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Social Work Health Disparities
by
Sarah Gehlert
  • LAST REVIEWED: 01 May 2017
  • LAST MODIFIED: 25 May 2011
  • DOI: 10.1093/obo/9780195389678-0029

Introduction

Health disparities is defined by the National Institutes of Health as differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States. According to United States Public Law 106–525, known as the Minority Health and Health Disparities Research and Education Act, “a population is a health disparity population if there is a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population” (p. 2498; see Policy). Although the vast majority of research in health disparities has focused on group differences by race or ethnicity, health disparities can occur by gender, socioeconomic status, disability status, sexual orientation, age, and location/geography. This bibliography’s primary focus is on disparities within the United States. These resources are meant to be useful to social work practice, policy, education, and research. While the identified references focus on social work applications, references dealing with clinical and policy-relevant issues that originate in other health professions and disciplines also are listed.

Textbooks

A few texts provide valuable overviews of health disparities. Although none to date has been generated within the field of social work, two texts in particular are useful for social work education, either for courses of health care of minorities or vulnerable populations or as adjunct texts in more generic health practice or policy courses. These texts also have value as resources for social workers and other professionals engaged in practice, policy, or research involving disparate populations. Of the texts listed in this section, Barr 2008 is the broadest, providing the most complete and encompassing overview of disparities. The author’s thoughtful analysis of central terms, such as race and health, and attention to devising solutions for disparities, is also valuable. With more than 250 references, it is useful in classroom teaching and raises essential questions for researchers in health and health care. LaVeist 2005 is the best for outlining demographic information, morbidity, and mortality of a number of racial/ethnic groups in the United States. It is an important text for students and researchers conducting research in health that cross-cuts racial/ethnicity and socioeconomic status and for social work and other practitioners attempting to understand group differences in health.

  • Barr, D. A. 2008. Health disparities in the United States: Social class, race, ethnicity, and health. Baltimore: Johns Hopkins Univ. Press.

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    Of value to graduate students and researchers as a source on social determinants of health disparities. Attention is paid to the effects of physician behavior. The author provides useful charts and graphs and defines key terms. The relationship between socioeconomic status, race, and health is also addressed.

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    • LaVeist, T. 2005. Minority populations and health: An introduction to health disparities in the United States. San Francisco: Jossey-Bass.

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      This text contains information on racial/ethnic demographics, morbidity, and mortality, with a number of useful graphics. It reviews theories of racial/ethnic group differences in health and mental health, with attention to socioeconomic status, behavior, and availability of services.

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      Reference Resources

      A number of web-based reference works are available on health disparities and the health of diversity populations. These resources can be used to support education on health disparities as well as to support practitioners seeking to incorporate elements of health disparities and disparity population health into their work. For students and practitioners wanting basic information on minority health and health disparities, the best web resources are the CDC’s Office of Minority Health and Health Disparities and the National Center on Minority Health and Health Disparities. The Rural Health Disparities site focuses on rural disparities and provides links to other websites. These sites also include funding information, as does Kaiser’s Monthly Update on Health Disparities and Measuring Healthcare Quality. Practitioners and organizations wanting to locate information on interventions to address disparities should examine the Health Disparities Database and the site of the Health Disparities Research and Diversity Resource Center. For keeping current on health disparities research, the most important and useful online resource is Kaiser’s Monthly Update on Health Disparities. Measuring Healthcare Quality is useful to graduate students and researchers as a rich source of statistics and data on health care quality.

      Manuals and Guides

      A number of resources are available to provide information for social work and other practitioners wishing to incorporate information about disability populations and health disparities into their work. These resources also support those conducting research in health disparities. Keppel, et al. 2002 provides trends on changes in the health status of racial and ethnic populations through time. This can be used in planning, design programs, inform policy, and guide research. Keppel, et al. 2005 is essential reading for social workers and others conducting health disparities research, because it systematically outlines methodological issues common to disparities research and provides guidance for how to think through competing approaches toward specific projects. Kilbourne, et al. 2006 breaks down the health disparities research process into three phases, each of which the authors discuss in depth. Stewart, et al. 2008 makes a case for using both qualitative and quantitative methods in health disparities research. The authors’ careful arguments and examples will be helpful for increasing graduate students’, practitioners’, and policy makers’ understanding of disparities research and will be invaluable to social work and other researchers considering or conducting research in health disparities.

