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Article

Valire Carr Copeland and Sandra Wexler

Despite technological advances and changes in healthcare delivery, some groups in the United States continue to have better health-related outcomes than others. This article discusses health disparities—differences in health status and healthcare utilization that are influenced by complex social structural, economic, and cultural factors. Illustrations are offered of health disparities found among diverse populations in this country. The “problem” with health disparities is then explored. From an ethical standpoint, health disparities can be seen as unjust. From a cost perspective, health disparities exact not just a financial toll that is borne by society, but individual, group, and community consequences, as well. From a human rights vantage, health disparities can further disadvantage people who are already vulnerable and marginalized—health disparities can cost people their lives. Factors contributing to health disparities, commonly referred to as social determinants, are reviewed. Finally, future directions, including social workers’ role as advocates, are considered.

Article

Shrivridhi Shukla, Sneha Jacob, and Karun Singh

India has witnessed a substantial decline in the rate of new HIV infections in the past decade. Despite the reduction in incidence, the social determinants of health, such as poverty, gender inequality, and stigma, have made tackling the disease challenging for medical practitioners, health educators, and social workers, among other stakeholders. This article describes social determinants of HIV/AIDS and provides a brief history of shifts in the HIV/AIDS policies in India, with an overview of the current policy that is complicated by regional variations in HIV prevalence and transmission. In addition, it discusses the nature and impact of HIV in different communities vulnerable to the infection, major interventions supported by the Indian government, and the diverse roles played by social workers in combating the epidemic and providing services to people living with HIV/AIDS.

Article

There are an estimated 300 million indigenous peoples worldwide. Although there is ample evidence of worse health and social outcomes for the majority of indigenous peoples, compared to their non-indigenous counterparts, there has yet to be a review of racism as a determinant of indigenous health using global literature. Racism constitutes unfair and avoidable disparities in power, resources, capacities, or opportunities centered on ethnic, racial, religious, or cultural differences that can occur at three levels: internalized, interpersonal, or systemic. For indigenous peoples this is closely related to ongoing processes of colonization. Available research suggests that at least a third of indigenous adults experience racism at least once during their lives and that about a fifth of indigenous children experience racism. For indigenous peoples, racism has been associated with a considerable range of health outcomes, including psychological distress, anxiety, depression, suicide, posttraumatic stress disorder, asthma, physical illness, obesity, cardiovascular disease, increased blood pressure, excess body fat, poor sleep, reduced general physical and mental health, and poor oral health, as well as increased alcohol, tobacco, and marijuana use and underutilization of medical and mental healthcare services. Disparities in medical care experienced by indigenous patients compared to non-indigenous patients have also been found. Existing studies indicate that avoidant and passive coping tends to exacerbate the detrimental health impacts of racism for indigenous peoples, whereas active coping ameliorates the ill-health effects of racism. Reducing individual and interpersonal racism can be achieved by (a) providing accurate information and improving awareness of the nature of racism and racial bias; (b) activating values of fairness, reconciling incompatible beliefs, and developing antiracist motivation; (c) fostering empathy and perspective-taking and confidence in regulating emotional responses; (d) improving comfort with other groups and reducing anxiety; and (e) reinforcing antiracist social norms and highlighting personal accountability. There are five key areas for combating systemic racism in organizations and institutions: (a) institutional accountability; (b) diversity in human resources; (c) community partnership; (d) antiracism and cultural competence training; and (e) research and evaluation.

Article

Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.

Article

Well-being is a core concept for both individuals, groups and societies. Greater understanding of trajectories of well-being in later life may contribute to the achievement and maintenance of well-being for as many as possible. This article reviews two main approaches to well-being: hedonic and eudaimonic well-being, and shows that it is not chronological age per se, but various factors related to age that underlie trajectories of well-being at older ages. Next to the role of genes, heritability and personality traits, well-being is determined to a substantial extent by external circumstances and resources (e.g., health and social relationships), and to malleable individual behaviors and beliefs (e.g., self-regulatory ability and control beliefs). Although many determinants have been identified, it remains difficult to decide which of them are most important. Moreover, the role of some determinants varies for different indicators of well-being, such as positive affect and life satisfaction. Several prominent goal- and need-based models of well-being in later life are discussed, which explicate mechanisms underlying trajectories of well-being at older ages. These are the model of Selection, Optimization, and Compensation, the Motivational Theory of Lifespan Development, Socio-emotional Selectivity Theory, Ryff’s model of Psychological Well-Being, Self-Determination Theory, and Self-Management of Well-being theory. Also, interventions based on these models are reviewed, although not all of them address older adults. It is concluded that the literature on well-being in later life is enormous, and, together with various conceptual models, offers many important insights. Still, the field would benefit from more theoretical integration, and from more attention to the development and testing of theory-based interventions. This remains a challenge for the science of well-being in later life, and could be an important contribution to the well-being of a still growing proportion of the population.

