Ethnic Minority Health Research Articles

The Role of Biological ‘Race’ in Understanding Genetic Disease

Much research into ethnic health inequalities seeks to explain these phenomena in terms of some ethnic groups suffering cultural and socioeconomic disadvantage. Although these factors undoubtedly influence ethnic minority health outcomes, this review explores what is currently understood about the biological causes of health inequalities between ethnic groups. These health outcomes are considered within the context of the evolutionary mechanisms underlying such differences. The article then explores limitations of the ‘race’ concept and considers its appropriate application within the settings of biomedical research and clinical decision making.

Acculturation and ethnic-minority health behavior: A test of the operant model.

The Operant Model of Acculturation predicts that health behaviors that have a low prevalence (< 20%) among Traditional (low-acculturated) minorities increase in prevalence with acculturation and hence have a higher prevalence among their Acculturated counterparts. Alternatively, health behaviors that have a high prevalence (> 45%) among Traditional minorities decrease with acculturation and thereby have a lower prevalence among their acculturated cohorts. The purpose of this study was to test this model for the first time. Data on the 7,249 Mexican American adults in the 2001 California Health Interview Survey (CHIS), a statewide, random-digit-dial telephone survey, were used. Two proxies for acculturation (nativity, language spoken at home) were predictors in analyses of cigarette smoking, exercise, and 5 + daily fruit/vegetable consumption. For all three health behaviors, results were fully supportive of the Operant Model irrespective of acculturation-proxy and demographic variables. The Operant Model may provide a coherent framework for predicting and understanding the role of acculturation in ethnic minority health behavior. Findings are discussed in terms of tailoring and targeting interventions in a manner consistent with the acculturation-related changes in health behavior that are likely to occur.

National newspaper coverage of minority health disparities.

To assess American newspaper coverage regarding racial and ethnic minority health disparities (MHDs). LexisNexis was queried with specific word combinations to elicit all MHD articles printed in 257 newspapers from 2000-2004. The full texts were read and articles categorized by racial/ethnic group and specific MHD topics mentioned. In the five years from 2000-2004, 1188 MHD articles were published, representing 0.09% of all articles about health. Newspapers gave much attention to MHD when discussed in conferences and meetings and speeches by senior health officials and politicians. Cancer, cardiovascular disease and HIV/AIDS were most frequent among disease-specific mentions. Articles about African Americans comprised 60.4% of all race/ethnicity-mentioning articles. Despite the release of major organizational reports and the publication of many studies confirming the prevalence of MHD, few newspaper articles have been published explaining MHD to the public. Because of the general public's low rate of health literacy, the health world should collaborate with the media to present a consistent, simple message concerning gaps in care experienced by all racial/ethnic minority groups. In a time of consumer-directed healthcare, if Americans understand that MHDs exist, they may galvanize to advocate for disparity elimination and quality improvement.

Vulnerable Populations and Health Care Disparities

The issue of vulnerable populations in health care can be examined on multiple levels. By definition, all consumers in health care are vulnerable; that is, the potential for harm or injury is almost always present. Consumers rely on and trust the providers and the delivery system to meet their needs with honesty and equity, delivering the best care possible that is safe, effective, and ethical. The term vulnerable populations is also closely related to health care disparities. Vulnerable populations often experience disparities in the health care they receive or in their outcomes of care. It is such disparities in treatment and outcomes that often are the focus of providers and researchers. Statistics inform us that patients are extremely vulnerable and are at risk simply by entering the health care system. This is especially true for hospitalized patients, where the risk of errors occurring and potential for injury are much higher than the health care system or the general public are willing to accept (Page, 2004). Today, patient safety has become a universal concern in every type of practice setting. Typically, the issue of vulnerable populations is examined more specifically with a focus on particular socially defined characteristics of groups of patients. Care received by a designated group is then examined and compared with the care received or the health outcomes demonstrated in society at large. These groups generally have some type of specially defined rights or are protected because of limited capacity of some type. This would include groups such as infants and young children, prisoners, and the cognitively impaired or mentally disabled. Groups of this nature are considered to have great vulnerability because they are generally less able to stand up for their individual rights or health care needs. Despite ongoing improvement in the overall health of populations, racial and ethnic minorities generally still experience higher rates of morbidity and mortality. Considerable data exist about disparities, or differences, in health care related to race, ethnicity, and socioeconomic status. In fact, disparities are observed in almost all aspects of health care. Recent data reveal that disparities exist across all types of care, ranging from preventive care through management of chronic disease. Disparities also exist in many clinical conditions including heart disease, HIV/AIDS, substance abuse and mental health, cancer, diabetes, and end-stage renal disease. These disparities in treatment are found in all care settings. They also are found within many subpopulation groups such as children, women, elderly, and individuals with special health needs (Agency for Healthcare Research and Quality, 2006). Considerable opportunities exist for reducing disparities in health care. One challenge that exists is defining the breadth and depth of disparities in health care. A model has been developed that identifies various sources and types of health care disparities. …