      • Keppel, K. G., J. N. Pearcy, and D. K. Wegener. 2002. Trends in racial and ethnic-specific rates for the health status indicators: United States, 1990–1998. Hyattsville, MD: National Center for Health Statistics.

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        This seminal publication provides analysis of trends in seventeen health status indicators, such as infant mortality and homicide deaths, from 1990 to 1998 by five racial/ethnic groups in the United States. It is good for classroom use in health policy for social workers and allied health professionals as well as for researchers, planners, policy makers, and practitioners who are designing services.

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        • Keppel, K., E. Pamuk, J. Lynch, O. Carter-Pokras, Insun Kim, V. Mays, J. Pearcy, V. Schoenbach, and J. S. Weissman. 2005. Methodological issues in measuring health disparities. Vital Health Statistics 2.141: 1–16.

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          This CDC publication addresses six methodological issues affecting health disparities research, such as whether to measure favorable or adverse events and how to weight groups. Examples illustrate the outcomes of various approaches to addressing each issue. This is useful for classroom teaching as well as for researchers in social work and allied disciplines.

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          • Kilbourne, A. M., G. Switzer, K. Hyman, M. Crowley-Matoka, and M. J. Fine. 2006. Advancing health disparities research within the health care system: A conceptual framework. American Journal of Public Health 96.12: 2113–2121.

            DOI: 10.2105/AJPH.2005.077628Save Citation »Export Citation »E-mail Citation »

            This article is valuable for health-services researchers, practitioners, policy makers, and advanced graduate students. It provides a framework that divides disparities research into three phases and discusses issues unique to each phase. This is extremely useful for helping to structure research and for practitioners and policy makers to understand the contingencies of disparities research.

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            • Stewart, M., E. Makwarimba, A. Barnfather, N. Letoureau, and A. Neufeld. 2008. Researching reducing health disparities: Mixed-methods approaches. Social Science & Medicine 66.6: 1406–1417.

              DOI: 10.1016/j.socscimed.2007.11.021Save Citation »Export Citation »E-mail Citation »

              Presents an argument for using mixed methods in disparities research and offers suggestions. Added benefit comes from the use of two examples of how mixed methods have been used effectively.

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              Bibliographies

              Cultural Competence/Health Disparities Selected Resources is a bibliography on health disparities that is useful for students at all levels as well as for practitioners and researchers interested in translating knowledge on cultural competence into outcomes and interventions. The website has a number of current references on cultural competence and health disparities in general.

              Journals

              A number of journals within and outside the field of social work have published articles relevant to health disparities and to the health of disparity populations. These journals, although not dedicated to health disparities, are useful to social work education, practice, policy, and research. Although no journal within the field of social work is devoted exclusively to health disparities, Social Work in Public Health publishes a number of articles on disparities and the health and health care access of disparate populations. A special issue on disparities was published in 2010 (see Special Issues) with articles on the role of ad hoc translators on disparities in care by race/ethnicity and socioeconomic status, the contribution of transdisciplinary collaborations to ameliorating health disparities, and disparities among women with disabilities. Other health social work journals, such as Health & Social Work and Social Work in Health Care, occasionally publish articles on issues relating to health disparities. Health & Social Work also published a special issue on health disparities (Gorin, et al. 2010, cited under Special Issues) in 2010. For faculty, students, and practitioners in health settings, key journals outside the field of social work might be of interest; they, too, offer important articles pertaining to health disparities and the health of disparity populations. The Journal of Health Disparities Research and Practice, American Journal of Public Health, and Journal of Healthcare for the Poor and Underserved provide the most consistent and substantive coverage of disparities. A number of journals in allied disciplines have in recent years devoted special issues to health disparities.

              Special Issues

              The following special issues contain articles that are of particular interest to social workers. Social Work in Public Health published a special issue in May 2010, with articles addressing a variety of health conditions across disparity populations. This is of particular interest to public health social workers. Four articles in the February 2006 edition of Journal of Health Politics, Policy and Law demonstrate the relationships between disparities, politics, and policy and are useful in teaching students possible avenues for change, by helping to refocus discussions of policy on finding solutions. The American Journal of Public Health has devoted issues to health disparities, in December 2005 and most recently in July 2009. Health Affairs, a leading journal in health policy, devoted a 2008 issue to health disparities. Articles in this issue are often cited and provide valuable information for students, practitioners, and researchers in social work and other disciplines.

