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Health disparities are pervasive in the United States. Health and health care disparities are the differences or gaps in health (eg, life expectancy, morbidity, risk factors, and quality of life) and health care access and quality between segments of the United States population as related to race/ethnicity and socioeconomic status (eg, income, education). Multiple factors are associated with such disparities in asthma management and education. This article explores some of those factors and summarizes the strategies developed and interventions implemented to address disparities associated with asthma care and education among racial and ethnic minority children. It also discusses the need for further research to identify effective asthma education approaches for improving the management of asthma among racial and ethnic minority children. More exploration of the root causes of health care disparities, including policy studies in the area of social determinates of health and health equity, is also needed.

Race, although an unscientific concept, remains prominent in health research and clinical guidelines, and is routinely invoked in clinical practice. In interviews with 58 primary care clinicians we explored how they understand and apply concepts of racial difference. We found wide agreement that race is important to consider in clinical care. They explained the effect of race on health, drawing on common assumptions about the biological, class, and cultural characteristics of racial minorities. They identified specific race-based clinical strategies for only a handful of conditions and were inconsistent in the details of what they said should be done for minority patients. We conclude that using race in clinical medicine promotes and maintains the illusion of inherent racial differences and may result in minority patients receiving care aimed at presumed racial group characteristics, rather than care selected as specifically appropriate for them as individuals. [race and genetics, primary care, health disparities, racial profiling]

Race and socioeconomic status (SES) health disparities imply massive impact in terms of unequal suffering and dramatic social and economic costs. It is clear that status differences in the availability, use, and effectiveness of medical care and in a variety of health behaviors are implicated in these disparities. However, it is equally clear that adjustments for these differences leave the majority of race and SES health disparities unexplained. Despite wide acceptance of the idea that differences in stress exposure may contribute importantly to such disparities, it is contended that the stress hypothesis has never been effectively tested because of misclassification in the distinction between the disordered and the well and the inadequate estimation of differences in exposure to social stressors. This article reviews the empirical basis for this contention and describes an ongoing community study designed to more effectively evaluate the hypothesis that lifetime stress exposure represents a fundamental factor in observed race and SES health disparities. It is suggested that the application of aspects of the approach described may advance the capacity of future research to fully evaluate the mental health significance of the stress process.

Child health is fundamental to well-being and achievement throughout the life course. Prior research has demonstrated strong associations between familial socioeconomic resources and children 's health outcomes, with especially poor health outcomes among disadvantaged youth who experience a concentration of risks, yet little is known about the influence of maternal health as a dimension of risk for children. This research used nationally representative U.S. data from the National Health Interview Surveys in 2007 and 2008 (N = 7,361) to evaluate the joint implications of maternal health and socioeconomic disadvantage for youth. Analyses revealed that maternal health problems were present in a substantial minority of families, clustered meaningfully with other risk factors, and had serious implications for children 's health. These findings support the development of health policies and interventions aimed at families.Key Words: child well-being, family health, inequality, intergenerational, parenting.Understanding the social factors that underlie disparities in children's health is of major concern to scholars of inequality. Poor health in childhood can contribute to a trajectory of relatively low attainment and well-being later in life. Children with serious health problems are more likely to drop out of school, have health problems in adulthood, and earn lower incomes than their healthy counterparts (Case & Paxson, 2006). Identifying the sources of child health disparities is essential to the development of effective policies and programs to reduce inequalities in children's development and achievement over the life course.Prior research has demonstrated unequivocally that the social and economic resources of children's families are critical to their health. Family members share economic resources, home and community environments, and social networks, all of which have an impact on health. Family income is related linearly to children's overall health (Case, Lubotsky, & Paxson, 2002) , and low parental education and growing up in a single-parent family increase the likelihood that children will experience poor health outcomes (Bauman, Silver, & Stein, 2006; Montgomery, Kiely, & Pappas, 1996). These factors operate on children's physical and mental health in an additive fashion (Bauman et ah; Evans, 2003) and influence various health outcomes in a similar manner (Braveman, Cubbin, Egerter, Williams, & Pamuk, 2010; Currie & Lin, 2007).Apart from identifying inheritable genetic traits, less attention has been paid to linkages between parental health and children's well-being. We propose that parents' health is an additional dimension of family inequality that contributes to disparities in children's health, and we tested this proposition using data from the 2007 and 2008 National Health Interview Surveys (NHIS; see http://www.cdc.gov/nchs/nhis.htm). We first show how socioeconomic and health disparities cluster within families. We then employ multivariate models to examine disparities in children's health, showing how socioeconomic and health risk profiles are correlated with children's health outcomes. Our analysis makes several contributions to the literatures on multiple risks, family health, and social inequality. First, our use of latent class analysis (LCA) to show how socioeconomic and health disadvantages cluster within families provides unique insight into the distribution of risk in American families. As expected, we found groups of mothers who face socioeconomic disadvantages only, health disadvantages only, both disadvantages, and neither. We also found a significant proportion of mothers who had limited access to socioeconomic resources and health care but did not report health problems, and a smaller group, composed mostly of disadvantaged single mothers who smoked, had limited access to health care, and a slight elevation in the risk of depression but few other health disadvantages. …

Despite the subjectivity inherent in individuals' interpretation of good health, self-reported health is widely used in health-related studies. With data from the pilot survey of the new China Health and Retirement Longitudinal Study, this paper applies the vignette method to control for differences in individual response scales and examines regional differences in self-reported health among the elderly in China. The results show that people in different provinces seem to use different criteria when assessing their health conditions. Regional health disparities are underestimated if differentials in response scales are not accounted for. A substantial share of the disparities cannot be explained by the observed differences in respondents' chronic health condition, demographic characteristics, and household wealth, a finding confirmed by a test based on inpatient-care information. Copyright © 2013 John Wiley & Sons, Ltd.

