Minority Health and Health Equity Archive
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Item Racial and ethnic disparities in the receipt of cancer treatment.(2002) Shavers, Vickie L; Brown, Martin LA disproportionate number of cancer deaths occur among racial/ethnic minorities, particularly African Americans, who have a 33% higher risk of dying of cancer than whites. Although differences in incidence and stage of disease at diagnosis may contribute to racial disparities in mortality, evidence of racial disparities in the receipt of treatment of other chronic diseases raises questions about the possible role of inequities in the receipt of cancer treatment. To evaluate racial/ethnic disparities in the receipt of cancer treatment, we examined the published literature that addressed access/use of specific cancer treatment procedures, trends in patterns of use, or survival studies. We found evidence of racial disparities in receipt of definitive primary therapy, conservative therapy, and adjuvant therapy. These treatment differences could not be completely explained by racial/ethnic variation in clinically relevant factors. In many studies, these treatment differences were associated with an adverse impact on the health outcomes of racial/ethnic minorities, including more frequent recurrence, shorter disease-free survival, and higher mortality. Reducing the influence of nonclinical factors on the receipt of cancer treatment may, therefore, provide an important means of reducing racial/ethnic disparities in health. New data resources and improved study methodology are needed to better identify and quantify the full spectrum of nonclinical factors that contribute to the higher cancer mortality among racial/ethnic minorities and to develop strategies to facilitate receipt of appropriate cancer care for all patients.Item An Ecological Perspective on Health Promotion Programs(1988) McLeroy, K. R.; Bibeau, D.; Steckler, A.; Glanz, K.During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.Item Challenges and Successes in Reducing Health Disparities: Workshop Summary(The National Academies Press, 2008) Cohen, Jennifer A.In early 2007, the Institute of Medicine of the National Academies convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, further the development of programs and strategies to reduce disparities, foster the emergence of leadership on this issue, and track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable on Health Disparities includes representatives from the health professions, state and local government, foundations, philanthropy, academia, advocacy groups, and community based organizations. Its mission is to facilitate communication across sectors and—above all—to generate action. Through national and local activities, the Roundtable strives to advance the goal of eliminating health disparities. On July 31, 2007, the first workshop of the Roundtable on Health Disparities was held at Harris-Stowe State University in St. Louis, Missouri. To help stimulate new thinking about solutions and to inform its future meetings and discussions, the Roundtable brought together a diverse group of participants from a variety of fields to discuss racial and ethnic differences in life expectancy in the United States. Measured in terms of life expectancy, tens of millions of Americans experience levels of health that are more typical of middle- and low-income developing countries. These mortality differences are caused primarily by chronic diseases and injuries with well established risk factors and are potentially amenable to intervention.Item The PRAISE! Project: A Church-Based Nutrition Intervention Designed for Cultural Appropriateness, Sustainability, and Diffusion(2002) Ammerman, Alice; Washington, Chanetta; Jackson, Bethany; Weathers, Benita; Campbell, Marci; Davis, Gwen; Garson-Angert, Dan; Paige, Joseph, Sr.; Parks-Bani, Carol; Joyner, Margo; Keyserling, Thomas; Switzer, BoydCancer prevention research has inadequately reached the African American community despite a higher risk for cancer and many other chronic diseases. Reasons for this failure include historical mistrust of research and medical institutions; lack of culturally relevant interventions; and a failure to design and implement interventions that “ give back” to the community. The Partnership to Reach African Americans to Increase Smart Eating (PRAISE!) project is a National Cancer Institute-funded study that developed and tested a nutrition intervention program in partnership with African American churches. Sixty churches and over 1300 individuals participated in this 5 year randomized controlled trial. In this article, the authors describe the design and implementation of the PRAISE! intervention, building on the strengths of the African American church to create a community-university partnership to enhance cultural relevance of the intervention and foster the potential for long term sustainability and diffusion in the African American community.Item PRESCRIPTION FOR PENNSYLVANIA Right State Right Plan Right Now: STRATEGIC PLAN(2008) UNSPECIFIEDThe present system of providing health care was designed to treat acute illness, not control chronic diseases. In the face of rising levels of chronic disease and spiraling health care costs, governments, businesses, insurance companies and Pennsylvania families have, out of necessity, chosen to limit health care services, benefits and visits as ways of fighting expenses. Evidence is mounting around the country that exactly the opposite approach to chronic disease is more successful. Early, consistent and persistent health care intervention for those with chronic disease will likely be more cost-effective and will dramatically improve the quality of life for anyone with chronic disease. In May 2007 the Pennsylvania Chronic Care Management, Reimbursement and Cost Reduction Commission was created and its first requirement was to develop a strategic plan for a Chronic Care Model to improve the quality of care while reducing avoidable illnesses and their attendant costs. This report is part of that requirement.Item Perspectives on American Indian Health(2002) Roubideaux, Yvette, MD, MPHAmerican Indians and Alaska Natives continue to experience significant disparities in health status compared with the US general population and now are facing the new challenges of rising rates of chronic diseases. The Indian health system continues to try to meet the federal trust responsibility to provide health care for American Indians and Alaska Natives despite significant shortfalls in funding, resources, and staff. New approaches to these Indian health challenges, including a greater focus on public health, community-based interventions, and tribal management of health programs, provide hope that the health of Indian communities will improve in the near future.