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The world's two most populous countries, China and India, are undergoing dramatic demographic, societal, and economic transformations. However, the health status of residents of China and India still lags behind relative to other populations, and the health gains in each country have been uneven across subpopulations. Although they have achieved substantial advances in life expectancy and disease prevention since the middle of the 20th century, the Chinese and Indian health systems provide little protection against financial risk, and patient satisfaction is a lower priority than it should be. This paper compares the health systems of China and India to determine what approaches to improving health in these two countries do and do not work. In particular, the authors compare the health systems in China and India along three dimensions: policy levers, intermediate outcomes, and ultimate ends. The authors conclude that both countries must (1) restructure health care financing to reduce the burden of out-of-pocket medical care costs on individual patients; (2) increase access to care, especially in rural areas; (3) reduce dependence on fee-for-service contracts that promote overutilization of medical care; (4) build capacity for addressing and monitoring emerging diseases; and (5) match hospital capabilities with local needs.

Praise for the first edition:“This book is exemplary in amassing demographic, policy, and sociopsychological data from around the world… The content of the book is rich with current information seldom accumulated into one sourceI recommend this volume to gerontologists, aging studies undergraduate and graduate students… demographers, and global studies scholars.”Dr. Carol A. Gosselink, PsycCritiquesWritten by leading scholars, this esteemed text on global aging is distinguished by its unique perspective on universal similarities and sociocultural differences across nations. Fully revised, updated, and reorganized, the second edition presents comprehensive coverage of major topics in social gerontology and expands its treatment of health behavior, health care, families, caregiving, older workers, and retirement. It delivers new information on living environments, religious beliefs and practices; environmental threats; cross-cultural views of dementia; ageism in advertising; age-friendly communities; global immigration and cultural assimilation, and end-of-life caregiving.The second edition also offers additional case studies, first-person narratives and focused essays to enhance core material and a greater number of non-Western contributors. The topical essays reflect changing mores and current issues affecting societies and the aging experience. Discussion questions conclude each chapter, and an Instructor's Manual and PowerPoint slides are available to instructors. Print version of the book includes free, searchable, digital access to entire contents.New to the Second Edition:Expanded content on health beliefs and health behavior, religious belief and practice, environmental threats, housing and living environments, physical security, consumer control of health care, family life, and moreAdditional topics on global immigration and cultural assimilation, age portrayals in advertising, voluntarism, and the use of social media in caregivingAbundant new and expanded essaysNew case studies and first-person narrativesMany more non-Western contributorsKey Features:Delivers comprehensive coverage of major topics in gerontologyUses a unique comparative, cross-national perspectiveAuthored by world-renowned aging scholarsIncludes case studies/essays/personal narratives to enliven core informationProvides the most comprehensive demographic data on aging around the world

This book focuses on the issues encountered by children and young people who are living with HIV/AIDS. It examines their lived experiences associated with HIV/AIDS, and studies groups of children and youngsters from around the globe. Connecting empirical information with real-life situations, the book brings together results from empirical research that relates to these children and young people. Its chapters can be used as evidence for health care providers to implement socially and culturally appropriate services to assist individuals and groups of children and young people who are living with HIV/AIDS in many societies. Many of these young people are from the most marginalized and vulnerable groups; and many have been orphaned by the death of their HIV-positive parents. Marginalized young people such as refugees, migrants and street children are most at risk due to the use of illicit drugs, their exposure to unprotected sex (in exchange for food, money and protection), and stigma associated with their marginalized lives. The impact that HIV/AIDS has on the opportunities for these young people to be able to lead healthy adult lives is considerable. This book gives a voice to these children and young people and advances our understanding of their lived experiences and needs.

