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Article

Larry E. Davis, John M. Wallace Jr., and Trina R. Williams Shanks

African Americans have been a part of the nation's history for nearly four hundred years. Although their history includes the forced imposition of chattel slavery, the strict enforcement of legal segregation, and a tenuous acceptance as equal citizens, African Americans have been, and continue to be, major contributors, creators, investors, and builders of America. In this article we summarize briefly the history of African Americans, we examine racial disparities in key indicators of social, mental, and physical well-being, and we highlight persistent strengths that can be built upon and areas that provide hope for the future. The challenge for social work is to simultaneously celebrate the historical successes and ongoing contributions of African Americans to this country while also recognizing the vestiges of structural racism and fighting for greater civil rights and social and economic justice.

Article

Paula S. Nurius and Charles P. Hoy-Ellis

Evolving understandings of stress have literally transformed how we think about health as contextualized within complex and multilevel transactions between individuals and their environment. We present core concepts of stress through the lens of life-course and life-span perspectives, emphasizing appraisal-based and biobehavioral models of stress response systems. We describe theories of allostatic load, embodiment, epigenetics, weathering processes, and accelerated aging that operationalize mechanisms through which stress affects health and contributes to health disparities. In addition to social determinant and life-span developmental perspectives on stress and health, we emphasize the value of health-promotive factors that can serve to buffer stress effects. Social work has important roles in targeting health-erosive stress from “neurons to neighborhoods”.

Article

Sara Wakefield and Janet Garcia-Hallett

The rapid rise in the incarceration rate, most notably in the United States over the last four decades, has drawn greater attention to the disabilities imposed by incarceration experiences and the spillover of these complications to the families of inmates. Prisons have always disproportionately drawn upon the disadvantaged, but research today details how imprisonment creates new harms for inmates as well as for those who are connected to them but were never incarcerated. In this contribution, the effects of incarceration on the family are briefly described across several domains. First, the social patterning of incarceration effects are described, for inmates and for their families, showing that imprisonment effects are both widespread and overwhelmingly repressive for some groups. Next, the effects of incarceration on the families of inmates are described, focusing on the partners and children of inmates, and differentiating between maternal and paternal incarceration. Incarceration is broadly harmful for families, but there is a significant gender gap in knowledge—research on paternal incarceration and the romantic partners of male inmates is much more common, rigorous, and uniform in findings. Where findings are mixed, scholarship is reviewed on how examining incarceration and family life has expanded across varying fields that often differ in their research approach, emphasis, and methodology. Finally, the discussion ends with the most pressing challenges for researchers going forward, suggesting that studies interrogating heterogeneity and leveraging new data sources offer the most fruitful path. This review is focused largely on the United States. First, and most practically, much of our knowledge about the effects of incarceration on the family is based on U.S.-based samples. Second, the effects of incarceration on the family have worsened significantly as a result of the prison boom in the United States. It remains to be seen how such effects translate to different contexts; some research suggests similar process at much lower incarceration rates, while others show less harm in other contexts.

Article

Much has been written about mass incarceration and how it has fallen especially hard on people of color. Given their representation in the U.S. population, for example, black and Hispanic males are far more likely than their white counterparts to be sent to jail or prison. Such disproportionality may be due to the greater involvement of blacks and Hispanics in serious street crime, especially violent crime, which would result in differential incarceration. It also could be due to discretionary decisions by criminal justice officials during arrest, charging, conviction—and, key to the focus of this article, sentencing—which might produce disparity, to the disadvantage of black and Hispanic men. Various theories seek to explain racial and ethnic sentencing disparity by focusing on characteristics of individuals and criminal cases, features of court organization and decision-making, and social contexts surrounding courts. Literally hundreds of studies in the past 40 years and beyond have focused on sentencing decisions in local courts and unwarranted racial/ethnic punishment disparity, defined as racial/ethnic differences that persist after accounting for legally prescribed and perhaps case-processing influences. Some reviews of this large and mature body of literature have shown that young, black, and (to a lesser extent) Hispanic male defendants tend to receive more severe sentences than other defendants. In addition, reviews have noted how the sentencing role of race/ethnicity is often conditional on gender and other factors, and that racial/ethnic disparity in sentencing varies in connection with characteristics of courts and their surrounding social contexts. Future research on race, ethnicity, and sentencing should address disparity in relation to earlier (e.g., charging and conviction) and later (e.g., parole, probation, or parole revocation) stages of criminal justice decisions, as well as how the social characteristics of judges, prosecutors, and defense attorneys affect disparity. Research studies should continue to examine how specific punishment policies (e.g., mandatory minimums, risk assessments, and sentencing guideline provisions and departures) may be the sources of racial and ethnic disparity.