Article

Vimla Nadkarni and Roopashri Sinha

The entry outlines a historical and global overview of women’s health in the context of human rights and public health activism. It unravels social myths, traditional norms, and stereotypes impacting women’s health because social workers must understand the diverse factors affecting women’s health in a continually changing and globalized world. There is need for more inclusive feminist and human rights models to study and advocate women’s health. There is as much scope for working with women in a more holistic manner as there is for researching challenging issues and environments shaping women’s health.

Article

Kira Fortune, Francisco Becerra, Paulo Buss, Orielle Solar, Patricia Ribeiro, and Gabriela E. Keahon

There is a broad consensus that the health of an individual or population is not influenced solely by the efforts of the formal health sector; rather, it is also defined by the conditions of daily life as well as the inputs, intentional or not, of various stakeholders and policies. The recognition that health outcomes and inequity in health extend beyond the health sector across many social and government sectors has led to the emergence of a comprehensive policy perspective known as Health in All Policies (HiAP). Building on earlier concepts and principles outlined in the Alma-Ata Declaration (1978) and the Ottawa Charter for Health Promotion (1986), HiAP is a collaborative approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. Health in All Policies has become particularly relevant in light of the adoption of the 2030 Agenda for Sustainable Development and the 17 Sustainable Development Goals (SDGs), as achieving the goals of the agenda requires policy coherence and collaboration across sectors. Given that local governments are ideally positioned to encourage and galvanize partnerships between a diversity of local stakeholders, the implementation of HiAP at the local level is seen as a powerful approach to advancing health and achieving the SDGs through scaled-up initiatives. As there is no single model for the development and implementation of HiAP, it is critical to examine the different experiences across countries that have garnered success in order to identify best practices. The Region of the Americas has made much progress in advancing the HiAP approach, and as such much can be learned from analyzing implementation at country level thus far. Specific initiatives of the Americas may highlight key examples of local action for HiAP and should be taken into consideration for future implementation. Moving forward, it will be important to consider bottom up approaches that directly address the wider determinants of health and health equity.

Article

Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Determinants of health can be categorized along a number of dimensions, but common designations consider behavioral, social, and environmental factors that lead to health disparities, as well as differences in access to health care and health services. Of central interest to communication researchers, differences in health literacy and health information seeking are revealed between advantaged and disadvantaged groups. Media influences involve the effects of access or exposure to different kinds of health information on the health behavior and health outcomes of different groups, as well as the effects of health disparity media coverage on public support for initiatives to reduce health disparities. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions. Taking a broader view, this essay briefly discusses trends in scholarship on health disparities, noting the precipitous increase in academic journal article publications on the topic, including the publication of journals specifically focused on publishing health disparities scholarship. Future directions for research are suggested, and recommendations for interventions to improve health disparities offered by the Principal Investigators of the 10 Centers for Population Health and Health Disparities are presented. Finally, an annotated list of primary sources (books, special issues of journals, reports) and a list of sources for further reading are offered to provide a starting point for beginning scholars to orient themselves to research in health disparities.

Article

Agents of change serve as catalysts for stimulating social change, particularly at community and societal levels of analysis. We often think about the characteristics of individuals who act as change agents, such as their capacity to motivate others or their training skills. However, organizations and disciplinary fields can also serve as agents of change. There is an emerging awareness in the fields of public health and community organizing as to how these respective fields can collaborate to leverage their collective insights and skills to become effective agents of change for community health outcomes. Importantly, while public health is concerned with the social determinants that shape health inequities in all communities, community organizing is focused on community issues that residents confront as constraints or problems in their daily lives. There is an inchoate understanding within the fields of public health and community organizing that the social determinants addressed in public health are often the same issues identified and addressed by community organizing groups. Both disciplines work as agents of change through their traditional efforts; however, there is promise in the evolving collaborations between these two fields. Recognition that both fields are addressing the same community phenomena is an important step, but whether collaborations and shared practices become distributed and institutionalized is an open question. Public health possesses research and analytic sophistication capable of identifying different social determinants and the pathways through which such determinants contribute to poor community health outcomes. In contrast, community organizing supplies an understanding of social change that requires the exercise of power through the participation and active engagement by those most directly affected by local issues or social determinants. One tension in this emergent collaborative practice stems from the fact that, at times, these different disciplinary skill sets are at odds. Whereas public health has a deep value of data analysis and expertise, community organizing prioritizes the participation and self-determination of those impacted by community problems. Fundamentally, the tension here is between the value placed on expertise versus the value placed on public participation. Neither value is inherently superior to the other; understanding how these two values can complement one another to address social determinants that shape community health outcomes is critical for realizing the promise of these organizational agents of change.