              Mental Health

              Consensus is lacking on whether the determinants of health disparities in general apply to disparities in mental health and whether policies to reduce health care disparities will be effective in addressing mental health disparities. Breslau, et al. 2005 provides the best overall picture of the risk and persistence of mental health conditions across race and ethnicity in the United States. Empirical work by McGuire and Miranda 2008 and Miranda, et al. 2008 address whether population group differences in the incidence and prevalence of diseases such as cancer operate in the same way as do differences in mental conditions. These articles are valuable for practitioners, policy makers, and students because they offer useful suggestions for addressing mental health care disparities. The Beals, et al. 2005 article is included because it provides a useful example of mental health disparities within a specific racial/ethnic group and discussion of issues for that group.

              • Beals, J., S. M. Manson, N. R. Whitesell, P. Spicer, D. K. Novins, and C. M. Mitchell. 2005. Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry 62:99–108.

                DOI: 10.1001/archpsyc.62.1.99Save Citation »Export Citation »E-mail Citation »

                This article by the American Indian Services Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) is one of the few empirical articles to discuss the mental health of American Indians. Alcohol disorders and posttraumatic disorder were found to be more prevalent among the two groups studied than among other population groups.

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                • Breslau, J., K. S. Kendler, M. Su, S. Gaxiola-Aguilar, and R. C. Kessler. 2005. Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychological Medicine 35:317–327.

                  DOI: 10.1017/S0033291704003514Save Citation »Export Citation »E-mail Citation »

                  The authors compared the psychiatric morbidity of Hispanics, non-Hispanic blacks, and non-Hispanic whites, using data from the National Comorbidity Study, and found no evidence of increased risk for psychiatric disorders among the former two groups compared to non-Hispanic whites. This article provides a clear and cogent overview of psychiatric morbidity across ethnic groups in the United States.

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                  • McGuire, T. G., and J. Miranda. 2008. New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs 27.2: 393–403.

                    DOI: 10.1377/hlthaff.27.2.393Save Citation »Export Citation »E-mail Citation »

                    These authors hold that addressing disparities in health care should improve mental health disparities. They suggest that a diverse workforce will help to decrease population-group differences in health.

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                    • Miranda, J., T. G. McGuire, D. G. Williams, and P. Wang. 2008. Mental health in the context of health disparities. American Journal of Psychiatry 165:1102–1108.

                      DOI: 10.1176/appi.ajp.2008.08030333Save Citation »Export Citation »E-mail Citation »

                      This commentary by experts in the social and behavioral sciences addresses the causes of health and mental health care disparities and makes suggestions for policies to affect the disparities in mental health care.

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                      Disparity Populations

                      Disease incidence, prevalence, morbidity, mortality, or survival rates differ for some population groups compared to those of the general population. These groups are distinguished by gender, sexual orientation, race and ethnicity, age, place, socioeconomic status, and disability status. In the following subsections, the best and most current references for each category are offered for specific disparity populations.

                      Gender

                      The nature and extent of gender disparities remains unclear and may vary by health status measure considered. Gorman and Read 2006 provides the most careful review and analysis of existing data on differences in physical health among men and women.

                      • Gorman, B. K., and J. G. Read. 2006. Gender disparities in adult health: An examination of three measures of morbidity. Journal of Health and Social Behavior 47:95–110.

                        DOI: 10.1177/002214650604700201Save Citation »Export Citation »E-mail Citation »

                        The authors examine gender-by-age differences in three measures of morbidity and find different explanations for each of the three. The article is useful in bringing policy makers, students, practitioners, and researchers up to date with the state of knowledge about health status differences among men and women.

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                        Sexual Orientation

                        Sexual orientation as a source of health disparities has received little attention. This is attributable in part to a general lack of objectively obtained data on lesbian, gay, bisexual, and transgendered (LGBT) persons. Without these data, it is difficult to design policies and programs to address disparities. Only in the past several years have empirical studies of the health of lesbian and bisexual women been undertaken. Objectively obtained information on transgendered person is rare. Mays, et al. 2002 is the best resource for information on the intersection of sexual orientation and race/ethnicity in health disparities. Sell and Becker 2001 helps students, practitioners, policy makers, and researchers in social work and related disciplines to gauge the nation’s progress toward meeting its health-status goals for LGBT persons. Diamant, et al. 2000 and Rhodes, et al. 2007 provide empirical data on the health behaviors and health status/sexual orientation disparity population groups. These data are useful for targeting interventions and developing supports.

