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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Now showing 1 - 10 of 10
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    Black--White Disparities in Disability Among Older Americans: Further Untangling the Role of Race and Socioeconomic Status
    (2009) Fuller-Thomson, E.; Nuru-Jeter, A.; Minkler, M.; Guralnik, J. M.
    Abstract available at publisher's website.
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    Health in the African American Community: Accounting for Health Inequalities
    (1993) Dressler, William W.
    African Americans are at a higher risk of having a variety of health problems and have less access to health care than white Americans. This article explores these health inequalities and their explanations. Three conventional models of health inequalities—a racial-genetic model, a health behavior or lifestyle model, and a socioeconomic status model—are examined and found to be insufficient to account for observed disparities. A fourth alternative, termed a “social structural model,” is proposed. In this model, it is argued that the primary index of ethnic status, namely skin color, serves as a criterion of social class in color-conscious societies such as that of the United States. This alters social mobility processes and creates health inequalities for African Americans.
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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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    Action on the Social Determinants of Health: learning from previous experiences
    (WHO Document Production Services, 2010) UNSPECIFIED
    Today an unprecedented opportunity exists to improve health in some of the world’s poorest and most vulnerable communities by tackling the root causes of disease and health inequalities. The most powerful of these causes are the social conditions in which people live and work, referred to as the social determinants of health (SDH). The Millennium Development Goals (MDGs) shape the current global development agenda. The MDGs recognize the interdependence of health and social conditions and present an opportunity to promote health policies that tackle the social roots of unfair and avoidable human suffering. The Commission on Social Determinants of Health (CSDH) is poised for leadership in this process. To reach its objectives, however, the CSDH must learn from the history of previous attempts to spur action on SDH. This paper pursues three questions: (1) Why didn’t previous efforts to promote health policies on social determinants succeed? (2) Why do we think the CSDH can do better? (3) What can the Commission learn from previous experiences – negative and positive – that can increase its chances for success?
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    What If We Were Equal? A Comparison Of The Black-White Mortality Gap In 1960 And 2000
    (2005) Satcher, David; Fryer, George E., Jr.; McCann, Jessica; Troutman, Adewale; Woolf, Steven H.; Rust, George
    The United States has made progress in decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health inequalities persist. We examined trends in black-white standardized mortality ratios (SMRs) for each age-sex group from 1960 to 2000. The black-white gap measured by SMR changed very little between 1960 and 2000 and actually worsened for infants and for African American men age thirty-five and older. In contrast, SMR improved in African American women. Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated.
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    THE PUBLIC HEALTH OBSERVATORY HANDBOOK OF HEALTH INEQUALITIES MEASUREMENT
    (SEPHO, 2005) Carr-Hill, Roy; Chalmers-Dixon, Paul; Lin, Jennifer
    Tackling health inequalities must be a central plank of public policy for any government, so I was honoured to be asked to undertake the review of health inequalities for the Labour Government in 1998. I hope that the report from the review, “The Independent Enquiry into Inequalities in Health”, has helped to shape the policy direction, and influence the targeting and delivery of services, in tackling inequalities. We have moved a long way in our commitment to tackle health inequalities since then. The evidence base about “what works” is still fairly weak, but there is now a commitment to address this. Resources are going into research and development to advance our knowledge and understanding of what works. In parallel with that we need to be able to measure inequalities, in order to plan, set targets, monitor and evaluate. I recommended in my report the need to establish mechanisms to monitor inequalities in health and to evaluate the effectiveness of measures taken to reduce them. This book is therefore a welcome contribution to the resources available to people working to reduce inequalities in health in their communities. I commend it to anyone involved in addressing health inequalities. The measurement of inequalities is a complicated and convoluted science, but this book brings together much of that science in a rigorous but accessible way. It is a rich source of information and will contribute to advancing our knowledge and practice, with the ultimate aim to reduce inequalities and to make this country a more equitable society.
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    Mapping global health inequalities: challenges and opportunities
    (2007) Tugwell, Peter; Robinson, Vivian; Morris, Erin
    Health inequalities both between and within countries persist, for almost all diseases and health problems. Between countries, both average life expectancy and child mortality have improved more in the richest countries than the poorest (Marmot 2007). Within countries, progress on redressing health inequalities is uneven, and data are not always available over time. Analysis of 22 countries with available data found that only five of 22 countries reduced health inequalities in childhood mortality across income from 1995 to 2000 (Moser 2005). Health inequalities are differences in health across population groups defined by socioeconomic, demographic, or geographic factors. These factors can be summarized using the acronym PROGRESS: Place of residence (urban/rural), Race/ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, and Social capital/resources (Evans and Brown 2003).
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    Evidence for public health policy on inequalities: 2: Assembling the evidence jigsaw
    (2004) Whitehead, Margaret; Petticrew, Mark; Graham, Hilary; Macintyre, Sally J; Bambra, Clare; Egan, Matt
    Study objective: To garner research leaders’ perceptions and experiences of the types of evidence that influence policy on health inequalities, and their reflections on how the flow of such research evidence could be increased. Design, setting, and participants: Qualitative two day residential workshop with senior research leaders, most of whom were currently involved in evaluations of the health effects of major policies. In four in depth sessions, facilitated by the authors in turn, focused questions were presented to participants to reveal their views and experiences concerning evidence synthesis for policy on inequalities. These were analysed thematically. Main results: Five types of evidence for policy on health inequalities were felt to be particularly persuasive with policymakers: observational evidence showing the existing of a problem; narrative accounts of the impacts of policies from the household perspective; controlled evaluations; natural policy experiments; and historical evidence. Methods of improving the availability and use of these sources of information were put forward. Conclusions: This paper and its companion have considered the current evidence base for policies to reduce health inequalities, and how this could be improved. There is striking congruence between the views of the researchers in this study and policy advisers in paper 1, suggesting that a common understanding may be emerging. The findings suggest significant potential for rapid progress to be made in developing both evidence based policy, and policy relevant evidence to tackle inequalities in health.
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    Evidence for public health policy on inequalities: 1:The reality according to policymakers
    (2004) Petticrew, Mark; Whitehead, Margaret; Macintyre, Sally J; Graham, Hilary; Egan, Matt
    Objective: To explore with UK and international policy advisors how research evidence influences public health policy making, and how its relevance and utility could be improved, with specific reference to the evidence on the production and reduction of health inequalities. Design, setting, and participants: Qualitative residential workshop involving senior policy advisors with a substantive role in policy development across a range of sectors (mainly public health, but also including education, social welfare, and health services). In four in depth sessions, facilitated by the authors, focused questions were presented to participants. Their responses were then analysed thematically to identify key themes, relating to the availability and utility of existing evidence on health inequalities. Main results: The lack of an equity dimension in much aetiological and evaluative research was highlighted by participants. Much public health research was also felt to have weak underlying theoretical underpinnings. As well as evaluations of the effectiveness and cost-effectiveness of policy and other interventions, they identified a need for predictive research, and for methodological research to further develop methods for assessing the impact on health of clusters of interventions. Conclusions: This study reinforces the view that there is a lack of information on the effectiveness and costeffectiveness of policies, and it uncovered additional gaps in the health inequalities evidence base. A companion paper discusses researchers’ views of how the production of more relevant public health evidence can be stimulated.