In Baltimore's inner-city neighborhood of Upton/Druid Heights, a man's life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world.In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years of a maternal-related cause; in Italy, the figure is one in 17,100; but in the United States, which spends more on healthcare than any other country in the world, it is one in 1,800 (and now, with the new administration chipping away at Obamacare, the statistics stand to grow even more devastating). Why?Dramatic differences in health are not a simple matter of rich and poor; poverty alone doesn't drive ill health, but inequality does. Indeed, suicide, heart disease, lung disease, obesity, and diabetes, for example, are all linked to social disadvantage. In every country, people at relative social disadvantage suffer health disadvantage and shorter lives. Within countries, the higher the social status of individuals, the better their health. These health inequalities defy the usual explanations. Conventional approaches to improving health have emphasized access to technical solutions and changes in the behavior of individuals, but these methods only go so far. What really makes a difference is creating the conditions for people to have control over their lives, to have the power to live as they want. Empowerment is the key to reducing health inequality and thereby improving the health of everyone. Marmot emphasizes that the rate of illness of a society as a whole determines how well it functions; the greater the health inequity, the greater the dysfunction.Marmot underscores that we have the tools and resources materially to improve levels of health for individuals and societies around the world, and that to not do so would be a form of injustice. Citing powerful examples and startling statistics (“young men in the U.S. have less chance of surviving to sixty than young men in forty-nine other countries”), The Health Gap presents compelling evidence for a radical change in the way we think about health and indeed society, and inspires us to address the societal imbalances in power, money, and resources that work against health equity.

'Punchily written … He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed'Times Literary Supplement'Splendid and necessary'Henry Marsh, author of Do No Harm, New StatesmanThere are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor.A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

Breastfeeding is an intimate and deeply rooted bodily practice, as well as a highly controversial sociocultural process which invokes strong reactions from advocates and opponents. Touching on a wide range of issues such as reproduction, sexuality, power and resources, and maternal and infant health, the controversies and cultural complexities underlying breastfeeding are immense.Ethnographies of Breastfeeding features the latest research on the topic. Some of the leading scholars in the field explore variations in breastfeeding practices from around the world. Based on empirical work in areas such as Brazil, West Africa, Darfur, Ireland, Italy, France, the UK and the US, they examine the cross-cultural challenges facing mothers feeding their infants.Reframing the traditional nature/culture debate, the book moves beyond existing approaches to consider themes such as surrogacy, the risk of milk banks, mother-to-mother sharing networks facilitated by social media, and the increasing bio-medicalization of breast milk, which is leading its transformation from process to product. A highly important contribution to global debates on breast milk and breastfeeding.

This comprehensive text is unique in its compilation of experiences in addressing the global diabetes epidemic and description of diverse worldwide prevention initiatives. Background chapters describe the diagnosis and definition of diabetes, the epidemiology, pathophysiology of prediabetes as well as clinical trial evidence for diabetes prevention and treatment. Furthermore, the critical role of government in formulating a global health agenda, policy perspectives for European initiatives, the importance of nutritional policies for diabetes prevention as well as the development of the necessary capacity and infrastructure for diabetes prevention are described. Given the prevalence of diabetes in South Asians and migrants, one chapter focuses on risk factors and prevention of diabetes in these communities. Other chapters detail local and regional approaches covering a truly global span: United States, Latin America, Europe, India, Turkey, (Siberia) Russia, the Middle East and North Africa, South Africa, Israel, East Asia and Australia.Authored by academic experts in endocrinology and diabetes and global leaders in epidemiology and public health, this landmark text is an authoritative reference for a diverse audience including government, public health and policy experts and researchers, academicians, healthcare professionals, endocrinologists and clinicians interested in prediabetes and diabetes prevention, graduate students and faculty in public and global health graduate programs, epidemiologists, nutritionists, sociologists and those in translational medicine. Readers will broaden their awareness of the prevailing and burgeoning diabetes epidemic and the remarkably creative worldwide prevention initiatives undertaken to address the seemingly insurmountable inherent challenges posed by this global health care crisis. The text is an attestation to the wonderful potential for enormous human collaboration and achievement when communal organizations, governments at local, regional and national levels, researchers, the medical and public health communities, and nutrition experts join with global citizenry in confronting one of the most significant healthcare challenges witnessed in this century.

