Compared to the general population, people with intellectual and developmental disabilities (IDD) face worse health outcomes, and outcomes are even worse for children and adults with IDD from minoritized populations. Examining the intersection of people with IDD from minoritized groups is critical to understanding appropriate policies and services that promote health among all people with IDD. People with IDD from minoritized racial and ethnic groups have greater exposure to detrimental social determinants of health, which leads to poor access to adequate healthcare and poor health outcomes. Policies that aim to improve health outcomes among people with IDD and that are related to their disability and appropriate accommodations are not enough. Policies need to address poverty in families, racism and discrimination, poor housing, and other social determinants that are more prevalent among minoritized populations. Most research on racial and ethnic disparities among children and adults with IDD has been conducted in the United States. While there is emerging research globally on racial and ethnic disparities, there a paucity of this research in the field of IDD. Furthermore, there may be detrimental health effects for other minoritized groups, such as religious minorities, but research is lacking in this area. Clearly, more research on these intersections is needed in the global context.
Sandy Magaña, Nazanin Heydarian, and Sandra Vanegas
There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced. Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration. Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care. Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health. Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care. Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.
Around 700,000 people take their lives each year worldwide. Suicide accounts for approximately 1.3% of all deaths and therefore represents a major public health problem. The global age-standardized suicide rate is 9 per 100,000 population, yet there are large variations among genders, ages, countries, and world regions. The stress–vulnerability model of suicidal behaviors has been proposed to explain how a diathesis, developed through the influence of genetic and neurodevelopmental factors in relation to perinatal, postnatal, and life experiences, interacts with different risk and protective factors that either decrease or enhance the individual’s level of resilience to stress and suicidal risk. Public health suicide prevention strategies include suicide means restriction, reducing harmful substance use, promoting responsible media reporting, public-awareness campaigns, gatekeeper trainings, school-based interventions, crisis helplines, and postvention. Mental health strategies comprise identification, treatment, and rehabilitation of persons in distress and at risk for suicide. Multicomponent strategies that use a combination of evidence-based methods from public and mental health sectors are recommended. Future work should aim at enhancing the quality of epidemiological data, improving the research on protective and ideation-to-action factors, expanding the quantity and quality of data coming from low- and middle-income countries, and evaluating the cost-effectiveness of different suicide prevention strategies.
Amy L. Ai, Hoa B. Appel, and Sabrina L. Dickey
Cardiovascular disease (CVD) is the leading cause of death in the United States, but the burden of CVD falls disproportionately on racial and ethnic minority populations. Blacks are especially impacted by CVD. Since the 2010s, mortality from CVD has declined and life expectancy disparity between White and Black males has decreased. However, the mortality rate in Blacks remains the highest among all racial and ethnic groups. For example, concerning survival differences between White and Black patients with acute myocardial infarction, 5-year mortality for Black patients is significantly higher than that for White patients. Also, hypertension or high blood pressure and stroke, two of the most disabling diseases, burden Blacks much more than other groups. Furthermore, several major CVD comorbidities or risk factors are linked with disparity in Blacks, especially diabetes, obesity, and chronic kidney diseases. Physical inactivity is a major risk factor. Blacks and Hispanics, as well as Asian American women, all have higher rates of physical inactivity compared with Whites. The literature indicates the remarkable psychosocial and environmental issues that underlie CVD disparities in Black populations. Specifically, the social determinants of health (SDOH) have been shown to be significant indicators of CVD morbidity and mortality causing a disproportionate impact on racial and ethnic minorities and low socioeconomic status populations. These SDOH involving economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context provide a framework for a multifactorial approach to understand the impact of CVD on the Black community. The Black community has a history of trauma from racism and discrimination, which is still evident in the existence of structural racism. Trust in the health care system within the Black community remains an ongoing issue and stems from the unethical Tuskegee Study. The lack of trust in the U.S. health care system by the Black community is evident in the limited number of Black participants in research and the excess of health disparities within the Black community. Utilizing SDOH provides a context for understanding the complexity of addressing health disparities among historically marginalized groups. A unifactorial approach will not suffice when there are a number of physical, psychosocial, economic, and environment factors that adversely impact the health of underserved and underrepresented groups such as African Americans. Stringent policies to address racism, discrimination, and adequate access to health care for the Black community must be implemented to decrease the presence of CVD as a health disparity. Without the presence of a social and physical environment that provides adequate resources, such as health care services, quality education to attain employment and be health literate, employment to afford access to health care, and the support to engage in preventive care, African Americans will continue to suffer from various health disparities, such as CVD, and have shorter life spans compared to other racial and ethnic groups.
William A. Vega and Esther J. Calzada
Undermining educational attainment at any stage is a threat to life course health. A strong educational platform is required for adequate human development in the 21st century because it provides a foundation for lifelong knowledge, skills, and competencies that protect health. The importance of educational attainment for health has been acknowledged but remains understudied as an interdisciplinary issue. In US American society, unequal educational opportunity is a historical reality and is reflected in health disparities among African American and Latinx populations over the life span. Reform efforts have been initiated for decades, yet gains in educational attainment show limited progress and wide disparities in lifetime health persist. Educational attainment is a fundamental social determinant of health because it leverages higher income, improves the management of other social determinants of health, improves social skills, improves occupational life chances, and extends life expectancy. The reverse is also true. Low educational attainment that is intergenerational imperils human development by failing to prepare youth with the capabilities to overcome structural disadvantages and poverty, which themselves imperil development. African American and Latinx populations in the United States, who together represent nearly 100 million people and who will be the largest component of the majority-minority American population by the year 2046, confront a web of aversive social determinants, including poverty in de facto segregated communities, violence and trauma, toxic exposures, poorly compensated and often temporary employment, a lack of universal health insurance, racism, and sexism in their daily lives. Clearly, there are social, biologic, and psychological issues associated with the educational attainment and health gradient, and early childhood learning experiences represent a critically important opportunity for human potential by advancing cognitive performance, problem-solving ability, motivation to learn, and overall structural and functional brain development. Families from low educational attainment backgrounds experience the negative impacts of social determinants in their daily lives, and their children’s life chances are diminished by poorly funded schools with ineffective educational programs. Putative causes and potential responses to overcoming the historical problem of neglect have been identified, and there are promising efforts at educational system reform aiming to promote health with effective programs and comprehensive strategies that will close the gaps in educational attainment.