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Infant mortality rates (IMRs) are considered to be one of the most important indicators of a healthy society and a key marker of maternal and child health. In the United States, progress has been made in reducing the overall infant mortality rate, but this reduced aggregated rate masks significant racial disparities. The objective of this study is to systematically examine racial differences in a number of social determinants of infant mortality at the county-level, specifically differences between non-Hispanic Black and non-Hispanic White populations. Multivariate OLS regression modeling is used to analyze the association between the demographic, economic, and health predictor variables and IMRs. The results show that while there are marked differences in the predictors of Black and white IMRs, there are also remarkable similarities. Median household incomes and numbers of practicing midwives are found to be two of the significant factors in reducing infant mortality rates for both groups. .
National Academies of Sciences, Engineering, and Medicine
Author : National Academies of Sciences, Engineering, and Medicine Publisher : National Academies Press Page : 583 pages File Size : 37,94 MB Release : 2017-04-27 Category : Medical ISBN : 0309452961
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'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.
Author : National Research Council Publisher : National Academies Press Page : 184 pages File Size : 25,55 MB Release : 2004-09-08 Category : Social Science ISBN : 0309165865
As the population of older Americans grows, it is becoming more racially and ethnically diverse. Differences in health by racial and ethnic status could be increasingly consequential for health policy and programs. Such differences are not simply a matter of education or ability to pay for health care. For instance, Asian Americans and Hispanics appear to be in better health, on a number of indicators, than White Americans, despite, on average, lower socioeconomic status. The reasons are complex, including possible roles for such factors as selective migration, risk behaviors, exposure to various stressors, patient attitudes, and geographic variation in health care. This volume, produced by a multidisciplinary panel, considers such possible explanations for racial and ethnic health differentials within an integrated framework. It provides a concise summary of available research and lays out a research agenda to address the many uncertainties in current knowledge. It recommends, for instance, looking at health differentials across the life course and deciphering the links between factors presumably producing differentials and biopsychosocial mechanisms that lead to impaired health.
Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the "normal" infant mortality rate, risk was calculated as the percentage of deviation from the (")normal("). A rate was also calculated to demonstrate the difference between black and white percent deviations from the "normal". Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework.
ABSTRACT: The period 1980-2000 was important for infant health in Florida and the United States more generally. This period of dramatic social change and substantial improvements in therapeutic technology has produced striking improvements in infant health and survival. Despite overall declines in all-cause infant mortality, some evidence has suggested that racial disparities have persisted and even widened during this period. While the maternal socio-demographic factors associated with these racial disparities are well-established areas of research, several points remain unclear. First, it is not well- known which causes of death have contributed to the widening racial disparities in infant mortality. Second, it is uncertain how the changing social context may have affected these patterns. Finally, it is unknown which has been more influential, changes in the social context or changes in individual maternal socio-demographic characteristics.
Author : Institute of Medicine Publisher : National Academies Press Page : 536 pages File Size : 26,89 MB Release : 2003-02-01 Category : Medical ISBN : 0309133181
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
Background: There is a widening health gap in birth outcomes for Black women and white women in America. Historically this gap has been relegated to disparities regarding other social factors such as; socioeconomic status, geographic location, and education level. However, these factors prove to only be partially responsible for the gap in birth outcomes between Black women and white women. Improved understanding of the burden of racial stress that Black women undergo throughout their lifetimes provides a better foundation for improving health outcomes, specifically birth outcomes for Black women. Objectives: Secondary data analysis is utilized on National Vital Statistics System data from 2002-2012 to determine if there is a link between adverse birth outcomes and race, despite similar education levels and prenatal care visits between non-Hispanic Black women and non-Hispanic white women. Methods: Using retrospective birth data from the National Vital Statistics System from 2002-2012, five variables were analyzed. These variables; maternal education attainment, number of prenatal care visits, preterm birth, low birthweight, and very low birthweight showcase different birth factors. By using aggregate data for non-Hispanic Black women, and non-Hispanic white women for each factor in each year, the percentage was then calculated. Following the calculation of averages, the statistical t-test was run to determine the p-values for each factor to determine statistical significance. Additionally, the total number of births for non-Hispanic Black women and non-Hispanic white women was recorded to showcase the difference in total birth rates for the aforementioned races. Results: The data from 2002-2012 showed a significant widening in health outcomes for Black and white women. There was no statistical significant difference for educational attainment between the races with a p-value of: 0.08163186. A significance was found between the rates of prenatal care visits between the races with a p-value of: 0.00015265. Statistical significance was found between the rates of preterm birth and low birthweight, and very low birthweight between Black and white women with p-values of
The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.