This volume deals with strategies aimed at increasing psychological well-being in both clinical and non-clinical settings, with a special focus on the impact of cross-cultural influences on these processes. Consisting of two parts, the book first examines clinical interventions for increasing well-being and positive functioning in adult populations. It looks at cultural differences in the experience of psychological well-being, presents an analysis of the concept of psychological well-being and discusses various interventions, including Well-Being Therapy and Cognitive Behavioral Therapy. Other concepts discussed are post-traumatic growth, wisdom and motivation.The second part of the book deals with psychological interventions in childhood and adolescence and has a strong emphasis on educational settings. It provides an overview of the main evidence-based psychotherapies for affective disorders in youths, and looks at the importance and impact of positive education, resilience, and hope. The book presents models for intervention and discusses several therapies in detail.

Up until now, many articles have been written to portray stigma and discrimination which occur with people living with HIV/AIDS (PLWHA) in many parts of the world. But this is the first book which attempts to put together results from empirical research relating to stigma, discrimination and living with HIV/AIDS. The focus of this book is on issues relevant to stigma and discrimination which have occurred to individuals and groups in different parts of the globe, as well as how these individuals and groups attempt to deal with HIV/AIDS. The book comprises chapters written by researchers who carry out their projects in different parts of the world and each chapter contains empirical information based on real life situations. This can be used as an evidence for health care providers to implement socially and culturally appropriate services to assist individuals and groups who are living with HIV/AIDS in many societies. The book is of interest to health care providers who have their interests in working with individuals and groups who are living with HIV/AIDS from a cross-cultural perspective. It will be useful for students and lecturers in courses such as anthropology, sociology, social work, nursing, public health and medicine. In particular, it will assist health workers in community health centres and hospitals in understanding issues related to HIV/AIDS and hence provide culturally sensitive health care to people living with HIV/AIDS from different social and cultural backgrounds. The book is useful for anyone who is interested in HIV/AIDS-related stigma and discrimination in diverse social and cultural settings.

In Fevered Measures, John Mckiernan-González examines public health campaigns along the Texas-Mexico border between 1848 and 1942 and reveals the changing medical and political frameworks U.S. health authorities used when facing the threat of epidemic disease. The medical borders created by these officials changed with each contagion and sometimes varied from the existing national borders. Federal officers sought to distinguish Mexican citizens from U.S. citizens, a process troubled by the deeply interconnected nature of border communities. Mckiernan-González uncovers forgotten or ignored cases in which Mexicans, Mexican Americans, African Americans, and other groups were subject to—and sometimes agents of—quarantines, inspections, detentions, and forced-treatment regimens. These cases illustrate the ways that medical encounters shaped border identities before and after the Mexican Revolution. Mckiernan-González also maintains that the threat of disease provided a venue to destabilize identity at the border, enacted processes of racialization, and re-legitimized the power of U.S. policymakers. He demonstrates how this complex history continues to shape and frame contemporary perceptions of the Latino body today.

During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages—cancer and cardiovascular disease—available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which—unlike randomized controlled trials—are subject to many biases.

As the world's population expands, so too does the risk of communicable disease and global pandemics. Consequently, healthcare has assumed a greater centrality in the public consciousness both in the United States and around the world. With various national and international organizations dedicated to epidemiological research and disease control, societal welfare has become an increasingly significant aspect of public policy. The historical, legal, and scientific factors that form the basis of public health locally and globally are the subjects of this relevant and revealing volume.

It's natural... It's unsightly... It's normal... It's dangerous. To breastfeed or not? For millions of women around the world, this personal decision is influenced by numerous social, cultural, and health factors. Infant Feeding Practices is the first book to delve into these factors from a global perspective, revealing striking similarities and differences from country to country. Dispatches from Asia, Australia, Africa, the U.K., and the U.S. explore as wide a gamut of salient issues affecting feeding practices as traditional beliefs about colostrums, “breast is best” campaigns, partner attitudes, workplace culture, direct government intervention, and the pressure to be a “good mother.” Throughout these informative pages, women are seen balancing innovation and tradition to nurture healthy, thriving babies. A sampling of topics covered: •Policy versus practice in infant feeding. •Infant feeding in the age of AIDS. •Managing the lactating body: the view from the U.S. •Motherhood, work, and feeding. •The effects of migration on infant feeding. •From breastfeeding tradition to optimal breastfeeding practice. Infant Feeding Practices is a first-of-its-kind resource for researchers and practioners in maternal and child health, public health, global health, and cultural anthropology seeking empirical findings and culturally diverse information on this sensitive issue.