Article

Gerard Bodeker and Kishan Kariippanon

An estimated 370 million Indigenous people reside in 90 countries and make up 5% of the global population. Three hundred million Indigenous people live in extremely disadvantaged rural locations. Indigenous people have suffered from historic injustices due to colonization and the dispossession of their lands, territories, and resources, thus preventing them from exercising their right to development according to their own needs and interests. Across the board, Indigenous people have poorer health outcomes when compared to their non-Indigenous fellow citizens. Cancer, respiratory disease, endocrine, nutritional, and metabolic disorders, primarily diabetes, affect Indigenous people disproportionately. Newborns of Indigenous women are more than twice as likely to be of low birth weight as those born to non-Indigenous women. Indigenous rates of suicide are the highest in the world. For public health to be effective, a social determinants approach, along with health interventions, is insufficient to create lasting health impact. Partnerships with Indigenous organizations, Indigenous researchers, and the professionalization of health workers is essential. Integration of traditional medicine and traditional health practitioners can enable the Western biomedical model to work in partnership with Indigenous knowledge systems and become more locally relevant and accountable. The Indigenous health workforce is increasingly using evidence-based, innovative approaches to address the shortage of health professionals as they move toward universal health coverage. Internet, mobile, and communication technologies are enhancing the mobilization of Indigenous health efforts and the support for health workers in rural locations. Presented are country examples of integrated medicine and Indigenous partnerships that effectively implement health interventions.

Article

Serious inequalities in health abound the world over. For example, there are marked differences in average life expectancy both between and within countries. Individual life expectancy varies by more than 30 years between the highest national average and the lowest. Even worldwide, average life expectancy lags more than 10 years below the highest national average. Within single countries, inequalities in life expectancy between the top and bottom groups of men, for example, have been recorded at 7 years in England and Wales and at almost 15 years in the United States, albeit using rather differently constituted groups. Intuitively, these inequalities in health will strike many observers as unjust. But why are they unjust, if they are? Are inequalities in health unjust per se? If not, what makes some inequalities in health unjust, but not others? According to an influential analysis, inequalities in health are unjust when they are avoidable, unnecessary, and unfair. Thus, if an inequality in health is inevitable, it is not unjust. Following this analysis means that answering these questions requires a combination of empirical and normative understanding. On the empirical side, some understanding of the socially controllable causes of health is required. On the normative side, various dimensions of fairness have to be understood. In addition, some appreciation of the interaction between these two sides is needed.. Each side of the question is fairly complicated. With respect to the requirements of fairness, three subsidiary controversies can be distinguished. To begin with, should a general principle of equality be applied directly to the case of health? An alternative approach traces the injustice of avoidable inequalities in health to the independent injustice of their social causes instead. Next, should inequalities be defined across social groups (such as class or race within countries or, indeed, countries themselves)? If so, which groups? An alternative is to define inequalities across individuals. Finally, should equality be defined in comparative terms (as is traditional)? An alternative is to define the requirements of fairness non-comparatively (as a matter of “priority” to the worst off). Even if a given inequality in health is avoidable, some resolution of all three controversies is needed to decide whether that inequality is unfair.

Article

We provide an overview on the role of culture in addressing the social determinants of health and risk. The fact that everyone is influenced by a set of locally defined forms of behavior means that while not overtly expressed, culture’s effects can be ubiquitous, influencing everything including the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping health and risk messaging. While the dynamic nature of culture is underestimated and often not reflected in most research, efforts to close the gap on social determinants of health and risk will require greater clarity on what culture is and how it impacts culture-sensitive health communication. Thus, the paper begins by reviewing why culture is so vital and relevant to any attempts to improve health and reduce health inequalities. We discuss what is meant by the term “culture” through a narrative synthesis of historical and recent progress in definitions of culture. We conclude by describing three distinct cultural frameworks for health that illustrate how culture can be effectively used as a vehicle through which to address culturally sensitive health communication in local and global contexts. Overall, we believe that culture is indispensable and important for addressing inequalities and inequities in health as well as for facilitating culture-sensitive health communication strategies that will ultimately close the gap on the social determinants of health and risk.

