|
Disparities In Health: Expanding The FocusHEALTH AFFAIRS HAS a long-standing commitment to publishing new research and perspectives on social disparities and their impacts on health and health care, dating back to our first thematic issue on health and poverty twenty years ago and carried forward to our thematic issue (Sep/Oct) on vulnerable populations in 2007. In the current issue we tighten the focus to highlight the specific contribution of racial and ethnic disparities to health status and health care, but we also broaden the discussion to cover aspects of inequality and dimensions of health that have not been discussed in our pages before. This issue of the journal comes at a pivotal time. The Robert Wood Johnson Foundation, which sponsored this issue, recently launched the nation’s first independent, nonpartisan health commission to consider solutions outside the medical care system for reducing health disparities and improving America’s health. Led by Alice Rivlin and Mark McClellan, the commission will investigate promising solutions in the areas of education, environment, housing, and transportation. The journal opens with a discussion of two key social determinants of health: neighborhoods and education. Dolores Acevedo-Garcia and colleagues demonstrate not only that neighborhoods are segregated by race and ethnicity more than by income, but also that this segregation creates an "unequal geography of opportunity." Neighborhoods characterized by the lack of employment opportunities, good schools, access to health care, transportation, and healthy food outlets are environments that limit the opportunities for positive growth and good health status. Sarah Gehlert and colleagues demonstrate that poor and segregated neighborhoods also create a rich soil for biological processes that increase risk and mortality, as demonstrated in their study of breast cancer. Papers by Ellen Meara and colleagues and by Rachel Kimbro and colleagues address the education gradient. Meara and colleagues demonstrate that much of the gain in life expectancy in the past twenty years has been distributed unevenly in the population, with most of the gains going to people with more years of schooling. They describe an education gap, or education-related disparity, in the United States, particularly in regard to smoking. Kimbro and colleagues show that this education gradient needs to be applied with flexibility in addressing immigrants living in the United States. The level of education achieved is an important determinant of health behavior, but its power varies across Hispanic and Asian populations living in the United States. This issue of the journal covers a broader-than-usual range of populations and forms of health. As the methods of collection for racial and ethnic data have improved, as discussed by Linda Bilheimer and others, we can address communities and issues unique to immigrants and their children. We also bring to light the problems accessing dental care faced by minorities in this country. Oral health often is given short shrift in health policy discussions, but it is a gateway to overall health. Susan Fisher-Owens and colleagues present an overview. Likewise, we present a review of the problems facing minority communities and their mental health care providers in a paper by Tom McGuire and Jeanne Miranda. Finally, as the larger debate over health care reform has highlighted, much activity is occurring at the state level (unless that is blocked at the federal). Brian Smedley, our guest editor for this special issue, together with Mara Youdelman and with Dolores Acevedo-Garcia and Lisa Cacari Stone survey state activities in promoting language services, maternal and child health, and reductions in health disparities. As noted above, this thematic issue was sponsored by the Robert Wood Johnson Foundation, the mainstay of Health Affairs from our earliest years. The foundation has a dual focus on health and health care and is committed to promoting access and improvement for all Americans. This issue of the journal is dedicated to that agenda.
This article has been cited by other articles:
Comments:Read all Comments
| ||||||||||||||||||||||||||||||||