                        • Diamant, A. L., C. Ward, K. Spritzer, and L. Gelberg. 2000. Health behaviors, health status, and access to and use of health care: A population-based study of lesbian, bisexual, and heterosexual women. Archives of Family Medicine 9.10: 1043–1051.

                          DOI: 10.1001/archfami.9.10.1043Save Citation »Export Citation »E-mail Citation »

                          Calculates adjusted relative risks of a number of health conditions using data from a population-based study whose data were gathered via random-digit dialing, for self-identified heterosexual, lesbian, and bisexual women. The latter two groups fared less well than did heterosexual women in terms of health behaviors and access to health care.

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                          • Mays, V. M., A. K. Yancey, S. D. Cochran, M. Weber, and J. E. Fielding. 2002. Heterogeneity of health disparities among African American, Hispanic, and Asian American women: Unrecognized influences of sexual orientation. American Journal of Public Health 92.4: 632–639.

                            DOI: 10.2105/AJPH.92.4.632Save Citation »Export Citation »E-mail Citation »

                            Explores the prevalence rates of chronic illnesses among self-identified lesbian/bisexual across three racial groups and compares rates to those of heterosexual women. Compares health indicators of groups of lesbian/bisexual women living in Los Angeles County to those of heterosexual women in the same locale.

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                            • Rhodes, S. D., T. McCoy, K. C. Hergenrather, M. R. Omli, and R. H. Durant. 2007. Exploring the health behavior disparities of gay men in the United States: Comparing gay male university students to their heterosexual peers. Journal of LGBT Research 3.1: 15–23.

                              DOI: 10.1300/J463v03n01_03Save Citation »Export Citation »E-mail Citation »

                              This is one of the few empirical studies of health disparities that affect gay men. The gay men in the study who reported higher-risk behaviors reported higher sexual-risk behaviors and illicit drug use. The authors argue that strategies targeting disparities among disparity populations must be based on an objective understanding of health/behavior disparities.

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                              • Sell, R. L., and J. B. Becker. 2001. Sexual orientation data collection progress toward Healthy People 2010. American Journal of Public Health 91.6: 876–882.

                                DOI: 10.2105/AJPH.91.6.876Save Citation »Export Citation »E-mail Citation »

                                This important paper, supported by funding from the US Office of the Assistant Secretary of Planning and Evaluation, outlines the gaps in knowledge about the health of LGBT Americans and outlines a plan for collecting data on the population groups.

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                                Race and Ethnicity

                                Disparities by race and ethnicity receive the majority of attention in policy, practice, and research. A number of references are available that define, and consider the unique contribution of race and ethnicity in health disparities practice and research. Importantly, they also discuss its complex interactions with other determinants. Copeland 2005 focuses on issues involved in disparities across health conditions for African Americans, with a focus on access to care and services. The article is valuable for social work students and practitioners because it is written through a social work lens, which is useful for students, and includes clearly articulated implications for social work. Fiscella, et al. 2002 considers the often-overlooked contribution of language in disparities. The Centers for Population Health and Health Disparities 2007 report is sophisticated and thus better suited for use with advanced graduate students and practitioners with existing basic knowledge about disparities. The best single resource for understanding racial/ethnic disparities is the LaVeist 2002 edited volume. Written by experts, its chapters provide information on a variety of issues for a variety of racial/ethnic groups in a manner that is accessible to students, researchers, policy makers, and practitioners with varying knowledge about disparities.

                                • Centers for Population Health and Health Disparities. 2007. Cells to society: Overcoming health disparities.

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                                  Carefully outlines how determinants at multiple levels contribute to a number of health conditions across racial/ethnic groups, based on empirical work at the eight funded centers. The report makes a strong case for a collaborative, cross-disciplinary approach to disparities to capture the complexity of determinants of disparities and their interactions.

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                                  • Copeland, V. C. 2005. African Americans: Disparities in health care access and utilization. Health & Social Work 30.3: 265–270.

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                                    Provides an overview of disparities among African Americans, with emphasis on access and quality of care. It is useful for teaching at the undergraduate and graduate levels, because it examines disparities through a social work lens.

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                                    • Fiscella, K., P. Franks, M. P. Doescher, and B. G. Saver, 2002. Disparities in health care by race, ethnicity, and language among the insured. Medical Care 40.1: 52–59.