The purpose of this paper is to describe health profiles of adolescents in foster care. The Child Health and Illness Profile-Adolescent Edition clustered adolescents in foster care into 13 mutually exclusive health profiles using dimensions of satisfaction with health, risks, resilience, and discomfort. Health profiles were further characterized into four health status rankings from best to worst health status. Many reported best health status (39%); nearly equal numbers (30.6%) had profiles indicating poor or worst health status, particularly girls and those with high risk behaviors, aggression, sexual abuse, or suicidality. It is valuable to identify health characteristics of the most vulnerable subgroups of foster youth to tailor specific interventions.

In this article the authors survey the evidence for the role of gender in health status analyze responses to gender by key global health actors and propose strategies for mainstreaming gender-related evidence into policies and programs. Using the WHO definition of gender the article attempts to disentangle and quantify the exact contributions that sex and gender make to health status which often interact with other social determinants of health. The authors analyzed the recent Global Burden of Disease (GBD) from a gender perspective. Data from this study are intended to help policy makers to set priorities and allocate resources according to population health needs. Evidence shows that gender – a social construct – has a substantial effect on health behaviors access to health care and health system responses. The tendency to underplay or misunderstand the role of gender or to equate the gender dimensions of health solely with the specific health needs of women has led to a failure to address the evidence of gendered determinants that affect and drive the burden of ill health of both men and women.

Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area’s organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.

Background In human beings, dark skin requires more exposure to ultraviolet light to synthesize the same amount of vitamin D as lighter skin. It is has been repeatedly shown that at the latitude of the United States there are vitamin D disparities related to skin color. Although inadequate vitamin D status and health disparities have been associated with many of the same diseases, neither nutrition policy nor public health policy in the United States currently recognizes any role at all for vitamin D as a determinant of health disparities. Objective This study investigated the relationship between health, skin color, and vitamin D nutriture in the US population. Design The design is cross-sectional, correlational, and can be generalized to the population of the United States. Participants We used data from 12,505 (unweighted) subjects (3,402 non-Hispanic blacks, 3,143 Mexican Americans, and 5,960 non-Hispanic whites), aged 13 years or older, from the continuous National Health and Nutrition Examination Survey 2003-2006. Main outcome measure Self-rated health, a repeatedly validated indicator of objective health status, was used as a continuous measure of health. Statistical analyses performed Using software appropriate for the complex survey design of the National Health and Nutrition Examination Survey, the study consisted of six regression models, one predicting vitamin D status and five predicting self-rated health. Results Controlling for the covariates sex, interview language, country of birth, tobacco use, age, body mass index, and leisure exercise as well as the socioeconomic variables education and family income, remaining disparities in self-rated health are greatly reduced or eliminated by controlling for serum 25-hydroxyvitamin D levels. Conclusions We found that socioeconomic factors are the strongest determinant of skin-color based health disparities in the US population, but that it may not be possible to eliminate health disparities in the United States without eliminating the skin-color–related disparities in vitamin D nutriture.

Nurse researchers need to be able to identify the race and ethnicity of participants in their studies for several reasons including addressing health disparities, ensuring adequate representation from under-represented minorities, and making sure other nurses can understand how findings may or may not pertain to their own patient population. However, obtaining accurate information about race and ethnicity requires careful attention to norms of study participants. Race and ethnicity are not always viewed as 2 separate constructs and the definition of both changes over time. In fact, a random sample of 100 patients in 1 hospital found an 11% discrepancy between patients’ self-identification of race using 2 different methodologies of self-identification. To optimize accuracy of self-identification of race and ethnicity, this paper discusses techniques learned in practice and in the literature for improving self-identification of these 2 constructs.

Healthcare treatment differences persist for African Americans even after controlling for socioeconomic status (van Ryn and Burke 2000). Although blacks represent a sizable percentage of the middle class, most disparities research does not address class heterogeneity. Furthermore, research indicates patient–provider race concordance may mitigate racial disparities in health care (Laveist and Neru-jeter in J Health Soc Behav 43(3):296–306, 2002; IOM in Unequal treatment: confronting racial and ethnic disparities in health care. National Academies Press, Washington, 2002). This study explores race and gender preference for black middle-class women in healthcare settings. The study uses in-depth interviews and focus groups to explore the experiences of thirty African American women between 38 and 67 in a large urban area. The majority of respondents expressed a strong preference for a female OB/GYN (of any race) while 9 preferred a female primary care provider (of any race). Although the women did not express an explicit race preference, they had a strong affinity for black female providers. Importantly, respondents complicated the idea of provider-level race preference by noting that other site-level factors like wait times and the site’s racial composition affected their racial preferences. Although increasing racial diversity among providers is generally positive, respondents suggest that alone will not ameliorate racial disparities. The complexities of the healthcare encounter, including time pressure, clinical uncertainty, and the patient’s desire for expertise regardless of race or gender, all impinge on respondents’ race preferences. Lastly, women noted that site-level factors may be conflated with the race of provider such that having a black provider does not necessarily lead to better care or protect women from discrimination or bias.

Knowledge from human genetic research continuously challenges the notion that race and biology are inextricably linked, with implications across biomedical and public health disciplines. However, biomedical research continues to explore health and disease under a racial framework ignoring and at times confounding the identification of true biological and/or environmental risk factors. Within this article, we present a brief overview of the use of race in biomedical research and studies of human genome variation and how genetic ancestry may help us understand health disparities. We believe that the casual use of “race” to define groups in biomedical research has contributed to our limited understanding of complex disease etiology and risk factors driving health disparities.

