Intersecting Positions of Social Disadvantage and Self-Reported Health Status Disparities

Health disparities along the gender, race and class are particularly important to monitor and study given the predicted differential distribution of health along these social identities. Intersectionality is a theoretical framework that allows public health and health disparities researchers to account for the simultaneous, mutually constitutive, reinforcing and multidimensional effects of gender, class, and race with the aim to better understand health disparities. Disparities along gender, race and class have been noted in self-reported health status (SRHS) which has been shown to be a strong predictive factor of mortality, morbidity and mental health independent of other physiologic, behavioral and psychosocial risk factors. To assess SRHS disparities through an intersectional lens, a quantitative application of the framework was applied to a secondary data analysis of the 2010 Medical Expenditure Panel Survey (MEPS) Household Component. Two models were constructed to assess the relationship between the probability of reporting a poor/fair health status and two versions of a variable denoting socially disadvantaged populations. The first model explored the relationship between poor/fair health status and a variable of interest that denoted low-income females of any minority racial group where the referent comprised of those individuals who did not meet the socially disadvantaged criteria for the model. The second model explored the relationship between poor/fair health status and a variable of interest that identified low-income females of five different racial groups (White, Black, Asian, Native [NativeAmerican/Alaskan Native & Native Hawaiian & other Pacific Islander], and Multiracial) compared to the referent (which was composed of those who did not meet the criteria to be in any of the social disadvantaged groups pertaining to the model). The models were estimated using survey-weighed logit regression with average marginal effects at varying levels of age (25, 45, and 65) and years of education (12 or 16 years). Results show that for the two models the social disadvantage variables had a positive relationship with the probability of reporting a poor/fair health status. For both models, the magnitude of the social disadvantage effect on the probability of reporting a poor/fair health status increased with age and was moderated by education levels, with higher levels of education reducing the magnitude of the social disadvantage effect. The second model results show that Black low-income females had an almost ten percentage point increase in the probability of reporting a poor or fair health status compared to the referent, the largest magnitude noticed in the results. It is important to study the joint effects of the social positions occupied by those bearing the burden of health disparities; applying the intersectional framework may elucidate on new ways to present, address and target health disparities. Keywords: Health Disparities, Health Inequities, Intersectionality, Social Disadvantage, Self-Reported Health Statu

Rural-urban gradients and all-cause, cardiovascular and cancer mortality in Spain using individual data

The literature reporting on rural-urban health status disparities remains inconclusive. We analyzed data from a longitudinal population-based study using individual observations. Our results show that the risks of all-cause and cancer mortality are greater in large cities than in other municipalities, with no clear urban-rural gradient. Not differences were found among territories in cardiovascular mortality.This work was supported by the Institute of Health Carlos III (ISCIII), Ministry of Science and Innovation [grant number PI19CIII/00021 and FI17CIII/00003].S

The Health Status of African Americans in Allegheny County-A Black Paper for the Urban League of Pittsburgh

This report examines the health conditions of African Americans in Allegheny County (hereafter referred to as “the County”). It documents the leading causes of death of black men and women, infant mortality, rates of firearm injuries and fatalities, and rates of sexually transmitted diseases (STDs). The data reported serves to benchmark the current health status of African Americans and, by way of comparison, whites in the County. It is an important initial step towards achieving the Healthy People 2010 goal of eliminating racial/ethnic health status disparities in the County

Asthma management: an ecosocial framework for disparity research

Background: Asthma management disparities (AMD) between African and White Americans are significant and alarming. Various determinants have been suggested by research frameworks that affect the unfair distribution of resources for asthma management to groups who are more or less advantaged socially. Ecosocial models organize determinants into individual/family, healthcare, community, and sociocultural levels. Multilevel interventions can affect AMD through simultaneous actions on different levels and pathways between determinants. Objective: Provide a comprehensive summary of the known determinants of AMD. Method: Peer reviewed research frameworks of AMD from 1998-2009 were retrieved from PubMed/ Web of Science databases using (“Socioeconomic Factors”[Mesh] OR (“Healthcare Disparities”[Mesh] OR “Health Status Disparities”[Mesh])) AND “Asthma”[Mesh] AND “African Americans”[Mesh] OR “Ethnic Groups”[Mesh]). Abstracts assessed for a focus on AMD, and determinants. Articles were analyzed for ecosocial levels and determinants. Results: 13 research frameworks described 34 determinants. Compared to other levels, Individual/family levels had the most emphasis, and frameworks using healthcare and community levels were the most narrow in focus. Stress, poverty, violence/crime, quality of care, healthcare access, and indoor air quality were well described determinants. Conclusions: Multilevel investigations should include those well described determinants of AMD and increase knowledge of pathway interactions between healthcare and community levels