                                      DOI: 10.1097/00005650-200201000-00007Save Citation »Export Citation »E-mail Citation »

                                      The authors of this empirical study examined language fluency with race and ethnicity and found that low language proficiency exacerbated group differences in health among the adults studied.

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                                      • LaVeist, T. A., ed. 2002. Race, ethnicity, and health: A public health reader. San Francisco: Jossey-Bass.

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                                        Contains a wealth of chapters on individual topics germane to racial/ethnic disparities. These include the often-cited “Under the Shadow of Tuskegee: African Americans and Health Care” by Gamble and “Immigration and the Health of Asian and Pacific Islander Adults in the United States” by Frisbie, Cho, and Hummer.

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                                        Age

                                        Health disparities by age have multiple determinants, from the physical deterioration that comes with aging to changes in socioeconomic status that occur later in life. The nature of these determinants remains unclear. Population Reference Bureau 2008, a newsletter funded by the University of Michigan Demography Center, reports on socioeconomic status and aging provides an easily understood lifespan perspective.

                                        • Population Reference Bureau. 2008. Socioeconomic and health disparities in old age. Today’s Research on Aging 11. Washington, DC: Population Reference Bureau.

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                                          This online newsletter issue is equally useful for teaching, research, and practice within social work and related fields. Of particular value is an overview of the role of socioeconomic status in health disparities, considered from a life span perspective at both the individual and neighborhood levels.

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                                          Place

                                          A few empirical studies have demonstrated health disparities by place. Galambos 2005 nicely frames the issue of rural disparities for social workers. Everhardt and Pamuk 2004 is a good example of analysis of disparities by location using a large data set. In a carefully executed analysis, the authors found greater disparity among residents of the most rural and urban areas studied. Rather than using the traditional comparison by race/ethnicity, Murray, et al. 2005 divides the country into groups based on epidemiological patterns, which in part are geographic. Blacks who live in inner-city neighborhoods, for instance, are distinguished from black middle Americans and those living in the rural South. This article provides a catalyst for classroom discussion and challenges researchers to construct comparisons based on the constructs that might underlie and drive group differences in health.

                                          • Everhardt, M. S., and E. R. Pamuk. 2004. The importance of place in residence: Examining health in rural and nonrural areas. American Journal of Public Health 94.10: 1682–1686.

                                            DOI: 10.2105/AJPH.94.10.1682Save Citation »Export Citation »E-mail Citation »

                                            Argues for considering place of residence in studies of health disparities. Using data from the 2001 Urban and Rural Health Chartbook, the authors demonstrate disparities for the most rural and most urban areas, rather than a consistent rural to urban gradient.

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                                            • Galambos, C. M. 2005. Health care disparities among rural populations: A neglected frontier. Health & Social Work 30.3: 179–181.

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                                              This short editorial nicely outlines the argument for rural and frontier residents as a disparity population. The author portrays rural disparities through a social work lens and discusses the roles of the profession in addressing this disparity.

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                                              • Murray, C. L., S. Kulkarni, and M. Ezzati, 2005. Eight Americas: New perspectives on U.S. health disparities. American Journal of Preventive Medicine 29.5: 4–10.

                                                DOI: 10.1016/j.amepre.2005.07.031Save Citation »Export Citation »E-mail Citation »

                                                This innovative article moves from traditional conceptualizations of disparities by population group to divisions based on epidemiological patterns and mortality experience, in part based on geography. The article is useful in teaching, because it forces discussion on what truly drives disparities.

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                                                Socioeconomic Status

                                                Socioeconomic status differences as a determinant of health disparities is an emerging area of study. Ai and Carrigan 2007 offers a perspective on disparities by socioeconomic status and gender that will be easily understood by social work students, in part because the authors describe issues using cardiovascular disease as a concrete example. Marmot and Wilkinson 2006 is considered the seminal reference on the social determinants of health. Although the majority of its authors are from the United Kingdom, the expertise of US sociologist David Williams was tapped for a chapter on racial/ethnic inequality as a determinant of health disparities. The text effectively references a wide range of earlier work. It provides the best and most complete explanation of social factors that impact health and access to health care and may contribute to differences in health by age, race/ethnicity, and other factors. Meara, et al. 2008 takes a sophisticated approach to disparities, considering differences in race and ethnicity by education. It is useful for advanced graduate courses in health and is an important source for researchers and practitioners who might otherwise miss differences by education and other social factors within racial and ethnic groups. These differences are important for targeting effective interventions.