Study objective To determine whether patients with sickle cell disease (SCD) experience longer wait times to see a physician after arrival to an emergency department (ED) compared to patients with long bone fracture and patients presenting with all other possible conditions (General Patient Sample), and to attempt to disentangle the effects of race and disease status on any observed differences. Methods A cross-sectional, comparative analysis of year 2003 through 2008 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative sample of nonfederal emergency department visits in the United States. Our primary outcome was wait time (in minutes) to see a physician after arrival to an ED. A generalized linear model was used to examine ratios of wait times comparing SCD visits to the two comparison groups. Results SCD patients experienced wait times 25% longer than the General Patient Sample, though this difference was explained by the African-American race of the SCD patients. SCD patients waited 50% longer than did patients with long bone fracture even after accounting for race and assigned triage priority. Conclusions Patients with SCD presenting to an ED for care experience longer wait times than other groups, even after accounting for assigned triage level. The African-American race of the SCD patients, and their status as having SCD itself, both appear to contribute to longer wait times for these patients. These data confirm patient anecdotal reports and are in need of intervention.

A autoavaliação do estado de saúde é um importante indicador da percepção de saúde. Este estudo visa investigar a associação entre autoavaliação de saúde e fatores sociodemográficos, hábitos de vida e morbidade na população brasileira. Trata-se de estudo seccional, baseado num inquérito nacional, que avaliou 12.324 indivíduos, nas cinco regiões geográficas do país. Foram aplicados modelos de regressão para avaliar a associação entre o desfecho, avaliado de forma dicotômica, e variáveis de exposição: sexo, idade, renda, escolaridade, raça, situação conjugal, tabagismo, atividade física, consumo de álcool, presença de morbidade crônica e índice de massa corporal. O aumento da idade, possuir baixos níveis de escolaridade e renda, tabagismo, sedentarismo, presença de morbidade crônica e obesidade foram os principais fatores associados à autoavaliação ruim. A identificação das características da população que estão associadas a um pior estado de saúde percebido pode contribuir para traçar um perfil dos indivíduos mais propensos a procurar os serviços de saúde. Self-rated health is an important indicator used to measure health perception. This study aimed to investigate the association between self-rated health and social and demographic factors, health behavior, and morbidity. This was a cross-sectional study based on data from a national health survey. The sample consisted of 12,324 individuals from Brazil's five major geographic regions. Regression analyses were conducted to verify the association between the outcome and the following independent variables: gender, age, income, education, race, marital status, smoking, alcohol consumption, physical activity, chronic illnesses, and body mass index. Increasing age, low education and income, smoking, sedentary habits, chronic illness, and obesity were the factors most strongly associated with worse self-rated health. The identification of population attributes associated with worse self-rated health can help trace a profile of individuals more prone to seeking health services. La autoevaluación del estado de salud es un importante indicador de la percepción de salud. Este estudio tiene por objetivo investigar la asociación entre autoevaluación de salud y factores sociodemográficos, hábitos de vida y morbilidad en la población brasileña. Se trata de un estudio seccional, basado en una encuesta nacional, que evaluó a 12.324 individuos, en las cinco regiones geográficas del país. Se aplicaron modelos de regresión para evaluar la asociación entre el desenlace, evaluado de forma dicotómica, y variables de exposición: sexo, edad, renta, escolaridad, raza, situación conyugal, tabaquismo, actividad física, consumo de alcohol, presencia de morbilidad crónica e índice de masa corporal. El aumento de la edad, poseer bajos niveles de escolaridad y renta, tabaquismo, sedentarismo, presencia de morbilidad crónica y obesidad fueron los principales factores asociados a una mala autoevaluación. La identificación de las características de la población que están asociadas a un peor estado de salud percibido puede contribuir para trazar un perfil de los individuos más propensos a procurar los servicios de salud.

Subjective life expectancy is a powerful predictor of a variety of health and economic behaviors. This research expands upon the life expectancy literature by examining the influence of familial health histories. Using a genetic/environmental model, we hypothesize that individuals’ assessments of their life expectancies will be linked to the health of first-degree and second-degree relatives, with same-sex relatives’ health exercising a stronger effect than that of opposite-sex relatives. Multivariate analyses based on data from a 2009 survey merged with familial health records ( N = 1,019) confirm that the health experiences of same-sex, first-degree relatives are linked to respondents’ subjective life expectancy. The relationship between the health experiences of second-degree relatives and subjective life expectancy is much less pronounced. These findings have the potential not only to inform our understanding of health behaviors but also to encourage communication between patients and health professionals aimed at promoting preventative behaviors.

Health disparities (differences in health by socioeconomic groups) are a pressing issue in our society. This article provides an overview of a multilevel approach that seeks to understand the mechanisms underlying health disparities by considering factors at the individual, family, and neighborhood levels. In addition, we describe an approach to connecting these factors to various levels of biological processes (systemic inflammation, cellular processes, and genomic pathways) that drive disease pathophysiology. In the second half of the article, we address the question of why some low-socioeconomic-status (low-SES) individuals manage to maintain good physical health. We identify naturally occurring psychosocial factors that help buffer these individuals from adverse physiological responses and pathogenic processes leading to chronic disease. What is protective for low-SES individuals is not the same as what is protective for high-SES individuals, and this needs to be taken into account in interventions aimed at reducing health disparities.