Article

Cecilia Ayón, Tanya Nieri, and Maria Gurrola

Latinx immigrants represent a large segment of the immigrant population in the United States. While immigrants tend to be healthier than native-born people, they experience a number of health disparities. Latinx immigrants experience many barriers to accessing health care, including immigration policy barriers related to undocumented or recent permanent resident status, lack of culturally and linguistically responsive services, challenges during the access verification process, discrimination by providers, and external resource constraints (e.g., cost). Many are uninsured or underinsured and experience limited access to care. Existing models to understand health are examined. A social determinants of health framework is used to understand immigrants’ health outcomes. Within this framework immigration is a social determinant of health. Substantial empirical evidence illustrates how the immigration policy context impacts on immigrants’ health through exposure to enforcement activity, threat of detainment and deportation, and actual deportation. Enforcement activity is racialized to effect all Latinxs regardless of status. Other domains including economic insecurity, education, and community and social support are other sources that may disadvantage immigrants and impact on their health. The search for economic opportunity is a primary motivation for Latinxs to migrate to the United States, yet many face economic challenges and live in poverty. Education has significant impact on immigrants across the development spectrum as they experience disparities in access. Social ties are critical to the wellbeing of Latinx, evidence suggests disparities in access to support by status. Immigrants contend with a number of challenges as they integrate into society. Social determinants of health, through multiple domains, affect immigrants’ health.

Article

Michele Rountree and Courtney McElhaney Peebles

Communities of color are disproportionately burdened by the prevalence of HIV/AIDS. Research has shown that race and ethnicity in the United States are population characteristics that correlate with other fundamental determinants of health outcomes. This entry will chronicle the history of the epidemic, report the disparate impact of the disease affecting communities of color, and acknowledge the social determinants of health that contribute to the vulnerability of risk. A call to address the imbalance of health inequities, with a complement of individual-level interventions and new approaches that address the interpersonal, network, community, and societal influences of disease transmission, is discussed.

Article

In the United States, increasing numbers of transgender people are coming forward and working to change legislation to better protect their lives and identities. These changes have come over a long period of time with the work of transgender people and allies. Societal acceptance and support for transgender people has evolved, first in the provision of medical resources allowing for physical changes, and later in legislation supporting and protecting people’s ability to publicly and legally express their gender. However, these changes have not been always been to benefit transgender people as others sought to control and limit people’s ability to express nonnormative genders. Policy changes occur in reaction to transgender people, but at the same time, transgender people have been working to allow themselves the freedom to express their genders freely. Major changes first began when scientists and medical professionals became interested in medical technologies such as hormones and its affects on people’s bodies. It was these discoveries that also interested people who felt dysphoric about their gender expression and saw these procedures as being able to reduce their pain and improve their lives. The movement to utilize surgical techniques soon followed. As more people sought these services, medical professionals developed guidelines to identify those who would benefit from the procedures and how to utilize these technologies safely to help people transition from one gender to another. As more people were able to transition, policies arose to prevent or limit people’s ability to express their identity, but transgender people and allies also organized to counter this movement and propose policies that are more supportive and protective for them.

Article

Ellen Fink-Samnick

The past two decades have witnessed a surge in the growth of initiatives and funding to weave physical and behavioral health care, particularly with identification of the high costs incurred by their comorbidity. In response, a robust body of evidence now demonstrates the effectiveness of what is referred to as collaborative care. A wide range of models transverse the developmental lifespan, diagnostic categories, plus practice settings (e.g., primary care, specialty medical care, community-based health centers, clinics, and schools). This article will discuss the foundational elements of collaborative care, including the broad sweep of associated definitions and related concepts. Contemporary models will be reviewed along with identified contextual topics for practice. Special focus will be placed on the diverse implications collaborative care poses for the health and behavioral health workforce, especially social workers.