                                                • Ai, A. L., and L. T. Carrigan. 2007. Social-strata-related cardiovascular health disparity and comorbidity in an aging society: Implications for professional care. Health & Social Work 32.2: 97–105.

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                                                  Using cardiovascular disease, the leading cause of death in the United States, as an example, the authors carefully outline the differential effects of gender and socioeconomic status for a social work audience.

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                                                  • Marmot, M., and R. G. Wilkinson, eds. 2006. Social determinants of health. 2d ed. Oxford: Oxford Univ. Press.

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                                                    Experts from Britain and the United States carefully address social environmental factors at the group and individual levels that impact health and contribute to health disparities. Chapters are devoted to issues such as the work environment, social support, and racial/ethnic inequality. Although some material may now be slightly outdated, the text provides valuable information.

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                                                    • Meara, E. R., S. Richards, and D. M. Cutler. 2008. The gap gets bigger: Changes in mortality and life expectancy, by education, 1981–2000. Health Affairs 27.2: 350–360.

                                                      DOI: 10.1377/hlthaff.27.2.350Save Citation »Export Citation »E-mail Citation »

                                                      This article importantly considers the role of education in racial and ethnic disparities. Exploring the effect of education within racial/ethnic disparity populations reveals a growing educational gap in life expectancy, with almost all gains being experienced by more highly educated groups.

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                                                      Disability

                                                      Disparities by disability status, both for physical and intellectual disabilities, is an emerging area of inquiry. Krahn, et al. 2006 is useful for practitioners and students because it provides a useful conceptualization of intellectual disabilities. Drum, et al. 2005 reviews data on health disparities among persons with disabilities. Both provide the basic information needed by social work practitioners, students, policy makers, and researchers to understand salient issues.

                                                      • Drum, C. E., G. Krahn, C. Culley, and L. Hammond. 2005. Recognizing and responding to the health disparities of people with disabilities. Californian Journal of Health Promotion 3.3: 29–42.

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                                                        Provides a clear and articulate summary of available data documenting health disparities among persons with disabilities, broadly defined. It offers a number of suggestions for policy change involving specific existing policies and programs.

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                                                        • Krahn, G. L., L. Hammond, and A. Turner. 2006. A cascade of disparities: Health and health care access for people with intellectual disabilities. Mental Retardation and Developmental Disabilities Research Reviews 12:70–82.

                                                          DOI: 10.1002/mrddSave Citation »Export Citation »E-mail Citation »

                                                          This overview attempts to disentangle health from disability and considers the determinants of disparity among the 2 percent of the population with intellectual disability from a broad multilevel perspective. This analytical framework provides students, practitioners, policy makers, and researchers with a useful means of conceptualizing intellectual disabilities in a way that allows for the translation of knowledge into action and research.

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                                                          Determinants of Health and Health Disparities

                                                          Much work remains to be done to gain a clearer understanding of the underpinnings of health disparities. Nonetheless, few references are available that articulate how various determinants affect health outcomes at the population level to fuel disparities. All of these references can be used in teaching disparities and are important for practitioners, researchers, and policy makers to understand.

                                                          Social Environment

                                                          Brunner and Marmot 2006 and Nazroo and Williams 2006, both from Marmot and Wilkinson’s seminal text on the social determinants of health (see Marmot and Wilkinson 2006, cited under Socioeconomic Status), provide an overview for social work students, researchers, practitioners, and policy makers on how aspects of the social environment influence health and fuel disparities. Brunner and Marmot 2006 provides a foundation for understanding how social stressors originating at various levels affect health outcomes and contribute to health disparities. Nazroo and Williams 2006 specifically addresses how perceived discrimination and mistrust of healthcare providers contribute to group differences in health.

                                                          • Brunner, E., and M. Marmot. 2006. Social organization, stress, and health. In Social determinants of health. Edited by M. Marmot and R. G. Wilkinson, 6–30. Oxford: Oxford Univ. Press.

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                                                            Reviews existing empirical studies of the relationships between features of the social environment, stress, and health outcomes, with consideration of how these relationships impact group differences in health.

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                                                            • Nazroo, J. Y., and D. R. Williams. 2006. The social determination of ethnic/racial inequalities in health. In Social determinants of health. Edited by M. Marmot and R. G. Wilkinson, 238–266. Oxford: Oxford Univ. Press.