Crucial advances have been made in our knowledge of the social determinants of health and health behaviors. Existing research on health disparities, however, generally fails to address a known paradox in the literature: While blacks have higher risk of medical morbidity relative to non-Hispanic whites, blacks have lower rates of common stress-related forms of psychopathology such as major depression and anxiety disorders. In this article we propose a new theoretical approach, the Environmental Affordances Model, as an integrative framework for the origins of both physical and mental health disparities. We highlight early empirical support and a growing body of experimental animal and human research on self-regulatory health behaviors and stress coping that is consistent with the proposed framework. We conclude that transdisciplinary approaches, such as the Environmental Affordances Model, are needed to understand the origins of group-based disparities to implement effective solutions to racial and ethnic group inequalities in physical and mental health.

Low health literacy is an extensive problem in the United States. Approximately 80 million adults (36%) have limited health literacy.1, 2 Low health literacy is increasingly recognized as an important individual-level predictor of poor overall health and higher mortality among seniors.1, 3, 4 Research indicates those with low health literacy may have difficulty understanding, obtaining, and retaining health information.5 Low health literacy is also associated with under-utilization of preventive health care services, increased use of emergency services and hospitalizations, and worse physical functioning and mental health.1, 5–8 Broadly defined, the term “health literacy” encompasses an array of skills required to understand health and to function in a health care environment. The Institute of Medicine defined health literacy as the “degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding their health.”9 The American Medical Association states that health literacy is a “constellation of skills that constitute the ability to perform basic reading and numerical tasks for functioning in the health care environment and acting on health care information.”10 Health literacy has been found to be an important factor for cancer prevention and control.3, 11 Adults with limited literacy obtain less information from cancer prevention and control materials and may be less likely to be screened for cancer.11 For instance, a review of the literature found that low health literacy is associated with a lower probability of mammography screening.1, 4 Low literacy is also associated with a 1.6 times higher odds of being diagnosed at a later stage of prostate cancer and having an inadequate understanding of complex information about cancer.11, 12 Low health literacy may hinder cancer patients’ ability to understand consent forms, follow medication directions, and manage their disease.3, 5, 11 Previous research has examined the association between health literacy and sociodemographic factors, including income, education, racial and ethnic minority status, age, and recent immigration to the United States.1, 3, 5, 11, 13 Health literacy has also been associated with lack of insurance coverage.2 Results from the National Assessment of Adult Literacy (NAAL) showed that, among US adults without health insurance, 28% had low (below basic) health literacy.2 Relatively less attention has been paid to the relationship between health literacy and place of residence (urbanicity). Previous research has indicated that living in rural and non-metropolitan areas is associated with higher incidence of late-stage lymphoma and prostate cancer and lower survival rates among lymphoma patients.14, 15 Studies have shown that rural residence is also associated with lower cancer screening rates, later diagnosis stage, as well as a higher incidence of lung, prostate, colon, and cervical cancer in specific US regions.14, 16–18 Whether health literacy may explain, at least partially, these associations is unknown. Rural areas are disproportionately represented among US counties designated as medically underserved and have fewer physicians, specialists, and hospitals per capita than their urban counterparts.19, 20 One study reported no difference in health literacy between rural and urban residents.13 Instead, the results of that study suggested a U-shaped curve with lower literacy levels in urban and rural areas and higher health literacy in suburban areas.13 Characteristics typically associated with low health literacy (eg, poverty, inadequate or lack of health insurance, and the absence of a usual source of care) are more concentrated among residents of rural areas and could result in worse health outcomes and health care access for rural cancer patients independent of health literacy levels.18–20 Health literacy research has called for further investigation into sociodemographic characteristics as potential mediators, rather than confounders of relationships between health literacy and other variables such as health care utilization and health outcomes.6, 7 Cancer patients residing in medically underserved or rural areas may have lower income and education levels than patients in more urbanized areas. These socioeconomic factors could be associated with lower health literacy levels among rural patients compared to those living in more urbanized regions. Therefore, socioeconomic status could explain, at least to some extent, the relationship between rural residency and lower health literacy levels. This study attempts to fill the gaps in knowledge regarding the relationship between urbanicity and health literacy by a) investigating the association between rural residence and health literacy in a population-based sample of cancer patients in Wisconsin, and b) testing whether education, income, and other sociodemographic factors mediate this relationship.

Whereas determinants of self-assessed health status -subjective health are well scrutinized in developed countries, little is known about factors influencing how people appraise their own health in Sub-Sahara Africa. In the context of increasing burden of care due to high incidence of chronic diseases, poverty and social transformation this paper explores the predictors of self-appraised health status in Ghana. Using 2005–2008 wave of the World Values Survey, the authors employ parametric and ordered logistic regression techniques to assess the relative effect of economic, cultural, social capital, geographic, and demographic factors in molding subjective health among Ghanaians. The study reveals that cultural background has independent significant effect on subjective health over and above individual characteristics. The relative importance of cultural background in shaping subjective health is more significant and salient for Ewes compared to Akans. Income, age and satisfaction with life are noncultural variables that consistently emerged as predictors of subjective health among the respondents. Policy implications of the study are discussed echoing the need to adopt multidimensional approach to improving overall health paying attention to cultural background in the country. It is also suggested that more studies into the interplay between cultural background and social capital variables and subjective health are needed to untangle the rationale behind the association between culture and social capital and health status in the country. Future areas of research are also alluded to.

The effect of social determinants of health on depression prevalence and treatment access was examined using community survey and administrative data on mental health service users in the Calgary Health Region (CHR). Consistent with national prevalence data, depression was significantly associated with female gender, younger age, and health risk factors such as smoking, hypertension, and obesity. The prevalence of depression causing interference in daily functioning across 19 social districts (subregions within the CHR) was significantly related to community-level indicators of single-parent status, low-income families, and low educational achievement in each district. Disparities in treatment access were also found with persons living in the most impoverished districts having the lowest rates of accessing professional mental health services.