Cognitive behavioral stress management intervention improves quality of life in Spanish monolingual hispanic men treated for localized prostate cancer: results of a randomized controlled trial.

The efficacy of a group-based psychosocial intervention with ethnic minority health populations may depend on consideration for cultural factors that can interact with group processes. The current study explored the efficacy of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention that was linguistically and culturally adapted for use with Hispanic monolingual men recently treated for localized prostate carcinoma (PC). 71 Hispanic mono-lingual Spanish speakers were randomly assigned to a 10-week CBSM intervention or a half-day stress management seminar (control condition). Hierarchical regression was used to predict post-intervention QoL. After controlling for relevant covariates, assignment to the CBSM condition significantly predicted greater physical well-being, emotional well-being, sexual functioning, and total well-being after the 10-week intervention period. Results suggest that participation in a culturally and linguistically adapted CBSM group intervention improved QoL in Hispanic monolingual men treated for localized PC.

The Contribution of Ethnic Minority Status to Adaptive Style: A Comparison of Mexican, Mexican American, and European American Children

Ethnic minority status and health minority status (i.e., presence of illness) may facilitate repressive adaptive style (RAS) in an additive fashion, and a “double stigma” hypothesis has been proposed to explain this additive effect. The authors compare RAS in European American, Mexican American, and Mexican children and examine the association of RAS to the traditional values of simpatia and collectivism. Results do not confirm the hypothesis that minority status contributes to RAS; however, collectivism is a significant predictor of defensiveness supporting a cultural hypothesis for RAS.

A Framework for Addressing Disparities in Cardiovascular Health

Health disparities are pervasive in the United States. Life expectancy remains higher in women than in men and higher in whites than in blacks by approximately 5 years. In general, the health of racial and ethnic minorities, poor and uneducated people, and those without health insurance is worse than the health of the overall population. The care of these vulnerable groups tends to be of worse overall quality because they have trouble accessing the system, because standards of care are applied to them unevenly, and because health professionals are not consistently trained in culturally sensitive approaches. These disparities have been demonstrated in all aspects of health and healthcare for cardiovascular diseases, including the use of diagnostic and therapeutic interventions, prevalence of cardiovascular risk factors, and access to health information. Examination of national surveys revealed disparities in all cardiovascular disease risk factors, hospitalizations for major cardiovascular disease, overall mortality, and quality of life. Eliminating these disparities is a major public health challenge in the United States. Their causes and underlying mechanisms, however, remain incompletely understood. The healthcare delivery system itself, access to care, quality of care received, communication barriers, individual behaviors, culture and lifestyles, and discrimination and bias all play a part. The pursuit of systems and policy changes to address these determinants remains crucial. We present a strategic framework for eliminating health disparities that takes these determinants into account and provides an opportunity for cardiovascular nurses to make an impact on this important issue.