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                                                              Provides an in-depth discussion of how the social construction of race and resultant discrimination and mistrust affect health outcomes and health disparities.

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                                                              Physical Environment

                                                              Gordon-Larsen, et al. 2006 describes how the physical environments in which people live, such as open spaces in neighborhoods that foster social activities and interactions, promote health and may reduce disparities. Morland, et al. 2002 discusses how the availability of grocery stores versus fast food facilities varies by geographic location. The authors link the availability of healthful food to more favorable health outcomes for some groups.

                                                              • Gordon-Larsen, P., M. C. Nelson, P. Page, and B. M. Popkin. 2006. Inequality in the built environment underlies key health disparities in physical activity and obesity. Pediatrics 117.2: 417–424.

                                                                DOI: 10.1542/peds.2005-0058Save Citation »Export Citation »E-mail Citation »

                                                                This is one of the few articles that argue that the built or physical environments in which people live, such as the presence of physical activity facilities, affect health disparities.

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                                                                • Morland, K., S. Wing, A. Diez-Roux, and C. Poole. 2002. Neighborhood characteristics associated with the location of food stores and food service places. In Race, ethnicity, and health: A public health reader. Edited by T. A. LaVeist, 448–462. San Francisco: Jossey-Bass.

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                                                                  An empirical study of the distribution of food sources. The authors discuss the location, and thus ability to access, healthful foods as a source of disparities.

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                                                                  Access to Care

                                                                  Many authors have implicated access to healthcare as a contributor to health disparities. That is to say, groups that have greater access to care, by virtue of having health insurance and/or living near high-quality healthcare facilities, will have better health outcomes than groups that do not. Lurie and Dubowitz 2007 makes a particularly clear and cogent argument for the link between access to care and health disparities and carefully outline the policy implications of this link.

                                                                  • Lurie, N., and T. Dubowitz. 2007. Health disparities and access to care. JAMA 297.10: 1118–1121.

                                                                    DOI: 10.1001/jama.297.10.1118Save Citation »Export Citation »E-mail Citation »

                                                                    This journal article by researchers at the RAND Corporation carefully relates public policies in the United States that affect access to care to health disparities and outlines clearly a number of policy recommendations to reduce disparities.

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                                                                    Provider Bias

                                                                    The Smedley, et al. 2002 report provides the most thorough and clear explanation of how provider behavior and bias and mistrust of physicians affect health behaviors to foster health disparities. The Cooper, et al. 2006 journal article specifically addresses ways in which race and ethnicity affect patient and provider relationships to influence health.

                                                                    • Cooper, L. A., M. C. Beach, R. L. Johnson, and T. S. Inui, 2006. Delving below the surface: Understanding how race and ethnicity influence relationships in health. Journal of General Internal Medicine 21:S21–S27.

                                                                      DOI: 10.1111/j.1525-1497.2006.00305.xSave Citation »Export Citation »E-mail Citation »

                                                                      Reviews the literature on how patient and provider relationships and clinician and community relationships, largely those between white providers and patients who come from racial/ethnic groups, affect health care and health disparities. The authors provide examples of relationships and subsequent communication patterns that result in more favorable outcomes for patients.

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                                                                      • Smedley, Brian D., Adrienne Y. Stith, Alan R. Nelson, and Institute of Medicine. 2002. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press.

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                                                                        Makes a strong statement about the contribution of health care providers, principally physicians, to group differences in health outcomes in the United States. It provides useful charts and graphs, including a scheme of how provider bias can lead to poorer outcomes in treatment.

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                                                                        Biology and Genetics

                                                                        Carlson and Chamberlain 2005 effectively conveys how social phenomena interact with biology to produce disparities. Gehlert, et al. 2008 presents, from a social work perspective, a collaborative study among social, behavioral, and biological scientists in concert with community stakeholders. Empirical links are provided to demonstrate how neighborhood- and community-level factors affect biological processes to explain a health disparity. They make the point that targeting upstream factors influences clinical and biological processes downstream.

                                                                        • Carlson, E. D., and R. M. Chamberlain. 2005. Allostatic load and health disparities: A theoretical orientation. Research in Nursing & Health 28.4: 306–315.

                                                                          DOI: 10.1002/nur.20084Save Citation »Export Citation »E-mail Citation »

                                                                          Outlines in simple terms the concept of allostatic load, a biomarker of stress, and its potential contribution to health disparities research. Allostatic load is a biological phenomenon that comes from psychosocial stressors in the environment. It is higher among vulnerable populations and has been linked to poorer health outcomes among members of these populations.