Race and socioeconomic status (SES) significantly affect the content and delivery of healthcare for multiple chronic disease states. Inflammatory bowel disease (IBD) is a set of complex, chronic diseases with the potential for significant morbidity if the content or delivery of healthcare is suboptimal. However, the literature related to race, SES, and IBD remains fragmented.Using guidelines published by the Centre for Reviews and Dissemination, we performed a systematic review of the world's literature to identify studies related to: 1) IBD, 2) race/ethnicity, 3) SES, 4) healthcare delivery, and 5) healthcare effectiveness.We identified 40 studies that met inclusion criteria. Twenty-four studies (60%) assessed the role of SES and 21 (53%) evaluated race. Topics addressed by these studies included: 1) Utilization of Medical and Surgical Therapy; 2) Adherence to Medical Therapy; 3) Clinical Outcomes; 4) Healthcare Access and Utilization; 5) Disease Perception and Knowledge; and 6) Employment/Insurance. We identified race- and SES-based disparities in the content of medical and surgical healthcare, utilization of inpatient and ambulatory medical care, adherence to medical therapy, and disease perceptions and knowledge. Several studies also identified race- and SES-based disparities in outcomes for IBD, including in-hospital mortality rates and health-related quality of life.Race- and SES-based disparities in the delivery and effectiveness of healthcare for patients with IBD exist in numerous domains, yet studies remain limited in their scope and breadth. Concerted, prospective, multicenter efforts are needed to address underlying causes for disparities and to identify methods of reducing and eliminating disparities.

Background: We compare disparities in health status between first- generation immigrants and others in the United States (US) and Canada. Methods: We used data from the Joint Canada-US Survey of Health. The regression models adjusted for demographics, socioeconomic status, and health insurance (the US). Results: In both countries, the health advantage belonged to immigrants. Fewer disparities between immigrants and those native-born were seen in Canada versus the US. Canadians of every immigrant/race group fared better than US native-born Whites. Discussion: Fewer disparities in Canada and better overall health of all Canadians suggest that societal context may create differences in access to the resources, environments, and experiences that shape health and health behaviors.

Discrimination is detrimental to health behaviors and outcomes, but little is known about which measures of discrimination are most strongly related to health, if relationships with health outcomes vary by race/ethnicity, and if coping responses moderate these associations. To explore these issues, the current study assessed race/ethnic differences in five measures of race/ethnic discrimination, as well as emotional and behavioral coping responses, within a population-based sample of Whites, African Americans, Mexicans, and Puerto Ricans (n = 1,699). Stratified adjusted logistic regression models were run to examine associations between the discrimination measures and mental, physical, and health behavior outcomes and to test the role of coping. Overall, 86 % of the sample reported discrimination. Puerto Ricans were more likely than Mexicans and Whites to report most types of discrimination but less likely than Blacks. Discrimination was most strongly related to depression and was less consistently (or not) associated with physical health and health behaviors. Differences by measure of discrimination and respondent race/ethnicity were apparent. No support was found to suggest that coping responses moderate the association between discrimination and health. More work is needed to understand the health effects of this widespread social problem. In addition, interventions attempting to reduce health disparities need to take into account the influence of discrimination.

OBJECTIVE: To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. METHODS: The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. RESULTS: The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence, standard of living, health insurance, and education largely contribute to the inequitable distribution of health care. CONCLUSIONS: Despite improvements in health care utilization patterns, income-related health and health care inequities prevail. Equity remains a challenge for Mexico.

There is increased emphasis on physician attention to the overall health and wellness of homosexual and bisexual men, though little is known about the health-related attitudes of these groups. This study determined factors associated with the health attitudes of homosexual and bisexual men and identified preferred sources of health information. For this study, the 2008 ConsumerStyles panel survey was used to create three health attitude scales and to determine factors associated with each scale. The three scales were labeled: (1) health motivation; (2) relationship with health care provider; and (3) self-perception of health literacy. In addition to other factors, higher scores for health motivation and relationship with health care provider were associated with black compared with white men. In contrast, lower scores for self-perception of health literacy were associated with black compared with white men. For information on an unfamiliar health condition, most homosexual and bisexual men chose the Internet. Black homosexual and bisexual men reported being motivated to be healthy and working well with their health care provider to manage their health. However, their perception of their own health motivation was low compared with the white men. Attempts to improve health literacy through Internet sites may be helpful in improving health attitudes and reducing negative health outcomes.

In 2002, the Institute of Medicine released its landmark report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.” This report led to increased efforts in identifying, assessing, and documenting racial and ethnic disparities in health care, as well as developing, testing, and implementing interventions in an attempt to reduce health disparities throughout the United States. This article reviews the rise of health disparities research in the United States and reports on selected studies and interventions developed by researchers at the Northwestern University Feinberg School of Medicine. These interventions have used communication and behavioral science theories and frameworks in their development and dissemination, particularly in the realm of clinical preventive medicine.

This paper presents the results of a 2010 survey exploring the determinants of rural mental health in two farming groups in Waterloo, Ontario, Canada: Old Order Mennonites (OOMs) and non-OOM farmers. Comparing these two groups reduces the likely impact of many contextual features impacting both groups, such as local economic conditions. We explore a comprehensive list of health determinants to assess their relative importance and thus enable policy action to focus on those having the greatest impact. The mental component summary (MCS) of the short- form health survey (SF-12) was used to measure mental health. We compare mental health in the two populations and use multiple regression to determine the relative importance of the determinants in explaining mental health. The results show that OOMs experience better mental health than non-OOMs, in part due to the strong mental health of OOM women. Coping, stress and social interaction shape mental health in both groups, reflecting the broader determinants literature and suggesting these are important across many populations with different life circumstances. Other determinants are important for one group but not the other, underscoring the diversity of rural populations. For example, different social capital measures shape mental health in the two groups, and sense-of-place is associated with mental health in only one group (OOMs). The results are discussed in terms of their implications for future health determinants research and policy action to address rural mental health.