In a world now filled with more people who are overweight than underweight, public health and medical perspectives paint obesity as a catastrophic epidemic that threatens to overwhelm health systems and undermine life expectancies globally. In many societies, being obese also creates profound personal suffering because it is so culturally stigmatized. Yet despite loud messages about the health and social costs of being obese, weight gain is a seemingly universal aspect of the modern human condition. Grounded in a holistic anthropological approach and using a range of ethnographic and ecological case studies, Obesity shows that the human tendency to become and stay fat makes perfect sense in terms of evolved human inclinations and the physical and social realities of modern life. Drawing on her own fieldwork in the rural United States, Mexico, and the Pacific Islands over the last two decades, Alexandra A. Brewis addresses such critical questions as why obesity is defined as a problem and why some groups are so much more at risk than others. She suggests innovative ways that anthropology and other social sciences can use community-based research to address the serious public health and social justice concerns provoked by the global spread of obesity.

Description based on print version record.

Why are some societies more successful than others at promoting individual and collective well-being? This book integrates recent research in social epidemiology with broader perspectives in social science to explore why some societies are more successful than others at securing population health. It explores the social roots of health inequalities, arguing that inequalities in health are based not only on economic inequalities, but on the structure of social relations. It develops sophisticated perspectives on social relations, which emphasize the ways in which cultural frameworks as well as institutions condition people's health. It reports on research into health inequalities in the developed and developing worlds, covering a wide range of national case studies, and into the ways in which social relations condition the effectiveness of public policies aimed at improving health.

This book offers a timely account of health reform struggles in developed democracies. The editors, leading experts in the field, have brought together a group of distinguished scholars to explore the ambitions and realities of health care regulation, financing, and delivery across countries. These wide-ranging essays cover policy debates and reforms in Canada, Germany, Holland, the United Kingdom, and the United States, as well as separate treatments of some of the most prominent issues confronting policy makers. These include primary care, hospital care, long-term care, pharmaceutical policy, and private health insurance. The authors are attentive throughout to the ways in which cross-national, comparative research may inform national policy debates not only under the Obama administration but across the world.

Noted researchers, educators, and clinicians, from a wealth of backgrounds, introduce y ou to 30 population groups from around the globe. Each contributor uses the Purnell 12-step model to explore a cultural group, and examine the implications of each step on the delivery of health care. Their in-depth understanding of these societies brings you personal perspectives you will find nowhere else.

Health targets can help to improve the governance of health systems. They express a commitment to achieve specified outputs over a defined period, and allow progress towards broad goals and objectives to be monitored.They may be quantitative or qualitative, and based on outcomes or processes.This book draws on a series of case studies on the use of health targets, written by experts from Catalonia (Spain), England (United Kingdom), Flanders (Belgium), France, Germany, Hungary and the RussianFederation. It reviews the major technical, managerial and political challenges of defining and implementing health targets. While they help focus attention on agreed goals, to realize their potential they need to be based on evidence, accepted by those who work to achieve them, be embedded in frameworks of mutual accountability, linked to appropriate incentives and/or sanctions and supported by an adequate intelligence infrastructure.The experiences of these countries and regions can serve as examples to all those in government who strive to improve the performance of their health systems.

Culture, Health and Illness is the leading international textbook on the role of cultural and social factors in health, illness, and medical care. Since first published in 1984, it has been used in over 40 countries within universities, medical schools and nursing colleges. This new edition meets the ever-growing need for a clear starting point in