Article

Daniel S. Gardner and Caroline Rosenthal Gelman

Minority and immigrant elders constitute a greater proportion of the population than ever before and are the fastest growing segment of the older population. Within these racial and ethnic groups there is considerable variation with regard to age, gender, country of origin, language, religion, education, income, duration of U.S. residency, immigration status, living arrangements, social capital, and access to resources. The authors summarize research on older adults regarding racial and ethnic disparities, barriers to health and social service utilization, and dynamics of family caregiving. Implications are offered for social-work practice, policy, and research.

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

Grace Christ

The ability of medical technology to prolong life over the past century has forced an examination of the experience and care of the dying. Many diseases that once were expected to follow a sloping illness trajectory with predictable deterioration and ultimately death are now more commonly experienced as chronic illnesses. They require more medical and other resources and challenge the family's ability to cope for much longer periods. The knowledge, value, and skill base of social work, and its broad range of practice sites make it uniquely suited to contribute to the movement to improve the care of the dying. The Social Work Hospice and Palliative Care Network were formed in 2007 to advance and give voice to social work's expertise in this area and to promote its development in practice, education, research, and policy.

Article

Henrika McCoy and Emalee Pearson

Racial disparities in the juvenile justice system, more commonly known as disproportionate minority contact (DMC), are the overrepresentation, disparity, and disproportionate numbers of youth of color entering and moving deeper into the juvenile justice system. There has been some legislative attention to the issue since the implementation of the Juvenile Justice and Delinquency Prevention Act of 1974 (JJDPA) and most recently with attempts in 2017 to reauthorize the Act. Originally focused solely on confinement, it became clear by 1988 there was disproportionality at all decision points in the juvenile justice system, and the focus changed to contact. DMC most commonly is known to impact Black and Hispanic youth, but a closer look reveals how other youth of color are also impacted. Numerous factors have been previously identified that create DMC, but increasingly factors such as zero-tolerance in schools and proactive policing in communities are continuing to negatively impact reduction efforts. Emerging issues indicate the need to consider society’s demographic changes, the criminalization of spaces often occupied by youth of color, and gender differences when creating and implementing strategies to reduce DMC.

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

Rowena Fong, Ruth G. McRoy, and Alan Dettlaff

Racial disproportionality and disparities are problems affecting children and families of color in the child welfare, juvenile justice, education, mental-health, and health-care systems. The term “disproportionality” refers to the ratio between the percentage of persons in a particular racial or ethnic group at a particular decision point or experiencing an event (maltreatment, incarceration, school dropouts) compared to the percentage of the same racial or ethnic group in the overall population. This ratio could suggest underrepresentation, proportional representation, or overrepresentation of a population experiencing a particular phenomenon. The term “disparity” refers to “unequal treatment or outcomes for different groups in the same circumstance or at the same decision point.” A close examination of disproportionality and disparities brings attention to differences in outcomes, often by racial group, and by social service systems. It is necessary to examine the reasons for these differences in outcomes and to be sure that culturally competent practices are upheld.

Article

Education is strongly associated with better health and longer lives. However, the extent to which education causes health and longevity is widely debated. We develop a human capital framework to structure the interpretation of the empirical evidence and review evidence on the causal effects of education on mortality and its two most common preventable causes: smoking and obesity. We focus attention on evidence from randomized controlled trials, twin studies, and quasi-experiments. There is no convincing evidence of an effect of education on obesity, and the effects on smoking are only apparent when schooling reforms affect individuals’ track or their peer group, but not when they simply increase the duration of schooling. An effect of education on mortality exists in some contexts but not in others and seems to depend on (i) gender, (ii) the labor market returns to education, (iii) the quality of education, and (iv) whether education affects the quality of individuals’ peers.

Article

Peter A. Newman

AIDS (acquired immunodeficiency syndrome) is the most deadly epidemic of modern times. Since HIV (human immunodeficiency virus), the virus that causes AIDS, was first identified in the United States in 1981, nearly 1 million Americans have been diagnosed with AIDS and 530,756 have died. Forty million people are living with HIV worldwide. Although AIDS is still a fatal disease, new drug therapies have greatly slowed the course of disease progression and enhanced quality of life for persons living with HIV. Nevertheless, monumental disparities persist within the United States and between the developed and developing worlds in this two-tiered epidemic.