Self-rated health (SRH)—a person’s subjective evaluation of his general health—is a more valid and powerful predictor of morbidity and mortality than any other combination of objective and self-reported measures. However, current theoretical frameworks fail to explain this association. Here, we sought to investigate SRH in relation to health outcomes from a transdisciplinary perspective. Using a selective review of epidemiological, clinical and qualitative SRH literature, we analyzed the relationships between this global subjective self-perception of health (the whole) and its directly measurable constituents (the parts). Although SRH often predicts major health outcomes, its underpinnings vary from person to person. Factors influencing individual’s health interact in complex ways evade reductionist methods assessing the parts, and may be best captured by global self-perceptions of health. The study of SRH from a transdisciplinary perspective exemplifies the notion that the whole is greater than the sum of its parts. Insight into individual’s experience of “health”, their association with physiological processes, and impact on the health/disease continuum may contribute to the development of individualized strategies for health care and promotion with aging. In particular, this should be most valuable for addressing non-communicable health conditions where cross-talk between health domains (biological, psychological, social, behavioral, spiritual) may significantly contribute to pathophysiology.

Health disparity exists in the United States despite the medical advances and technological strides throughout the nation. The Office of Minority Health was established to ensure all Americans have the opportunity to live long, healthy, and productive lives. The Office of Minority Health is leading the charge by addressing concerns, promoting awareness, and creating programs for the reduction of poor health outcomes. “Poor health outcomes for the minority population are apparent when comparing their health indicators against those of the rest of the United States. Minority groups experience higher rates of illness, preventable diseases, and deaths” (About OMH). The Office of Minority Health web site contains health care information related to the awareness and elimination of health disparity in the United States.

Objectives. We examined the interrelationships between ethnicity, gender, and caregiving on the health of older New Zealanders. We hypothesized that those providing higher levels of care and more care across time would have poorer health outcomes and that these relationships would be moderated by ethnicity and gender. Method. A representative sample of participants ( N = 2,155) aged 54–70 years from the first 2 waves of the New Zealand Health, Work and Retirement study completed postal surveys in 2006 and 2008. Caregiving questions were adapted from the Australian Women’s Health study, and health measures were derived from the SF36 Health Survey. Results. Women and M āori (indigenous New Zealanders) were more likely to provide care than men and nonMāori. Respondents providing higher levels of care reported poorer mental health and this was particularly true of Māori and female caregivers. Male M āori caregivers providing the highest level of care reported the poorest mental health. Level of care was unrelated to physical health. There was minimal evidence for changes in health over time based on caregiver status. Discussion. The poorer health of caregivers supports previous findings on the detrimental health effects of caregiving. Caregiving may have more detrimental effects on M āori health outcomes due to existing inequalities in health, barriers to formal support services, and the multiple roles of elder M āori.

In one of the first longitudinal population-based studies examining adopted children's educational achievement, we analyze whether there is a test-score gap between children in adoptive families and children in biological families. Using data from the Early Childhood Longitudinal Study, we find in aggregate adopted children have lower reading and math scores than their counterparts living in biological families. Yet there is significant variation among adoptive families by their race and health status. On one hand adoptive parents tend to be White and have more economic capital than their non-adoptive counterparts potentially contributing to educational advantages. However adopted children are also more likely to have special educational needs, contributing to greater educational disadvantages. Untangling these variables through a multivariate regression analysis, we find that transracially adopted children have similar test scores to White children living with biological parents. We point to the interaction between race, family resources and children's health status and how these characteristics differentially shape achievement outcomes for adopted children.

This conceptual study focuses on health disparities among African Americans in the Arkansas Delta. The author uses an ecosocial perspective to explore several social and individual-level influences upon patients' perceptions of health care quality, including health beliefs and life experiences of discrimination that can lead to not accessing health care systems. The study findings identify community-based strengths that can inform the development of strategies and programs to reduce rural health disparities. The discussion includes the potential implications of the Patient Protection and Affordable Care Act for progress in health care quality and health equality, especially for rural racial/ethnic minorities.

Racial and ethnic health disparities remain a pandemic social issue in the United States, posing a significant challenge to health care organizations. Culturally responsive and competent care is key to addressing health disparities, and the lack of diversification in the health care workforce is a contributor. The purpose of this study was to investigate the barriers and best practices surrounding the development of diverse staffing in a sample of community health centers (CHCs) in Massachusetts. Survey responses and follow up interviews with CHCs were analyzed. Lessons and recommendations for CHCs and other human service organizations are discussed.

Although women experience poorer health conditions during their lives, they live longer than men. The main explanations for this paradox suggest that women's excess of ill-health is limited to minor illnesses and their different attitudes toward health. The authors test these assumptions by investigating disparities between men and women in health and healthcare in Portugal. Data are used from the Portuguese National Health Interview Survey 2005/2006 (N = 33,662). Multivariate regressions showed that women were more likely to report worse self-rated health, more days with disability, higher prevalence of hypertension, chronic pain, cancer, anxiety and depression, and more medical consultations. Heart disease was significantly more prevalent among men, possibly explaining part of the paradox. Women's more frequent use of medical consultations may reflect their heightened awareness of health problems, which may protect them against early death. Gender differences in socioeconomic status explain part of the differences in health, but fail to provide a complete understanding.