As we approach the 25th anniversary of the first recognition of HIV/AIDS in 1981, this book reflects on the international impact of the disease. It has persistently remained a global issue, with more than 50 million people worldwide estimated to have been infected since that date. This ambitious book, written by 165 authors from 30 countries, offers a multi-country comparative study that examines how the response to the common, global threat of HIV is shaped by the history, culture, institutions and health systems of the individual countries affected. Increasingly the shift of health systems has been from prevention only as the main containment strategy, to a strategy that includes scaling up HIV treatment, and care and prevention services, including antiretroviral therapy. Thus, all parts of the health system must be involved; policy makers, healthcare professionals and users of the services have been forced to think differently about how services are financed, how resources are allocated, how systems are structured and organized, how services are delivered to patients, and how the resulting activity is monitored and evaluated in order to improve the effectiveness, efficiency, equity and acceptability of the response. This book is unique in attempting to describe and assess a range of responses across the globe by situating them within the characteristics of each country and its health system. Most chapters combine a health policy expert with an HIV specialist, allowing both a'top down'health system approach and a'bottom up'HIV-specific perspective. There are thematic and analytical sections, which provide an overview and some suggestions for solutions to the most serious outstanding issues, and chapters which analyse specific country and organisational responses. There is no perfect health system, but the evidence provided here allows the sharing of knowledge, and a opportunity to assess the impact and reactions, to an epidemic that must be considered a long term issue.

This new edition provides up-to-date statistics and fresh analysis of changing trends in immigration, describes ethno-cultural community, discussing such issues as childbirth, mental illness, dental care, hospitalization, and death, as well as home country culture, common reasons for emigrating, and challenges in adjusting to a new culture.

'Dr. Gauld's collection of case studies is informativeand accessible. I would recommend it as acentral text for a course in comparative healthsystems.'Political Studies ReviewBased upon research from eight countries in the Asia-Pacific – Australia, China, Hong Kong, Japan, New Zealand, Singapore, South Korea, Taiwan – this book analyses and compares their differing health policies. Key issues the book probes include: ·The ways that health care is financed and delivered across the region ·The historical and institutional arrangements that impact upon health policy and health care·How the health systems differ between the countries under study·How policymakers and service providers deal with unlimited demand and limited funding and issues such as service coverage and quality ·How pharmaceuticals and population health strategies are managed ·What the roles of the state and various other players (such as the private sector and professional associations) are in the making of health policy and delivery of health care ·The challenges that lie ahead for health care and health policy in the regionComparative Health Policy in the Asia-Pacific is key reading for students, researchers and policy makers with an interest in health policy. It is relevant to those studying medicine and health studies, anthropology, history, sociology, public policy, politics and Asian studies.

The ability to communicate effectively with cancer patients and their family members has been linked to patient satisfaction, reduced psychological morbidity, enhanced health and reduced clinician'burn-out'. Yet, despite what we know about the benefits of effective communication, cancer clinicians have only recently begun to receive routine training in the psychosocial and emotional aspects of cancer patient care. This volume creates a multi-disciplinary dialogue about clinician-patient communication. It offers a description of the relevance of culture as a contextual effect that impacts the clinician-patient relationship. Some important topics addressed include: -Oncology care; -Quality of life issues; -Supportive survivorship; -Cultural differences in health care; -Multidisciplinary medical approaches. This book is for physicians, nurses, hospice and palliative care professionals and public health professionals who would like to understand the ways we can improve clinician-patient communication in culturally diverse medical settings. It is also suitable for graduate level courses in medical education, oncology, and health care.

Just and Lasting Change presents how to transform communities rapidly and inlocally appropriate ways. Daniel Taylor-Ide and Carl Taylor have been present at key events and worked with key thinkers in dealing with the large forces of inequity, environmental change, and globalization. The approach they have synthesized builds on what has worked over the last century—and can now be implemented rapidly and cost-effectively in many parts of the world. It relies on a three-way partnership of'bottom-up'initiatives from the community level,'top-down'support from government agencies, and'outside-in'ingenuity and objectivity from experts. Based on both a diverse range of case studies—from the earliest attempts to promote social development in India a century ago to current efforts in Tibet, the Peruvian Andes, China, and the American Southwest—and engaging personal experiences, this book describes, step-by-step, how SEED-SCALE can be effectively implemented.With contributions from leading international experts in community-based development and public health, Just and Lasting Change offers a hopeful description of how people have made a difference in diverse communities around the world and a practical, accessible handbook for those trying to improve the quality of life in underdeveloped communities everywhere.