Article

Mary E. Rogge

The concept of environmental justice gained currency in the public arena during the latter part of the 20th century. It embodies social work's person-in-environment perspective and dedication to people who are vulnerable, oppressed, and poor. The pursuit of environmental justice engages citizens in local to international struggles for economic resources, health, and well-being, and in struggles for political voice and the realization of civil and human rights.

Article

Social work and criminal justice have a shared history in the United States dating back to the 19th century when their combined focus was rehabilitation. But with an increase in crime, this focus shifted to punishment and incapacitation, and a schism resulted between social work and criminal justice. Given current mass incarceration and disparities in criminal justice, social work has returned in force to this important practice. The latest Bureau of Justice Statistics research reports that 1% of all adult males living in the United States were serving a prison sentence of a year or longer (Carson & Anderson, 2016) and rates of diversion, arrest, sentencing (including the death penalty), incarceration, etc., vary considerably by race/ethnicity (Nellis, 2016). This entry explores race and ethnicity, current population demographics, and criminal justice statistics/data analysis, plus theories and social work-specific strategies to address racial and ethnic disparities in the criminal justice system.

Article

Mass imprisonment in the United States is an epidemic that has spread across five generations affecting millions of individuals, their families, and hundreds of communities. The United States imprisons more people than any other nation in the world—with over 2 million behind bars and another 5 to 7 million under community supervision on parole and probation. With 5% of the world’s population, the United States has 25% of all the world’s prisoners. This U.S. system imposes many punitive policies, holding more of its citizens in isolation and solitary confinement than all the other prisons of the world combined and imposing the highest rates of life sentences of any nation. This public health analysis of mass incarceration in the United States (first proposed in Ernest Drucker’s 2011 book, A Plague of Prisons: The Epidemiology of Mass Incarceration in America) must therefore also address the high rates of prisoner reentry that accompany it—with over 600,000 U.S. prisoners reentering society each year—with the highest recidivism rate of any nation. This population is disproportionally poor and members of America’s large minority populations (African Americans and Latinos). The public health model provides a new tool for ending the American epidemic of mass imprisonment and, of equal importance, healing those who have survived its blows. This stage of the American story of mass incarceration is covered in Drucker’s 2018 book, Decarcerating America: From Mass Punishment to Public Health. But releasing people from prisons is not enough—the taint of punishment has a long-lasting and debilitating effect on the millions who return from prison to their home communities—facing social stigma and the many restrictions placed upon them as part of the conditions of parole—including limits of their access to public education, healthcare, and housing—as well as convicted felons’ loss of the right to vote. The United States badly needs a paradigm shift that replaces these impediments to successful reentry after prison, creating instead a positive place and normal life for this population in the outside world.

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

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

Building and sustaining relationships fundamentally requires mutual trust based on authentic and reciprocal communication. Successful academic and community partnerships require a deep understanding of the needs of all stakeholders facilitated through dialogue and ongoing communication strategies. This dialogue is especially crucial to address health disparities and bridge the divide between academics and other professionals and the communities they serve. Innovative and sound health communications and community engagement approaches can help to address this divide. For those working with communities to improve health, Community Based Participatory Research (CBPR) principles can serve as a compass to guide those efforts of building on the strengths and resources within the community and ensuring co-learning to address social inequities. Moreover, using innovative and interactive health communication strategies, such as community forums, photovoice projects, and the development of culturally sensitive and relevant messaging, can empower and engage the community, facilitating long-lasting relationships between the academic institutions and communities that ultimately address the unique concerns and values of those most in need.

Article

M. Aryana Bryan, Valerie Hruschak, Cory Dennis, Daniel Rosen, and Gerald Cochran

Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.

Article

Incarceration often separates individuals from opportunities to engage in learning environments and scholastic pursuits. Education programs afforded to incarcerated individuals look different across age and gender, as well as across different countries. While support for education for incarcerated people varies, research supports the importance education plays in one’s life post-release from incarceration. In the larger picture of education for incarcerated people, one element remains clear—women continue to experience disparities in educational equity. With the United States, among other countries, seeing a dramatic rise in the number of women sent to prison, the research on disparities in access to equitable educational opportunities lags. The complexity of identities with which people enter into incarceration largely remains unaddressed in educational settings, and failing to offer educational opportunities to those who are incarcerated creates additional barriers to success following release from prison. Globally, prison structures vary dramatically, from conditions that recognize the humanity of incarcerated individuals to conditions of squalor and disregard. The investments a country makes in providing education to its incarcerated population signals a larger commitment to its citizens and the belief in their worth to the rest of society. In countries with gender inequities, prisons often continue to exacerbate those inequities.