A robust socioeconomic gradient in health is well-documented, with higher socioeconomic status (SES) associated with better health across the SES spectrum. However, recent studies of U.S. racial/ethnic minorities and immigrants show complex SES-health patterns (e.g., flat gradients), with individuals of low SES having similar or better health than their richer, U.S.-born and more acculturated counterparts, a so-called “epidemiological paradox” or “immigrant health paradox”. To examine whether this exists among Asian Americans, we investigate how nativity and occupational class (white-collar, blue-collar, service, unemployed) are associated with subjective health (self-rated physical health, self-rated mental health) and 12-month DSM-IV mental disorders (any mental disorder, anxiety, depression). We analyzed data from 1530 Asian respondents to the 2002–2003 National Latino and Asian American Study in the labor force using hierarchical multivariate logistic regression models controlling for confounders, subjective social status (SSS), material and psychosocial factors theorized to explain health inequalities. Compared to U.S.-born Asians, immigrants had worse socioeconomic profiles, and controlling for age and gender, increased odds for reporting fair/poor mental health and decreased odds for any DSM-IV mental disorder and anxiety. No strong occupational class-health gradients were found. The foreign-born health-protective effect persisted after controlling for SSS but became nonsignificant after controlling for material and psychosocial factors. Speaking fair/poor English was strongly associated with all outcomes. Material and psychosocial factors were associated with some outcomes – perceived financial need with subjective health, uninsurance with self-rated mental health and depression, social support, discrimination and acculturative stress with all or most DSM-IV outcomes. Our findings caution against using terms like “immigrant health paradox” which oversimplify complex patterns and mask negative outcomes among underserved sub-groups (e.g., speaking fair/poor English, experiencing acculturative stress). We discuss implications for better measurement of SES and health given the absence of a gradient and seemingly contradictory finding of nativity-related differences in self-rated health and DSM-IV mental disorders.

Introduction Existing research documents strong inverse socioeconomic gradients in current smoking and lung cancer morbidity and mortality; these gradients appear stronger among non-Hispanic Whites and Blacks compared with Hispanics. We sought to examine a broader range of outcomes across the tobacco use continuum, examining socioeconomic gradients separately among the 3 largest racial/ethnic groups in the United States. Methods We used data from the 2010 National Health Interview Survey (n = 17,284) Cancer Control Supplement to calculate prevalences and means for outcomes across the tobacco use continuum by educational attainment and income separately among non-Hispanic Black, Hispanic/Latino, and non-Hispanic White adults. Results Findings demonstrate that current smoking, age at initiation, cigarettes per day, years quit, and secondhand smoke all exhibit strong inverse educational gradients and moderately strong inverse income gradients, especially among Whites and Blacks. Hispanics/Latinos generally have more favorable outcomes along the tobacco use continuum and less evident socioeconomic gradients. Conclusions Educational attainment is strongly associated with indicators across the tobacco use continuum among non-Hispanic Whites and Blacks. More research is needed to determine whether policies and programs to increase educational attainment may also reduce tobacco-related health disparities.

Research on racial and ethnic disparities using health system databases can shed light on the usual health care and outcomes of large numbers of individuals so that health inequities can be better understood and addressed. Such research often suffers from limitations in race/ethnicity data quality. We examined the quality of race/ethnicity data in a large, diverse, integrated health system that repeatedly collects these data on utilization of services. We tested the accuracy of Bayesian Improved Surname Geocoding for imputation of race/ethnicity data. Administrative race/ethnicity data were accurate as judged by comparison with self-report in adults. The Bayesian Improved Surname Geocoding method produced imputation results far better than chance assignment for the four most common race/ethnicity groups in the health system: Whites, Hispanics, Blacks, and Asians. These results support renewed efforts to conduct studies of racial and ethnic disparities in large health systems.

Race and ethnicity are social constructs that have been used to divide people categorically into superior and inferior groups. Historically in the United States, racial groups categorized as inferi...

Health literacy has emerged as an important factor related to health in older persons. The reason for the link between health literacy and health outcomes is not clear. Possible explanations include common relations among income, education, access to health care, health-promotion behaviors, frequency of reading, and perceptual impairments. In this study we investigate the relation of health literacy to self-reported health status and explore the impact of these explanatory variables on this relation in persons aged 40 years and older who participated in the 2003 U.S. National Assessment of Adult Literacy (NAAL). Using regression models, we evaluated the impact of potential explanatory variables on the relation of health literacy to self-reported health status. Regression models confirmed previously-observed relations of health literacy, age, income, and education to health. The inclusion of income and education significantly decreased the relation of health literacy to health. While other variables, such ...

Objective: Perceived discrimination is an important risk factor for minority health. Drawing from the scholarship on multi­dimensionality of race, this study exam­ines the relationships between perceived discrimination in health care and two dimensions of racial identity: self-identified race/ethnicity and perceived attributed race/ ethnicity (respondents’ perceptions of how they are racially classified by others).Methods: We used Behavioral Risk Factor Surveillance System data collected in 2004- 2013 and we specifically examined the data on perceived racial discrimination in health care during the past 12 months, perceived attributed race/ethnicity, and self-identified race/ethnicity.Results: In models adjusting for sociode­mographic and other factors, both dimen­sions of racial/ethnic identity contributed independently to perceived discrimination in health care. After controlling for self-identified race/ethnicity, respondents who reported being classified as Black, Asian, Hispanic, and Native American had higher likelihood of perceived discrimination than respondents who reported being classified as White. Similarly, after taking perceived attributed race/ethnicity into account, self-identified Blacks, Native Americans, and multiracial respondents were more likely to report perceived discrimination than coun­terparts who self-identified as White. The model using only perceived attributed race/ ethnicity to predict perceived discrimination showed a superior fit with the data than the model using only self-identified race/ ethnicity.Conclusion: Perceived attributed race/ ethnicity captures an aspect of racial/ethnic identity that is correlated, but not inter­changeable, with self-identified race/ethnic­ity and contributes uniquely to perceived discrimination in health care. Applying the concept of multidimensionality of race/ ethnicity to health disparities research may reveal understudied mechanisms linking race/ethnicity to health risks.Ethn Dis. 2016;26(4):501-512; doi:10.18865/ ed.26.4.501

