Suchergebnisse

OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.

OBJECTIVES: The objectives of this study were to assess racial/ethnic trends in surveillance data in four states--California, New York, Florida and Texas, identify structural barriers to and facilitators of access to HIV pharmaceuticals by individuals in Medicaid and the AIDS Drug Assistance Program (ADAP), and identify treatment education and outreach efforts responding to the needs of ethnic minority HIV patients. METHODS: State surveillance and claims data were used to assess trends by race/ethnicity in AIDS cases and mortality as well as participation rates in Medicaid and ADAP. Key informant interviews with state program administrators and local clinic-based benefit eligibility workers were used to identify social and policy barriers to and facilitators of access to HIV drugs and state strategies for overcoming racial/ethnic disparities. RESULTS: Racial/ethnic disparities in the reduction of AIDS-related mortality were identified in three of the four states studied. Policy barriers included Medicaid requirements for legal immigration status and residency, limits on Medicaid eligibility based on disability requirements, and state-imposed income and benefit limits on ADAP. Social barriers to accessing AIDS medications included lack of information, distrust of government, and HIV-related stigma. State strategies for overcoming disparities included contracting with community-based organizations for treatment education and outreach, the use of regional minority coordinators, and public information campaigns. CONCLUSIONS: State policies play a significant role in determining access to HIV drugs, and state policies can be used to reduce racial/ethnic disparities in pharmaceutical access. Overall, eliminating racial/ethnic disparities in access to HIV pharmaceuticals appears to be an achievable goal.

Recent analyses of guideline sentencing practices have demonstrated that sentences departing from guidelines serve as a significant locus of racial/ethnic and other extralegal disparity. Little is known, however, about the ways that different courtroom processes, such as modes of conviction, condition these effects. Using recent data from the Pennsylvania Commission on Sentencing (PCS), I analyze the overall effects of race/ethnicity and other factors on judicial decisions to depart from the sentencing guidelines, and then I reexamine these relationships according to four modes of conviction (non‐negotiated pleas, negotiated pleas, bench trials, and jury trials). I argue that the mode of conviction provides a useful indicator of the differential exercise of discretion by different courtroom actors in the sentencing process. As such, it is likely to condition the use of stereotypical patterned responses, thus moderating the effects of race/ethnicity and other relevant sentencing factors. Findings support this expectation, demonstrating that extralegal effects vary considerably across modes of conviction. These results raise important questions about the role of different courtroom actors in contributing to racial and ethnic disparities under sentencing guidelines.

FrontMatter -- Contributors -- Preface -- Contents -- 1 Introduction--Barney Cohen -- Section I--The Nature of Racial and Ethnic Differences -- 2 Racial and Ethnic Identification, Official Classifications, and Health Disparities--Gary D. Sandefur, Mary E. Campbell, and Jennifer Eggerling-Boeck -- 3 Racial and Ethnic Disparities in Health and Mortality Among the U.S. Elderly Population--Robert A. Hummer, Maureen R. Benjamins, and Richard G. Rogers -- 4 Ethnic Differences in Dementia and Alzheimer's Disease--Jennifer J. Manly and Richard Mayeux -- Section II--Two Key Conceptual and Methodological Challenges -- 5 The Life-Course Contribution to Ethnic Disparities in Health--Clyde Hertzman -- 6 Selection Processes in the Study of Racial and Ethnic Differentials in Adult Health and Mortality--Alberto Palloni and Douglas C. Ewbank -- 7 Immigrant Health: Selectivity and Acculturation--Guillermina Jasso, Douglas S. Massey, Mark R. Rosenzweig, and James P. Smith -- Section III--The Search For Causal Pathways -- 8 Genetic Factors in Ethnic Disparities in Health--Richard S. Cooper -- 9 Race/Ethnicity, Socioeconomic Status, and Health--Eileen M. Crimmins, Mark D. Hayward, and Teresa E. Seeman -- 10 The Role of Social and Personal Resources in Ethnic Disparities in Late-Life Health--Carlos F. Mendes de Leon and Thomas A. Glass -- 11 What Makes a Place Healthy? Neighborhood Influences on Racial/ Ethnic Disparities in Health over the Life Course--Jeffrey D. Morenoff and John W. Lynch -- 12 Racial/Ethnic Disparities in Health Behaviors: A Challenge to Current Assumptions--Marilyn A. Winkleby and Catherine Cubbin -- 13 Cumulative Psychosocial Risks and Resilience: A Conceptual Perspective on Ethnic Health Disparities in Late Life--Hector F. Myers and Wei-Chin Hwang.

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.

Substantial racial and ethnic disparities persist in children's health and use of health services in the United States. Although equitable access to primary care services is widely promoted as one of the most feasible remedies to reduce health disparities, there has only recently been an effort to assess its quality, particularly for children. Racial and socioeconomic differences in access to care have been previously well documented, but recent research has begun to elucidate differences in more qualitative experiences in the receipt of primary care. This article presents a synthesis and critique of the existing research according to the core attributes of primary care: first-contact care, longitudinality, comprehensiveness, and coordination. Finally, the article proposes an agenda for further research into the pathways by which racial and ethnic disparities in primary care exist.