A Picture of Health

A Picture of Health is made up of 16 enigmatic images that can perhaps best be described as ‘epic portrait-scapes’. Fullerton-Batten's use of complex yet subtle set lighting makes this collection truly fit for the big screen. And as well it might, for each sitter has contributed more to the positive advancement of healthcare than many that have received far grander pictorial homage. Fullerton-Batten's work reveals the photographer as a true artist. Her genius here lies in her ability to project a strange suspense around her subject whilst actually doing little more than dishing out the facts. Huge attention to the most fitting environment has been given to each well-researched sitter, suspended in flawless cinematic lighting. In fact you would be forgiven for wondering if these images were in some way digital montages, as the exceptional clarity produces deep layers of colour and light within each print. The breathing space allowed in each image pays homage to the professional field that has supported the sitter in their individual work. This of course only adds to the attractive surrealness of this collection and amplifies still further the viewer's intrigue toward each sitter. Sir Derek Wanless, Professor Lord Robert Winston, Professor Sir Brian Jarman, Claire Rayner, Professor Sir Ian Kennedy, Sir Iain Chalmers, Professor Sir Cyril Chantler, Nick Partridge, Christine Hancock,... the list of notables goes on into the night... Warmly frozen in time, this collection is a significant anthropological record of contemporary medical excellence. We see Ray Shannon, Chief Executive of South Yorkshire Ambulance Service NHS Trust, photographed behind the sliding glass window of what appears to be an A&E check in desk. He holds a phone poised and away from his face with respectful intent. A ponderous glint in his eyes inadvertently invites the viewer to speculate on the huge task of effectively modernising the ambulance service. Sheila Kitzinger is compassionately framed by the rich continental colours of the drapes and quilts of her four poster bed, where she often works. Fullerton-batten aims high and hits the mark when trying to summarise Sheila's massive contribution to midwifery by the use of this caring, vibrant and most fertile of locations. Another image shows Nola Ismael OBE—standing tall and calm, highlighted with strong positive light amongst the relative uncertainty of the randomly positioned desks surrounding her. A book is placed confidently to her right suggesting assurance in her responsibility for ethnic minority health issues and ethnic staff development in the NHS. The NPG and Fullerton-Batten have confidently delivered a most important and enjoyable body of work that rewards and educates the viewer whilst showing deep gratitude to each sitter's contribution to healthcare.

Sandy Littlejohn

Sandy Littlejohn

The Public Health Agenda and Minority Ethnic Health: a Reflection on Priorities

The Public Health Agenda and Minority Ethnic Health: a Reflection on Priorities

The public health agenda and minority ethnic health: a reflection on priorities

The National Health Service priorities are dictated either by the disease and health patterns of the population and population subgroups, or by the expectations and explicit standards of public services. These priorities include: the prevention and management of disease; the promotion of health; health education; reduction of inequalities in health; high quality healthcare; cost-effective and value-for-money services delivered within budget; and respectful, sensitive and equitable service. These priorities are the core of the NHS, and though the phraseology and emphasis change, they can be found in every important NHS policy document.

Introduction to a Supplemental Issue of the Journal of Applied Gerontology: Research on American Indian and Alaska Native Aging

The National Institute on Aging (NIA) has been committed to better understanding the health disparities experienced by older adults from racial and ethnic minority populations, and in 2000, published their Strategic Plan to Address Health Disparities. The primary focus of this plan is to develop and sustain research initiatives that will ultimately reduce and eliminate health disparities among these populations. The three major focus areas of the plan include (a) research, (b) research infrastructure, and (c) public information, outreach, and education. There are more than 60 research initiatives the NIA will pursue to address health disparities. This plan, in combination with the NIA Strategic Plan for Aging Research and the Review of Minority Aging Research by the National Advisory Council on Aging, provides guidance to researchers on how to best address health disparities in older adults (NIA, 2000). Since 1997, when the NIA established the Resource Centers for Minority Aging Research (RCMARs), this program has been an integral part of the NIA mission. The long-term goal of the RCMARs is to decrease health disparities among racial and ethnic minority elders by developing research infrastructure, improving the effectiveness of health interventions in these special populations (Stahl & Vasquez, 2004), and training junior minority investigators to work in the field of racial and ethnic minority health research. The six funded RCMARs work* with a Coordinating Center that supports and fosters communication among the centers. Each RCMAR is organized into four cores each linked to an aim and specified activities. The

Culture Change and Ethnic-Minority Health Behavior: An Operant Theory of Acculturation

Data on acculturation and ethnic-minority health indicate that acculturation has opposite effects on the same health behavior among different ethnic groups; opposite effects on different health behaviors within an ethnic group; opposite effects on the same health behavior for the women vs. the men of most ethnic groups; and no effect whatsoever on some health behaviors for some ethnic groups. This evidence is so incoherent that it is unintelligible, and hence it continues to be largely useless to health psychology and behavioral medicine. This paper presents a new theory of acculturation that renders these confusing data coherent by predicting such changes in minority health behavior a priori. By so doing, the operant model of acculturation has the potential to improve health promotion and disease prevention and thereby reduce ethnic health disparities.