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                                                                          • Gehlert, S., C. Mininger, D. Sohmer, and K. Berg, 2008. (Not so) gently down the stream: Choosing the targets to ameliorate health disparities. Health & Social Work 33.3: 163–167.

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                                                                            The editorial presents an empirically tested multilevel scheme of the determinants of black and white differences in breast cancer mortality. Social circumstances at the neighborhood and community level and psychological responses to those circumstances affect gene expression to produce malignant breast tumors.

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                                                                            Policy

                                                                            Changing existing public policies and developing new policies to address the gap between disparity populations and the general population is an important route to eliminating health disparities. Policy initiatives aimed specifically at health disparities have been launched since the Clinton administration. US Senate 2000 is an important historical document for understanding the federal approach to addressing health disparities. The Minority Health and Health Disparities Education and Research Act of 2000, signed into law later that year, is another such document. Recent articles, such as Kaplan, et al. 2008, address the effect on health status of social policies not specific to health disparities. This article provides a useful platform from which to generate classroom discussion on the effect of policy change on health, especially the health of disparity populations.

                                                                            • Congressional Research Service Summary S.1880: Minority Health and Health Disparities Research and Education Act of 2000.

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                                                                              This online resource prepared by the Congressional Research Service, a nonpartisan arm of the Library of Congress, describes the act and its major provisions. It is a useful summary of the legislation for use in the classroom or for anyone trying to understand health disparities policy at the federal level.

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                                                                              • Kaplan, G. A., N. Ranjit, and S. A. Burgard. 2008. Lifting gates, lengthening lives: Did civil rights policies improve the health of African American women in the 1960s and 1970s? In Making Americans healthier: Social and economic policy as health policy. Edited by R. F. Schoeni, J. S. House, G. A. Kaplan, and H. Pollack, 145–170. New York: Russell Sage Foundation.

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                                                                                Carefully reviews civil rights policies enacted in the 1960s and 1970s in the United States and the effect of these policies on the health outcomes of African-American women.

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                                                                                • US Senate. 2000. Health disparities: Bridging the gap; hearing before the Subcommittee on Public Health of the Committee on Health, Education, Labor, and Pensions, United States Senate, One Hundred Sixth Congress, second session, on examining health care disparities among women, minorities, and rural under-served populations, and the actions of the National Institutes of Health to address these disparities, as well as review any relevant legislation designed to address the issues of health disparities, July 26, 2000. Washington, DC: Government Printing Office.

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                                                                                  These proceedings are important to understanding the subsequent changes in federal policy toward the health of women, minorities, and rural under-served populations that have been enacted in the first decade of the 21st century.

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                                                                                  Teaching

                                                                                  At present, no shared resources are available in social work to support the teaching of health disparities. A few resources are available for allied health professions that can be adapted for use in social work education. Smith, et al. 2007 includes a series of recommendations and guidelines for curricula in health disparities developed by the Society of General Internal Medicine Health Disparities Task Force. These ideas are presented in a way that makes them easily translatable to curricula. Likewise, Vela, et al. 2008 describes a course for incoming medical students. It is directly applicable to social work education, both in regular classrooms and continuing education.

                                                                                  • Smith, W. R., J. R. Betancourt, M. K. Wynia, J. Bussey-Jones, V. E. Stone, C. O. Phillips, A. Fernandez, E. Jacobs, and J. Bowles. 2007. Recommendations for teaching about racial and ethnic disparities in health and health care. Annals of Internal Medicine 147.9: 654–665.

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                                                                                    This journal article, prepared by a task force of general practitioners, includes a clearly stated goal for a course on health disparities as well as three main learning objectives. The information is useful for anyone wanting to design a course on disparities.

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                                                                                    • Vela, M., K. E. Kim, H. Tang, and M. H. Chin. 2008. Innovative health disparities curriculum for incoming medical students. Journal of General Internal Medicine 23.7: 1028–1032.

                                                                                      DOI: 10.1007/s11606-008-0584-2Save Citation »Export Citation »E-mail Citation »

                                                                                      This is an empirical evaluation of a five-day course on health disparities, which was designed with input from social workers, for incoming medical students. The course significantly increased students’ knowledge of disparities and received the highest rating of any course in the curriculum. The course’s structure is outlined.

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