The Impact of the Patient-Centered Medical Home on Health Disparities in Adults: A Systematic Review of the Evidence

Introduction: The objective of this study was to review the empirical evidence on Patient-Centered Medical Home (PCMH) impact on health disparities in adults. Methods: We searched PubMed, Scopus, and Google Scholar to identify studies on PCMH/health homes and health disparities published in English between January 1, 2009 and December 31, 2014. Articles met inclusion criteria if they investigated at least one component of PCMH or health homes in vulnerable populations, defined by PROGRESS-PLUS criteria, and reported differences in one of five clinical quality measures. Results: 964 articles were identified through database searching and subsequent snowballing. 60 articles underwent full text screening. Further review eliminated 56 studies. In the final 4 studies, PCMH interventions showed small improvements in health disparities. Discussion: The PCMH has been suggested as a model for improving health disparities. Given rapid implementation in underserved settings, stakeholders should better understand the impact of the PCMH on health disparities

Challenges, solutions and future directions for public health innovations targeting dementia prevention for rural and remote populations

Currently, individuals living in rural and remote areas experience 1.4 times the total burden of chronic disease, including an 80% greater risk of late-life cognitive impairment and dementia, 2.5 times the number of preventable hospitalisations and a reduced life expectancy of up to 12 years compared to their metropolitan counterparts. Traditionally, health service planning and public health interventions have been largely built on the needs and characteristics of metropolitan populations. This disproportional focus can contribute to significant physical and cognitive health status disparities for rural and remote communities. This article focuses on existing challenges and strategies surrounding the cognitive health of rural and remote populations and provides short and long-term opportunities involving Australian public health policy and clinical practice to innovate dementia prevention for rural and remote communities

Recognizing and Responding to the Health Disparities of People with Disabilities

Health status is critically important to experiencing quality of life, self-sufficiency, and full participation in society. For the 54 million Americans with disabilities, maintaining health and wellness is especially important to reduce the impact of impairment on functioning in these critical life areas. Yet, people with disabilities may be the largest underserved subpopulation demonstrating health status disparities that stem from preventable secondary conditions. Healthy People 2010, the nation’s blueprint for improved health, addresses this problem in its objectives. In 2002 and 2005, the U.S. Surgeon General asked for public health efforts to improve the health and wellness of persons with disabilities. This article examines the concepts of health and wellness, summarizes currently available information documenting disparities in health for people with disabilities, and provides a framework for policy recommendations to reduce health disparities among people with disabilities

American Muslim Health Disparities: The State of the Medline Literature

Background: While religious beliefs and values influence health behaviors, conventional health disparities research rarely examines health outcomes by religious affiliation particularly within multi-ethnic minority communities. Methods: Using a systematic strategy we searched the Medline literature to identify empiric studies that report on health disparities between American Muslims and non-Muslim groups residing in America. In addition to use religious affiliation descriptors for Muslim groups we utilized geographic and ethnicity terms such as “South Asian” or “Pakistani” as proxy terms to help uncover studies of American Muslims. Results: 171 empirical studies were captured. South Asians and Arabs were the most commonly studied groups, and mental health was the most common studied health condition. The overwhelming majority of studies did not assess connections between the Islamic faith and health outcomes. Conclusion: Healthcare disparities among American Muslims remain under-investigated. The few empirical studies of American Muslim groups, or of ethnic groups with large numbers of Muslims, rarely examine relationships between Islam-related factors and health outcomes and thereby miss an opportunity to understand the relationships between religion and health disparities

Beyond Health Care: New Directions to a Healthier America

Outlines recommendations for governments, schools, healthcare providers, philanthropies, and others to collaborate on implementing feasible, evidence-based interventions that create healthier communities and address the needs of those most at risk

Children's Health Insurance and National Health Policy

Health Economics and Policy, Labor and Human Capital,