Health fair in a mosque: putting policy into practice

Towards the end of 2001, the Scottish Executive Health Department published a unique report, 'Fair for All', on the issue of addressing the health needs of ethnic minorities. One of the recommendations contained within the report was that different groups and organizations within communities should work together to provide services to minority groups. This descriptive paper is an illustration of how a settled community, in this case a Muslim community, was encouraged to become involved in its own health care by holding a health fair at its mosque. The health fair was organized by the Minority Ethnic Health Inclusion Project, in collaboration with the Local Health Care Co-operative, and in co-operation with Edinburgh Central Mosque. The health fair was held over two consecutive Fridays in May 2003 and focused primarily on diabetes, high blood pressure, healthy eating and oral hygiene, as well as providing information on cancer and local community services. The health fair was well received on both days, with around 200 men and 120 women participating. In total, there were 99 recorded blood pressure measurements and 81 blood glucose checks, and the community dental service was very well received. Strong participation by the community shows that people from ethnic minorities are interested in their health and will participate in health-related activities arranged for them. The success of this health fair shows that, as proposed by the Scottish Executive, different groups and organizations within the community can work together to provide services to minority ethnic groups.

Involving South Asian patients in clinical trials.

To investigate how South Asian patients conceptualise the notion of clinical trials and to identify key processes that impact on trial participation and the extent to which communication difficulties, perceptions of risk and attitudes to authority influence these decisions. Also to identify whether 'South Asian' patients are homogeneous in these issues, and which factors differ between different South Asian subgroups and finally how professionals regard the involvement of South Asian patients and their views on strategies to increase participation. A review of the literature on minority ethnic participation in clinical trials was followed by three qualitative interview studies. Interviews were taped and transcribed (and translated if required) and subjected to framework analysis. Face-to-face interviews were conducted with 25 health professionals; 60 South Asian lay people who had not taken part in a trial and 15 South Asian trial participants. Motivations for trial participation were identified as follows: to help society, to improve own health or that of family and friends, out of obligation to the doctor and to increase scientific knowledge. Deterrents were concerns about drug side-effects, busy lifestyles, language, previous bad experiences, mistrust and feelings of not belonging to British society. There was no evidence of antipathy amongst South Asians to the concept of clinical trials and, overall, the younger respondents were more knowledgeable than the older ones. Problems are more likely to be associated with service delivery. Lack of being approached was a common response. Lay-reported factors that might affect South Asian participation in clinical trials include age, language, social class, feeling of not belonging/mistrust, culture and religion. Awareness of clinical trials varied between each group. There are more similarities than differences in attitudes towards clinical trial participation between the South Asian and the general population. Important decisions, such as participation in clinical trials, are likely to be made by those family members who are fluent in English and younger. Social class appears to be more important than ethnicity, and older South Asian people and those from working class backgrounds appear to be more mistrustful. Approachable patients (of the same gender, social class and fluent in English) tend to be 'cherry picked' to clinical trials. This practice was justified because of a lack of time and resources and inadequate support. South Asian patients might be systematically excluded from trials owing to the increased cost and time associated with their inclusion, particularly in relation to the language barrier. Under-representation might also be due to passive exclusion associated with cultural stereotypes. Other characteristics such as gender, age, educational level and social class can also affect trial inclusion. Effective strategies for South Asian recruitment to clinical trials include: using multi-recruitment strategies; defining the demographic and social profiles of the population to be included; using focus groups to identify any potential barriers; consulting representative community members to provide assistance in the study; ensuring eligibility criteria are set as wide as possible; developing educational and recruitment approaches to attract ethnic minority health professionals; ensuring health professionals are adequately trained in culturally and ethnically orientated service provision; determining the most effective mass media to use in study promotion and recruitment; and targeting inner-city, single-handed practices likely to have high ethnic minority populations. Future research should consider: responses when invited to participate; the role of methodological and organisational barriers to recruitment; the complexities of recruitment from a health professional perspective; developing culturally sensitive research methods; the magnitude of the problem of under-recruitment; strategies to encourage inner-city, single-handed GP participation; and other factors affecting trial inclusion, such as age, gender, educational level and socio-cultural background.

