Minority Health and Health Equity Archive

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End date: 1989

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    Philosophical Reflections on Experimenting with Human Subjects
    (Biomedical Ethics and the Law, 1976) Jonas, Hans
    Experimenting with human subjects is going on in many fields of scientific and technological progress. It is designed to replace the overall instruction by natural, occasional, and cumulative experience with the selective information from artificial, systematic experiment which physicial science has found so effective in dealing with inanimate nature. Of the new experimentation with man, medical is surely the most legitimate; psychological, the most dubious; biological (still to come), the most dangerous. I have chosen here to deal with the first only, where the case for it is strongest and the task of adjudicating conflicting claims hardest. When I was first asked1 to comment “philosophically” on it, I had all the hesitation natural to a layman in the face of matters on which experts of the highest competence have had their say and still carry on their dialogue. As I familiarized myself with the material,2 any initial feeling of moral rectitude that might have facilitated my task quickly dissipated before the awesome complexity of the problem, and a state of great humility took its place. The awareness of the problem in all its shadings and ramifications speaks out with such authority, perception, and sophistication in the published discussions of the researchers themselves that it would be foolish of me to hope that I, an onlooker on the sidelines, could tell those battling in the arena anything they have not pondered themselves. Still, since the matter is obscure by its nature and involves very fundamental, transtechnical issues, anyone’s attempt at clarification can be of use, even without novelty. And even if the philosophical reflection should in the end achieve no more than the realization that in the dialectics of this area we must sin and fall into guilt, this insight may not be without its own gains.
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    Racial and socioeconomic disparities in childhood mortality in Boston.
    (1985) Wise, P H; Kotelchuck, M; Wilson, M L; Mills, M
    We examined racial and income-related patterns of mortality from birth through adolescence in Boston, where residents have high access to tertiary medical care. Childhood mortality was significantly higher among black children (odds ratio, 1.24; P less than 0.05) and low-income children (odds ratio, 1.47; P less than 0.001). Socioeconomic effects varied for different age groups and causes of death. The largest relative disparity occurred in the neonatal and postneonatal periods, and the smallest in adolescence. Of the total racial differential in neonatal mortality (6.88 deaths per 1000 live births), 51.2 per cent occurred in premature infants, 13.4 per cent in term infants who were small for their gestational age, and 25.9 per cent in neonates who were both premature and small for their age. Black neonatal mortality was elevated at all income levels. Beyond the neonatal period, mortality from respiratory disease, fire, and homicide had strong inverse relationships with income, and mortality from injuries to the occupants of motor vehicles was directly related to income. These data suggest that despite access to tertiary medical services, substantial social differentiation in mortality may exist throughout childhood. Equity in childhood survival will probably require policies that emphasize preventive goals.
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    AIDS in minority populations in the United States.
    (1987) Hopkins, D R
    Among ethnic minorities in the United States, blacks and Hispanics, who compose 12 percent and 7 percent of the U.S. population, respectively, constitute 24 percent and 14 percent of the cases of AIDS. Seventy-eight percent of all children with AIDS are black or Hispanic, as are 71 percent of all women with AIDS. In the black and Hispanic communities, intravenous (IV) drug abuse is associated with much of the AIDS transmission, and parenterally acquired infections are spread secondarily by sexual and perinatal transmission. Almost two-thirds of black and Hispanic persons with AIDS in the United States reside in New York, New Jersey, or Florida. Important differences in the understanding of AIDS and human immunodeficiency virus infection and control measures in minority communities must be considered in devising information and intervention programs for those communities. Programs intended specifically for minorities, especially greatly intensified prevention and treatment of IV drugs abuse, are needed to supplement programs aimed at the U.S. population in general. Combatting AIDS offers black and Hispanic populations an opportunity to greatly reduce IV drug abuse, other sexually transmitted diseases, and teenage pregnancy.
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    Community empowerment as a strategy for health promotion for black and other minority populations.
    (1989) Braithwaite, R L; Lythcott, N
    THE HEALTH status of blacks, other minorities, and the poor remains unconscionably low when contrasted with that of white Americans. This disparity is not new but is an historical trend that can be seen across all categories of the leading causes of death and disease. In August 1985, the Report of the Secretary's Task Force on Black and Minority Health2 noted that minorities experienced approximately 60 000 "excess deaths" annually. Margaret Heckler, who was then the secretary of the US Department of Health and Human Services, emphasized that the disparity is "an affront both to our ideals and to the ongoing genius of American Medicine." The six major contributors to the disparity between black and white death rates are cancer, cardiovascular disease and stroke, diabetes, chemical dependency, homicide and accidents, and infant mortality. Since the 1985 report, blacks and Latinos, in particular, also have evidenced a disproportionately high rate
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    Report of the Secretary's Task Force on Black and Minority Health: a summary and a presentation of health data with regard to blacks.
    (1986) Nickens, H
    The Task Force on Black and Minority Health was created in early 1984 by Margaret Heckler, then Secretary of the US Department of Health and Human Services (DHHS). The summary volume of the report was released by Secretary Heckler at a press conference on October 16, 1985.1 As described by her at the press conference, the impetus for the creation of the Task Force was her dismay at the persistent black and minority health disparities when compared with the white population. These disparities had been most recently reflected in DHHS's annual health statistical summary, Health USA for 1983.
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    Report of the Secretary’s Task Force Report on Black and Minority Health Volume I: Executive Summary
    (Gvernment Printing Office, 1985) Heckler, Margaret M.
    In January 1984--ten months after becoming Secretary of Health and Human Services--I sent Health, United States, 1983 to the Congress. It was the annual report card on the health status of the American people. That report--like its predecessors--documented significant progress: Americans were living longer, infant mortality had continued to decline--the overall American health picture showed almost uniform improvement. But, and that "but" signaled a sad and significant fact; there was a continuing disparity in the burden of death and illness experienced by Blacks and other minority Americans as compared with our nation's population as a whole
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    Bad blood: the Tuskegee syphilis experiment
    (The Free Press, 1981) Jones, James Howard
    An account of the experiment conducted by the U.S. Public Health Service describes how medical treatment was withheld from Black sharecroppers infected with syphilis
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    The ‘Tuskegee Study’ of syphilis: Analysis of moral versus methodologic aspects
    (1978) BENEDEK, T
    The background and course of the prospective investigation of the “natural history” of syphilis which was conducted by the U.S. Public Health Service in Macon County, Alabama from 1932 to 1972 (the “Tuskegee Study”) is reviewed. Unpublished correspondence is cited to illustrate some of the attitudes and problems of the investigators. The relevance of certain other studies of syphilis to the interpretation of the Tuskegee data which were not discussed by the investigators is shown. The study is analyzed by the application of some general principles of scientific investigation set forth at the beginning of the article.