means creating more opportunities to be healthy. The human impact of health is clear: Health is essential to well-being and full participation in society, and ill health can mean suffering, disability and loss of life. The economic impacts of health have become increasingly apparent. If current trends continue, medical care costs, now about 16 percent of the Gross Domestic Product (GDP),1 will reach 20 percent of GDP by 2015.2 The costs of medical care and insurance are now out of reach for many households, pushing some into bankruptcy. These costs are draining employers’ resources, threatening the bottom line of many American businesses. Federal, state and local health care spending is straining government budgets. Our society’s aging and the obesity epidemic will further increase costs of care.
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    Socioeconomic Status in Health Research One Size Does Not Fit All
    (2006) Braveman, Paula; Cubbin, Catherine; Egerter, Susan; Chideya, Sekai; Marchi, Kristen; Metzler, Marilyn; Posner, Samuel
    Problems with measuring socioeconomic status (SES)—frequently included in clinical and public health studies as a control variable and less frequently as the variable(s) of main interest—could affect research findings and conclusions, with implications for practice and policy.Wecritically examine standard SES measurement approaches, illustrating problems with examples from new analyses and the literature. For example, marked racial/ethnic differences in income at a given educational level and in wealth at a given income level raise questions about the socioeconomic comparability of individuals who are similar on education or income alone. Evidence also shows that conclusions about nonsocioeconomic causes of racial/ethnic differences in health may depend on the measure—eg, income, wealth, education, occupation, neighborhood socioeconomic characteristics, or past socioeconomic experiences—used to “control for SES,” suggesting that findings from studies that have measured limited aspects of SES should be reassessed. We recommend an outcome- and social group–specific approach to SES measurement that involves (1) considering plausible explanatory pathways and mechanisms, (2) measuring as much relevant socioeconomic information as possible, (3) specifying the particular socioeconomic factors measured (rather than SES overall), and (4) systematically considering how potentially important unmeasured socioeconomic factors may affect conclusions. Better SES measures are needed in data sources, but improvements could be made by using existing information more thoughtfully and acknowledging its limitations.