Refugee medicine in the United Kingdom

What9s new in refugee medicine? Peter Cross went to a recent conference organised by the black and ethnic minority health section of the Royal Society of Medicine to find out

Establishing Centers to Address Treatment Effectiveness in Diverse Ethnic Groups: The MEDTEP Experience

Objective. To investigate racial ethnic and socioeconomic disparities in health outcomes amenable to improvement through more effective delivery of health care services. Design. The Medical Treatment Effectiveness Program (MEDTEP) Research Centers on Minority Populations were a group of centers in the USA funded to improve the effectiveness of medical diagnosis and treatment to provide technical assistance to ethnic minority health researchers to train new researchers and to disseminate information to help ethnic minority patients and their health care providers. Results. Centers often provided many specific findings related to assessment of the magnitude of disparities in health outcomes and to approaches for eliminating these outcomes. The Centers were able to build community partnerships using an approach now defined as community-based participatory research. Centers changed the culture of their institutions by making them more aware of the need to train diverse investigators and do more to eliminate health disparities. Conclusions. A key to the success of the Centers has been the unification of a cadre of committed investigators dedicated to the mentoring of minority health researchers and to the elimination of ethnic and socioeconomic disparities in health. The MEDTEP Centers provide a model but there remains a need for continued work.

Investigating socio-economic explanations for gender and ethnic inequalities in health

This paper examines inequalities in the self-reported health of men and women from white and minority ethnic groups in the UK using representative data from the Health Survey for England, 1993–1996. The results show substantially poorer health among all minority ethnic groups compared to whites of working-age. The absence of gender inequality in health among white adults contrasts with higher morbidity for many minority ethnic women compared to men in the same ethnic group. The analysis addresses whether socio-economic inequality is a potential explanation for this pattern of health inequality using measures of educational level, employment status, occupational social class and material deprivation. There are marked socio-economic differences according to gender and ethnic group; high morbidity is concentrated among adults who are most socio-economically disadvantaged, notably Pakistanis and Bangladeshis. Logistic regression analyses show that socio-economic inequality can account for a sizeable proportion of the health disadvantage experienced by minority ethnic men and women, but gender inequality in minority ethnic health remains after adjusting for socio-economic characteristics.

Creating the Climate for Diversity and Race Equality in Health Care

In 1997 the Department of Health funded eight projects to demonstrate 'mainstreaming' responses to minority ethnic health in the NHS. 'Mainstreaming' is understood to require cultural, organisation and practice change; sustaining such change is a major challenge. Evaluation of the projects identified that leadership was a critical factor in encouraging change that was lasting. Other important issues were maintaining the desire changes in a turbulent organisational context and linking changes in practice with other priorities and initiatives. The agenda for the New NHS presents an opportunity for learning from this programme to be put into practice across the Department of Health and the NHS.

Improving access and quality for ethnic minority women— panel discussion

precede the care. In community clinics, the formula we use is 80% education and nurturing, 20% medical care. If you don’t do the education and nurturing and provide the love and affirmation for the patients, the medical care isn’t going to do what you’re hoping it’s going to do. We asked UCLA to do a study of our prenatal program to isolate the reasons our patients have so few low-birth weight babies. There wasn’t any magic formula. The people who were seeing the patients wanted to see them, cared about them, and gave individual attention to their individual needs. We don’t have fancy offices or fancy equipment, but each individual’s problems are identified and effectively addressed. It sounds like a simple formula, but it’s actually very hard to deliver for people who are poor, who are minority, or who speak another language. That’s the challenge that we face, but it’s really a labor of love. We have a great time doing it. Our approach seems to affirm the importance of the communities we serve, as well as the individual patients. The problems of racial and ethnic discrimination may be solved at least in part through this kind of local community delivery, and contribution from the ground level to policy discussions on quality care and health care access.