Article

Military coups happen for various political, economic, and historical reasons. A vast literature investigates the external factors that affect coup vulnerability, including interstate wars, security threats, regional spillovers, and foreign economic linkages. An even more impressive number of studies, going back almost seven decades, focuses on the domestic causes of military coups. These causes of coups can be classified under two broad headings: background causes and triggering causes. Background causes are those structural determinants that generally increase coup vulnerability in a given country and create motives for coup attempts. The most prevalent background causes concern the regime type and characteristics, historical legacies and cultural diversity, and economic conditions. The triggering causes are temporally and spatially more specific conditions that determine the opportunities for coup plotters. Various types of political instability and violence, such as popular protests and civil wars, can become important triggers. Additionally, the characteristics of the military organization and the effectiveness of coup-proofing strategies fall under this category. An extensive review of the cross-national civil-military relations literature reveals that very few of the proposed determinants survive empirical scrutiny. Three findings stand out as consistently robust predictors of coup activity. First and most notably, there is broad consensus that the “coup trap” is an empirical reality: coups breed coups. This finding is bolstered by the fact that military regimes are especially vulnerable to coup attempts. Second, income and wealth have a strong negative correlation with coup probability. All else equal, poor countries are more coup prone than their richer and more developed counterparts. Last but not the least, political instability and violence increase coup likelihood, although scholars differ on which exact type of instability or popular unrest is the most significant. Many other oft-cited factors such as colonial legacy, culture, ethnic fractionalization, resource wealth, and economic crisis are not consistently robust in global samples. This observation highlights the need for more metastudies to separate the relevant variables from idiosyncratic effects.

Article

As technology advances and offers enjoyable sedentary alternatives to sport, active recreation, and transportation, there is a growing need to understand and harness the drivers of physical activity and exercise among children and adolescents. Determining how youth perceive their physical capabilities and their opportunities and what motivates them to be physically active can provide essential information for teachers, coaches, youth leaders, and program planners who are interested in promoting physical activity. Several well-established and also more recently developed behavioral theories offer numerous avenues to gaining a better understanding of the perceptions and motivation of youth with respect to physical activity and exercise behavior, including the social ecological model, social cognitive theory, self-determination theory, habit theory, dual-process theory, and nudge theory, among others. Children and adolescents have individual characteristics that influence their perceptions, motivations, and behavior. They also exist within a multilayered ecological context that helps to shape those perceptions, motivations, and behavior. For youth to be sufficiently physically active and thereby help to reach their full potential, the environment must be conducive to consistent routines of physical activity. Such an environment can be designed to provide easily accessible and enjoyable opportunities for youth to fulfill their basic psychological needs for autonomy, relatedness, and competence to be physically active. There is potential for technology to contribute positively toward the design of conducive environments, and toward fostering motivation and enjoyment of exercise and physical activity among children and adolescents.

Article

Daphne S. Cain and Terri Combs-Orme

Parenting is a key part of social-work practice and research, particularly in the child welfare arena. Despite significant research and theory in other disciplines about the importance of the parent–child relationship to the quality of parenting, the focus of social work appears to lie in narrow goals such as the prevention of abuse and child placement and to employ interventions that lack significant evidence of effectiveness. This entry summarizes social-work practice and research in the area of parenting and reviews the state of the art overall in research and knowledge about parenting.

Article

In 1978, at an international conference in Kazakhstan, the World Health Organization (WHO) and the United Nations Children’s Fund put forward a policy proposal entitled “Primary Health Care” (PHC). Adopted by all the World Health Organization member states, the proposal catalyzed ideas and experiences by which governments and people began to change their views about how good health was obtained and sustained. The Declaration of Alma-Ata (as it is known, after the city in which the conference was held) committed member states to take action to achieve the WHO definition of health as “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Arguing that good health was not merely the result of biomedical advances, health-services provision, and professional care, the declaration stated that health was a human right, that the inequality of health status among the world’s populations was unacceptable, and that people had a right and duty to become involved in the planning and implementation of their own healthcare. It proposed that this policy be supported through collaboration with other government sectors to ensure that health was recognized as a key to development planning. Under the banner call “Health for All by the Year 2000,” WHO and the United Nations Children’s Fund set out to turn their vision for improving health into practice. They confronted a number of critical challenges. These included defining PHC and translating PHC into practice, developing frameworks to translate equity into action, experiencing both the potential and the limitations of community participation in helping to achieve the WHO definition of health, and seeking the necessary financing to support the transformation of health systems. These challenges were taken up by global, national, and nongovernmental organization programs in efforts to balance the PHC vision with the realities of health-service delivery. The implementation of these programs had varying degrees of success and failure. In the future, PHC will need to address to critical concerns, the first of which is how to address the pressing health issues of the early 21st century, including climate change, control of noncommunicable diseases, global health emergencies, and the cost and effectiveness of humanitarian aid in the light of increasing violent disturbances and issues around global governance. The second is how PHC will influence policies emerging from the increasing understanding that health interventions should be implemented in the context of complexity rather than as linear, predictable solutions.