Racial disparities exist in health care, even when controlling for relevant sociodemographic variables. Recent data suggest disparities in patient-physician communication may also contribute to racial disparities in health care. This study aimed to systematically review studies examining the effect of black race and racial concordance on patient-physician communication.A comprehensive search using the PRISMA guidelines was conducted across seven online databases between 1995 and 2016. The search resulted in 4672 records for review and 40 articles for final inclusion in the review. Studies were included when the sample consisted of black patients in healthcare contexts and the communication measure was observational or patient-reported. Data were extracted by pairs of authors who independently coded articles and reconciled discrepancies. Results were synthesized according to predictor (race or racial concordance) and communication domain.Studies were heterogeneous in health contexts and communication measures. Results indicated that black patients consistently experienced poorer communication quality, information-giving, patient participation, and participatory decision-making than white patients. Results were mixed for satisfaction, partnership building, length of visit, and talk-time ratio. Racial concordance was more clearly associated with better communication across all domains except quality, for which there was no effect.Despite mixed results due to measurement heterogeneity, results of the present review highlight the importance of training physicians and patients to engage in higher quality communication with black and racially discordant patients by focusing on improving patient-centeredness, information-giving, partnership building, and patient engagement in communication processes.

Despite major public health initiatives, significant disparities persist among racially and ethnically defined groups in the prevalence of disease, access to medical care, quality of medical care, and health outcomes for common causes of morbidity and mortality in the United States. It is critical that we develop new and creative strategies to address such inequities; mitigate the social, environmental, institutional, and genetic determinants of poor health; and combat the persistence of racial profiling in clinical contexts that further exacerbates racial/ethnic health disparities. This article argues that medical education is a prime target for intervention and that anthropologists and human population geneticists should play a role in efforts to reform US medical curricula. Medical education would benefit greatly by incorporating anthropological and genetic perspectives on the complexities of race, human genetic variation, epigenetics, and the causes of racial/ethnic disparities. Medical students and practicing physicians should also receive training on how to use this knowledge to improve clinical practice, diagnosis, and treatment for racially diverse populations.

The topic of persistent child health disparities remains a priority for policymakers and a concern for pediatric clinicians. Health disparities are defined as differences in adverse health outcomes for specific health indicators that exist across sub-groups of the population, frequently between minority and majority populations. This review will highlight the gains that have been made since the 1990s as well as describe disparities that have persisted or have worsened into the 21st century. It will also examine the most potent social determinants and their impact on the major disparities in mortality, preventive care, chronic disease, mental health, educational outcomes, and exposure to selected environmental toxins. Each section concludes with a description of interventions and innovations that have been successful in reducing child health disparities.

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

Background Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability. Methods We analysed baseline data from Ten to Men – an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18–55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index. Results Men with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing. Conclusion Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3700-y) contains supplementary material, which is available to authorized users.

Mental illness and physical ill health are inextricably linked. Separating the two has led to significant health inequalities and barriers to health care for some of our most vulnerable patients. In March this year, the King’s Fund built on findings from the Independent Mental Health Taskforce to the NHS in England’s Five Year Forward View for Mental Health 1 by publishing Bringing Together Physical and Mental Health: A New Frontier for Integrated Care .2 Both documents emphasise the need to integrate physical, mental, and social care. The latter cites the factors that have led us to this point: ‘... institutional and cultural barriers, separate payment systems for physical and mental health care, and the trend for increasing sub-specialisation in professional education.’ 2 New approaches should ensure that mental and physical health needs are considered together and that people with a mental disorder have equal access to services for their physical health as others. This is not an original concept. ‘Parity of esteem’, the principle of affording equal value to mental and physical health, was enshrined in statute within the Health and Social Care Act 2012. Despite this, the scale of the physical health gap between those with chronic mental illness and those without remains vast. Those with severe mental illness are less likely to attend routine screening3 or access medical assistance. People with bipolar affective disorder and schizophrenia are, on average, likely to die 15–20 years earlier than those without.1 Approximately two-thirds of these deaths are from potentially modifiable risks and diseases such as smoking, obesity, diabetes, ischaemic heart disease, and malignancy. The relationship …

This article reviews the existing literature on the association between the socioeconomic status (SES) and the health of the ageing population in the United Kingdom. It has been noted that socioeconomic differentials are more marked across the United Kingdom than they are in other developed countries. Social class gradients are significant in health for working-age people (up to age 65), whereas studies on older populations have so far been limited so as to draw any robust conclusions. In this article, we examine the inequalities through selected SES indicators in order to tease out the effects on health outcomes of the older population. We critically review the physical and mental health indicators of older people in the United Kingdom with regard to their SES differentials. The findings reveal that older people with lower SES are more likely to experience poorer health outcomes (e.g., long-standing illness or increased disability) and have shorter life expectancy compared with those of higher SES. We illustrate how education remains the single most important determinant of health inequality in later life. We suggest that educational level or occupational class allied with material deprivation offer the best combined indicators of SES for studying health inequalities among older people. The findings of this article has profound implications for prioritizing policies to improve the health and well-being of elderly people with lower SES and go offer an evidence base of how to understand and to develop interventions that minimize the inequalities in health in later life in the United Kingdom.