The Death Gap: how inequality kills by
We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical--their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD, has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients. While the contrasts and disparities among Chicago's communities are particularly stark, the death gap is truly a nationwide epidemic--as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn't need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence--the racism, economic exploitation, and discrimination--that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation--for all. Inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. But geography need not be destiny, urges Ansell. In The Death Gap he shows us how we can face this national health crisis head-on and take action against the circumstances that rob people of their dignity and their lives.
Just Medicine: A Cure for Racial Inequality in American Health Care by
Offers an innovative plan to eliminate inequalities in American health care and save the lives they endanger Over 84,000 black and brown lives are needlessly lost each year due to health disparities: the unfair, unjust, and avoidable differences between the quality and quantity of health care provided to Americans who are members of racial and ethnic minorities and care provided to whites. Health disparities have remained stubbornly entrenched in the American health care system--and in Just Medicine Dayna Bowen Matthew finds that they principally arise from unconscious racial and ethnic biases held by physicians, institutional providers, and their patients. Implicit bias is the single most important determinant of health and health care disparities. Because we have missed this fact, the money we spend on training providers to become culturally competent, expanding wellness education programs and community health centers, and even expanding access to health insurance will have only a modest effect on reducing health disparities. We will continue to utterly fail in the effort to eradicate health disparities unless we enact strong, evidence-based legal remedies that accurately address implicit and unintentional forms of discrimination, to replace the weak, tepid, and largely irrelevant legal remedies currently available. Our continued failure to fashion an effective response that purges the effects of implicit bias from American health care, Matthew argues, is unjust and morally untenable. In this book, she unites medical, neuroscience, psychology, and sociology research on implicit bias and health disparities with her own expertise in civil rights and constitutional law. In a time when the health of the entire nation is at risk, it is essential to confront the issues keeping the health care system from providing equal treatment to all.
Pushing Cool: big tobacco, racial marketing, and the untold story of the menthol cigarette by
Spanning a century, Pushing Cool reveals how the twin deceptions of health and Black affinity for menthol were crafted--and how the industry's disturbingly powerful narrative has endured to this day. Police put Eric Garner in a fatal chokehold for selling cigarettes on a New York City street corner. George Floyd was killed by police outside a store in Minneapolis known as "the best place to buy menthols." Black smokers overwhelmingly prefer menthol brands such as Kool, Salem, and Newport. All of this is no coincidence. The disproportionate Black deaths and cries of "I can't breathe" that ring out in our era--because of police violence, COVID-19, or menthol smoking--are intimately connected to a post-1960s history of race and exploitation. In Pushing Cool, Keith Wailoo tells the intricate and poignant story of menthol cigarettes for the first time. He pulls back the curtain to reveal the hidden persuaders who shaped menthol buying habits and racial markets across America: the world of tobacco marketers, consultants, psychologists, and social scientists, as well as Black lawmakers and civic groups including the NAACP. Today most Black smokers buy menthols, and calls to prohibit their circulation hinge on a history of the industry's targeted racial marketing. In 2009, when Congress banned flavored cigarettes as criminal enticements to encourage youth smoking, menthol cigarettes were also slated to be banned. Through a detailed study of internal tobacco industry documents, Wailoo exposes why they weren't and how they remain so popular with Black smokers.
Communities in Action: Pathways to Health Equity by
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual (TM)s health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Health Care Disparities and the LGBT Population by
Health Care Disparities and the LGBT Population addresses a people whose lack of health care access, including mistreatment and refusal of services, are often omitted from discussions about health care and insurance reform. Research suggests that LGBT people experience worse health outcomes than their heterosexual counterparts. Low rates of health insurance coverage, high rates of stress due to systematic harassment, stigma, discrimination, and lack of cultural competency in the health care system frequently manifest in negative health-related behaviors. The dearth of data collection on sexual orientation and identity in state and federal health care surveys has led to inadequate information about LGBT populations, and has impeded the establishment of health programs and public policies that benefit them. With its diverse perspectives, this book will not only benefit LGBT people, but will also more broadly improve the lives of entire communities, medical care, and prevention programs and services. This research provides a better understanding of the social and structural inequalities that LGBT populations experience. Improvements to our country's health care system should go beyond just providing universal insurance and should ensure equitable health care for all.
Strategies for Ensuring Diversity, Inclusion, and Meaningful Participation in Clinical Trials by
Even as the U.S. population becomes steadily more diverse, minorities and women remain underrepresented in clinical trials to develop new drugs and medical devices. Although progress in increasing minority participation in clinical trials has occurred, participation rates do not fully represent the overall population of minorities in the United States. This underrepresentation threatens the health of both these populations and the general population, since greater minority representation could reveal factors that affect health in all populations. Federal legislation has sought to increase the representation of minorities and women in clinical trials, but legislation by itself has not been sufficient to overcome the many barriers to greater participation. Only much broader changes will bring about the meaningful participation of all population groups in the clinical research needed to improve health. To examine the barriers to participation in clinical trials and ways of overcoming those barriers, the National Academies of Sciences, Engineering, and Medicine held a workshop in April 2015. This publication summarizes the presentations and discussions from the workshop.
Use the tabs across the top of the box for additional information.
