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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Item The Asian American Hepatitis B Program: Building a Coalition to Address Hepatitis B Health Disparities(2011) Trinh-Shevrin, Chau; Pollack, Henry J.; Tsang, Thomas; Park, Jihyun; Ramos, Mary Ruchel; Islam, Nadia; Wang, Su; Chun, Kay; Sim, Shao-Chee; Pong, Perry; Rey, Mariano Jose; Kwon, Simona C.Item Confronting Social Disparities in Child Health: A Critical Appraisal of Life-Course Science and Research(2009) Wise, P. H.Abstract available at publisher's website.Item Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care(2011) Joynt, K. E.; Orav, E. J.; Jha, A. K.Abstract available at publisher's website.Item Exploring Unconscious Bias in Disparities Research and Medical Education(2011) van Ryn, M.; Saha, S.The evidence that physician behavior and decision making may contribute to racial inequalities in health care1,2,3,4,5 is difficult to reconcile with the fact that most physicians are genuinely motivated to provide good care to all their patients.6 This apparent contradiction can cause considerable cognitive dissonance, the uncomfortable feeling that occurs when holding 2 conflicting ideas simultaneously. Cognitive dissonance has been shown to be so aversive that people are highly motivated to resolve it, often by discounting the evidence supporting one of the conflicting beliefs. For scientists, however, cognitive dissonance motivates inquiry into how 2 seemingly contradictory sets of facts can coexist. The study by Haider and colleagues 7 in this issue of JAMA is part of a growing body of work applying concepts and methods from cognitive and social psychology to medical care and education research to understand and inform …Item Getting to Equal: Strategies to Understand and Eliminate General and Orthopaedic Healthcare Disparities(2009) Dykes, Daryll C.; White, Augustus A.Abstract available at publisher's web site.Item Race and healthcare disparities: overcoming vulnerablity.(2002) Stone, JohnThe paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained in decision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard when they get there. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare--a radical change. In this decision setting, how to provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, how to evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention.Item Do lifestyle or social factors explain ethnic/racial inequalities in breast cancer survival?(2009) McKenzie, Fiona; Jeffreys, MonaDespite numerous studies documenting ethnic inequalities in breast cancer survival between minority and majority ethnic groups worldwide, reasons for these inequalities remain unclear. The authors performed a systematic review of published literature to identify studies that investigated the explanatory power of smoking, alcohol consumption, body mass index (BMI), and socioeconomic position (SEP) on ethnic inequalities in breast cancer survival. Sixteen studies were included in the review. From 5 studies, the authors found that differences in breast cancer survival between ethnic groups may be in part explained by BMI, but there was little evidence to implicate smoking or alcohol consumption as explanatory factors of this inequality. From 12 studies, the authors found that SEP explains part of the ethnic inequality in all-cause survival but that it was not evident for breast-cancer-specific survival. SEP explains more of the disparities among African-American versus white women in the United States compared with other ethnic comparisons. Furthermore, given social patterning of BMI and other lifestyle habits, it is possible that results for SEP and BMI are measuring the same effect. In this review, the authors make suggestions regarding the role of epidemiology in facilitating further research to better inform the development of effective policies to address ethnic differences in survival.Item Cardiometabolic health disparities in native Hawaiians and other Pacific Islanders.(2009) Mau, Marjorie K; Sinclair, Ka'imi; Saito, Erin P; Baumhofer, Kau'i N; Kaholokula, Joseph Keawe'aimokuElimination of health disparities in the United States is a national health priority. Cardiovascular disease, diabetes, and obesity are key features of what is now referred to as the "cardiometabolic syndrome," which disproportionately affects racial/ethnic minority populations, including Native Hawaiians and other Pacific Islanders (NHOPI). Few studies have adequately characterized the cardiometabolic syndrome in high-risk populations such as NHOPI. The authors systematically assessed the existing literature on cardiometabolic disorders among NHOPI to understand the best approaches to eliminating cardiometabolic health disparities in this population. Articles were identified from database searches performed in PubMed and MEDLINE from January 1998 to December 2008; 43 studies were included in the review. There is growing confirmatory evidence that NHOPI are one of the highest-risk populations for cardiometabolic diseases in the United States. Most studies found increased prevalences of diabetes, obesity, and cardiovascular risk factors among NHOPI. The few experimental intervention studies found positive results. Methodological issues included small sample sizes, sample bias, inappropriate racial/ethnic aggregation of NHOPI with Asians, and a limited number of intervention studies. Significant gaps remain in the understanding of cardiometabolic health disparities among NHOPI in the United States. More experimental intervention studies are needed to examine promising approaches to reversing the rising tide of cardiometabolic health disparities in NHOPI.Item Meaningful Disparities Reduction Through Research and Translation Programs(2011) Chin, M. H.; Goldmann, D.Health care disparities are unacceptable, but progress toward reducing them has been painfully slow. Each year the Agency for Healthcare Research and Quality's (AHRQ’s) National Healthcare Disparities Report documents persistent differences in care by factors such as race, ethnicity, and insurance status. 1 Public awareness of these disparities is growing, and the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 will hasten transparency by encouraging collection of race, ethnicity, and language data. However, recognizing the existence of disparities is not sufficient to catalyze meaningful action. Even the most motivated clinicians and health care organizations may not know how to proceed because information on which interventions work in specific contexts or at scale is limited. 2 There is broad agreement that meaningful efforts to reduce disparities are linked inextricably to quality improvement. In its 2001 report Crossing the Quality Chasm, the Institute of …Item Community-Based Participatory Research From the Margin to the Mainstream: Are Researchers Prepared?(2009) Horowitz, C. R.; Robinson, M.; Seifer, S.Despite an increasing arsenal of effective treatments, there are mounting challenges in developing strategies that prevent and control cardiovascular diseases, and that can be sustained and scaled to meet the needs of those most vulnerable to their impact. Community-based participatory research (CBPR) is an approach to conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health. To inform research design, implementation and dissemination, this approach challenges academic and community partners to invest in team building, share resources, and mutually exchange ideas and expertise. CBPR has led to a deeper understanding of the myriad factors influencing health and illness, a stream of ideas and innovations, and there are expanding opportunities for funding and academic advancement. To maximize the chance that CBPR will lead to tangible, lasting health benefits for communities, researchers will need to balance rigorous research with routine adoption of its conduct in ways that respectfully, productively and equally involve local partners. If successful, lessons learned should inform policy and inspire structural changes in healthcare systems and in communities.