Category Archives: Black (incl. African American)
In this interview with the Robert Wood Johnson Foundation's Steve Downs, SM, historian Keith Wailoo, PhD, discusses how we define our own cultures of health and shares how deeply held cultural narratives influence our perceptions of health. Wailoo is jointly appointed in the Department of History and the Woodrow Wilson School of Public and International Affairs at Princeton University. This video is part of the RWJF What's Next Health series. Also check out the accompanying infographic.
Infographic: When 'Good' Data Goes Bad
Good data can play a critical role in answering some of our most vexing questions concerning health. But history shows us that data is never collected or analyzed in a vacuum. Instead, the culture of the times acts as a lens that can either obscure or reveal truth. Here is one example, looking at the history of data collection concerning cancer and race.
Lorenzo Lorenzo-Luaces graduated from the University of Puerto Rico–Rio Piedras, where he studied cross-cultural differences in suicidality. He is currently a graduate student in the University of Pennsylvania clinical psychology PhD program. Lorenzo-Luaces is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation, the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
The population of groups referred to as “minority” is growing at a faster rate in this country than Caucasians, with estimates suggesting that by 2060, 57 percent of the U.S. population will be non-White. This demographic shift could create a public health concern if racial/ethnic minorities remain underrepresented in mental health research. At present, these populations are less likely to receive mental health care than Whites. When they do receive care, it is usually of lesser quality.
Stereotypes among racial/ethnic minority communities regarding mental health are complex. Research suggests that they tend to have more negative beliefs about mental illnesses than White communities; for example, they are more likely to believe that mental illnesses occur due to factors outside of the individual’s control (e.g., spiritual or environmental reasons). However, despite generally holding more negative views about mental illnesses, research shows that racial/ethnic minorities tend to have less punitive attitudes about the mentally ill. Moreover, they tend to be more accepting about mental health treatments, although they express a clear preference for psychological services over medications.
Differences in access to care, rather than attitudes, likely explain the racial/ethnic gap in service use. Besides the obvious discrepancies in socioeconomic status (SES) between Caucasians and racial/ethnic minorities, the latter’s preference for psychological services may be one barrier to access. This is because, even among the insured, psychological services are more expensive in the short term and harder to access than psychotropic medications. There also are questions as to whether psychological interventions tested largely on White populations are effective for minorities.
David Fakunle, BA, is a first-year doctoral student in the mental health department of The Johns Hopkins Bloomberg School of Public Health. He is an alumnus of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
It is always interesting to speak with my relatives when an egregious act of violence occurs, such as the shooting at Sandy Hook Elementary School back in December 2012. They are always so disheartened about the mindset of an individual who can perpetrate such a horrible act. When I mentioned that this particular perpetrator, Adam Lanza, suffered from considerable mental disorder including possible undiagnosed schizophrenia, the response was something to the effect of, “Okay, so he was crazy.”
That’s it. He was crazy. I love my family dearly, but it saddens me as to how misinformed some of my relatives are about mental health. Notice that I say “misinformed” as opposed to “ignorant” because to me, being ignorant means you are willingly disregarding the information provided to you. But that is the issue: communities of color, in many cases, are not well-informed, if informed at all, about mental health. That is what drives the negative stereotypes that are highly prevalent within communities of color.
Ayorkor Gaba, PsyD, is a clinical psychologist and project manager at the Center of Alcohol Studies, Rutgers University, as well as a clinical supervisor at the Rutgers Psychological Clinic. She has a private practice in Highland Park, New Jersey and is an American Psychological Association-appointed representative to the United Nations. She is an alumna of Project L/EARN, a project of the Robert Wood Johnson Foundation and the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Mental illness affects one in five adults in America. A disproportionately high burden of disability from mental disorders exists in communities of color. Research has shown that this higher burden does not arise from a greater prevalence or severity of illnesses in these communities, but stems from individuals in these communities being less likely to receive diagnosis and treatment for their mental illnesses, having less access to and availability of mental health services, receiving less care, and experiencing poorer quality of care. Even after controlling for factors such as health insurance and socioeconomic status, ethnic minority groups still have a higher unmet mental health need than non-Hispanic Whites (Broman, 2012).
There are a number of factors driving these statistics in our communities, including attitudes, lack of culturally and linguistically appropriate services, distrust, stigma, and more. In our society all racial groups report mental health stigma, but culturally bound stigma may have a differential impact on communities of color. Stigma has been described as a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses (President’s New Freedom Commission on Mental Health, 2003). Stigma in the general public often leads to internalized stigma at the individual level. Several studies have shown that internalized stigma is an important mechanism decreasing the willingness to seek mental health treatment.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to blog about improving health care for all. Rashawn Ray, PhD, is an assistant professor of sociology at the University of Maryland and a former RWJF Health Policy Research Scholar at the University of California in Berkeley and San Francisco.