There is a growing sense that the'health gap'between socioeconomic groups is getting worse in many countries. To address this gap, conceptual clarity and empirical evidence are needed along with a greater focus on equity in policy-making. This book is designed to present cutting-edge research and policy analysis to a wide non-specialist readership of students, professionals and policy-makers. It brings together in one volume new perspectives on the conceptual foundations of health equity, empirical evidence on the scale and nature of he inequities in health in twelve countries around the world, and assessments of the associated policy developments and their implications for the future. It aims to help build global capacity to measure, monitor and interpret developments in health equity at a national and international level. The in-depth country analyses draw on epidemiology, demography, economics and other fields to approach health inequalities from several different angles. The topics covered range from adolescent livelihoods in Tanzania to the health burden of indigenous peoples in Mexico, from health equity in Japan to the gender gap in life expectancy in Russia. The book is a unique demonstration of global cooperation in bringing together and giving equal weight to work on health equity carried out in the southern and northern hemispheres.

This publication focuses on street foods in selected developed and developing countries, including information on nutritional, economic, safety and regulatory aspects and comparing consumption patterns as well as the profiles of the street food vendor in different cultures. Street foods are inexpensive and available foods that in many countries form an integral part of the diet because they are consumed with regularity and consistency across all income groups, but particularly among the urban poor and, in some countries, children. International organizations have paid particular attention to the safety of street foods and much less to the composition and preservation of their nutritional quality. The street food trade is large and complex, providing an important means of generating income, particularly for women, and it is an affordable source of food for many millions of people. Street foods have therefore been considered as a way of reducing problems of urban food insecurity and as a possible vehicle for micronutrient supplementation. Scientists and policy makers in the areas of international health, nutrition, food and trade as well as physicians, nutritionists, dietitians, food scientists, anthropologists, sociologists will particularly benefit from this publication.

Health researchers routinely evaluate health and illness across subgroups defined by their sex, gender, ethnicity, and race. All too often, these classifications are proffered as an explanation for any differences that may be detected, for example, in access to care, frequency of disease, or response to treatment. Relatively few researchers, however, have examined what these classifications mean on a theoretical level or in the context of their own research. Assume, for example, that a researcher concludes from his or her data that African- Americans utilize certain surgical procedures less frequently than whites. This conclusion may mean little without an examination of the various underlying issues. Is there such a construct as race at all? How were whites and African-Americans classified as such? Does this finding reflect inappropriate overutilization of the specific procedures among whites or inappropriate underutilization among African-Americans? To what extent are socioeconomic status and method of payment related to the less frequent use? Are there differences in the manner in which health care providers present the various treatment options to whites and to African- Americans that could account for these differences in utilization? Are there differences in health care-seeking and health care preferences between the two groups that would explain the difference in utilization? Is the racial classification a surrogate measure for another variable that has remained unidentified and unmeasured? All too often, unfortunately, such issues are ignored or lightly dismissed with an entreaty for additional research.

The field of health psychology has grown dramatically in the last decade, with exciting new developments in the study of how psychological and psychosocial processes contribute to risk for and disease sequelae for a variety of medical problems. In addition, the quality and effectiveness of many of our treatments, and health promotion and disease prevention efforts, have been significantly enhanced by the contributions of health psychologists (Taylor, 1995). Unfortunately, however, much of the theo­ rizing in health psychology and the empirical research that derives from it continue to reflect the mainstream bias of psychology and medicine, both of which have a primary focus on white, heterosexual, middle-class American men. This bias pervades our thinking despite the demographic heterogeneity of American society (U. S. Bureau of the Census, 1992) and the substantial body of epidemiologic evidence that indicates significant group differences in health status, burden of morbidity and mortality, life expectancy, quality of life, and the risk and protective factors that con­ tribute to these differences in health outcomes (National Center for Health Statistics, 1994; Myers, Kagawa-Singer, Kumanyika, Lex, & M- kides, 1995). There is also substantial evidence that many of the health promotion and disease prevention efforts that have proven effective with more affluent, educated whites, on whom they were developed, may not yield comparable results when used with populations that differ by eth­ nicity, social class, gender, or sexual orientation (Cochran & Mays, 1991; Castro, Coe, Gutierres, & Saenz, this volume; Chesney & Nealey, this volume).