Some people assume that promoting diversity and combating health disparities means giving preferential treatment to minorities over Whites. However, these pursuits simply mean providing equitable opportunities and a health care system that is responsive to everyone. Education studies continuously show that promoting diversity and reducing discrimination benefits all students. Regarding health care, these pursuits may mean life or death.
The percentage of Black physicians has stayed roughly unchanged since the early 1900s. The percentage of Black and Latino professors at research-intensive university shows a similar pattern. I suggest that reducing health disparities and changing our current culture of health is contingent on more effectively integrating minorities into health professions and research positions.
How Can Health Systems Effectively Serve Minority Communities? Use Electronic Health Records to Discover How to Improve Outcomes.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Bonnie L. Westra, PhD, RN, FAAN, an associate professor at the University of Minnesota School of Nursing, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Westra is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Electronic health records (EHRs) are rapidly proliferating and contain data about health or the lack thereof for minority communities. Evidence-based practice (EBP) guidelines can be embedded in EHRs to support the use of the latest scientific evidence to guide clinical decisions. However, scientific evidence may not reflect differences in minority communities served.
As a first step to compare the effectiveness of EBP guidelines for minority populations, practicing nurses and nurse leaders need to advocate for implementation of EBP nursing guidelines in EHRs. Additionally, EBP guidelines must be coded with national nursing data standards to compare effectiveness within and across minority communities. Nurse researchers need to conduct comparative effectiveness research to learn how to optimize EBP guidelines for minority communities through the reuse of EHR data and to derive patient-driven evidence.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Jamila Michener, PhD, an assistant professor of government at Cornell University, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Michener is an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program at the University of Michigan, Ann Arbor.
In my undergraduate class on the politics of poverty, there is an uncomfortable yet persistent question that looms whenever the conversation turns to racial and ethnic disparities: why? The students generally (and rightly) believe that biological distinctions are not the answer and in the search for other solutions, culture frequently emerges as a likely suspect. In response, I challenge these young people to think more conscientiously about cultural explanations of poverty. I push them to problematize the notion that racial and ethnic groups are homogenous bearers of a common and undifferentiated culture. I prompt them to consider how social, economic, and political institutions constitute and are constituted by various elements of culture.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Marni Kuyl, RN, MS, interim health and human services director in Washington County, Oregon, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Kuyl is an RWJF Executive Nurse Fellow.
When I was first asked to consider this question, I pondered the issues by describing theoretical approaches, including the need to address social determinants, use a social-ecologic framework, and take a life course perspective. I threw in the need to use evidence-based practices and research. I gave this first draft to someone and asked ... So what do you think? She very politely asked: Are you in outer space?
I continue to believe that addressing inequality in our country requires that we recognize, understand, and commit to changing its root causes which include racism, inadequate affordable and safe housing, inadequate access to quality education (pre-to post graduate), and grossly uneven wealth distribution. These are deeply rooted in our political and economic structures and must be fundamentally changed if we truly want to build a culture of equality and health for all.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Elizabeth Gross Cohn, PhD, RN, an assistant professor at the Columbia University School of Nursing, responds to the question, “What does the country need to do to address disparities and build a culture of health that includes all people?” Cohn is an RWJF Nurse Faculty Scholar.
How can we get more people to think pro-actively about health and health care? One approach would be to identify what people value and think about how to fold health into that equation—especially for populations where disparities exist, like health screening for men.
In the case of where I live, the answer was cars. Long Island loves cars: hot rods, customs, muscle cars, and classic cars. We are fascinated with antique fire apparatus and old motorcycles. Long Island Cruizin' for a Cure leverages this fascination. Now in its tenth year, with 600 cars, this event attracts, screens, and educates more than 3,500 men about prostate cancer.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Italo M. Brown, MPH, a rising fourth-year medical student at Meharry Medical College, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Brown holds a BS from Morehouse College and an MPH from Boston University, School of Public Health. He is an alumnus of the Health Policy Scholars Program at the RWJF Center for Health Policy at Meharry Medical College.
In our domestic health care system, we nurture the drive to improve patient outcomes, and apply evidence-based knowledge to solve contemporary health care challenges. Yet, studies have demonstrated that minorities are disproportionately affected by chronic conditions, and on average are less likely to receive ongoing care/management of their comorbidities. In addition, public health experts have asserted that social determinants of health (e.g., education level, family income, social capital) directly impact the minority community, and effectively convolute the pathway to care.