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Index A African Moors, 498 Agassiz, Louis, 501 AAHP. See American Association of Health Age-adjusted death rates Plans for all causes of death by race and AAMC. See Association of American Hispanic origin, 82 Medical Colleges for selected causes of death by race and AAPI. See Asian Americans and Pacific Hispanic origin, 83 Islanders Agency for Healthcare Research and AAPIHF. See Asian American and Pacific Quality (AHRQ), 219, 223, 226, Islander Health Forum 235, 243, 386, 420, 659, 711 Aboriginal people (Australia), 441 Assessment of Quality Improvement Access Strategies in Health Care, 386 to data sources, 229 Measures of Quality of Care for to medical treatment, 645-647 Vulnerable Populations, 386 to services, 143-144 Translating Research into Practice, 386 Acculturation, defined, 464, 475, 521 Understanding and Eliminating Acute myocardial infarction (AMI), 44, 46, Minority Health Disparities 426-428, 431 Initiative, 386 Administrative choices AHRQ. See Agency for Healthcare in the design of managed care systems, Research and Quality 691-693 Alaska Native Colorectal Cancer Education in establishing conditions of Project, 387 participation and quality of care Alaska Native Tribal Health Consortium, management, 690-691 534n in separate SCHIP programs, 689-690 Alaska Natives, 34, 85, 89, 477-478 African Americans, 2, 34, 84-85, 278, 475- defined, 34, 522 477. See also Blacks Albert Einstein School of Medicine, 634 defined, 32n, 34 Alexander v. Sandoval, 158, 641-642, 656, 661- and the “over-diagnosis” of 662, 693n schizophrenia, 612-613 Alien, Sedition, and Naturalization Acts, 459 739

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740 INDEX AMA. See American Medical Association Asthma, 62-63, 296-297 American Association of Health Plans Attitude of healthcare providers, 400-401 (AAHP), 218 Australian Aboriginal, defined, 474 American College of Surgeons, 108 Availability of services, 143-144 American Health Dilemma, An, 489 Aversive racism, 494, 614-616 American Indian and Alaskan Native Awareness of racial and ethnic differences Planning Grants, 391 in healthcare American Indians, 34, 85, 89, 477-478 increasing among healthcare providers, defined, 34, 474, 522 6, 20, 124 American Medical Association (AMA), 107- increasing among the general public and 108, 273, 419, 503, 505, 507, 659 key stakeholders, 6, 20, 124 Council on Medical Education, 107 AZT medication, 436 American Nursing Association, 203 American Public Health Association, 609 B American racial and ethnic relations, 458- 460 Bakke decision, 121 AMI. See Acute myocardial infarction Balanced Budget Act of 1997, 683, 689n Amputations, 74 Barriers for immigrants, 660 Analgesia, 64-66, 290-295 Bayer Institute, 196 Analgesic medication, 326-327 Bayesian physicians, 167-168 differential levels of prescription of, 11 Becker, Howard, 599 Ancient origins, 497-498 2002 Behavior Risk Factor Surveillance Angina, 165 System, 387-388 Angiography and angioplasty, 137, 427, 434 Bernier, François, 499 Anglo-Protestants, 471, 483 BIA. See Bureau of Indian Affairs defined, 522 Bias Anglo-Saxon, defined, 522 defined, 522 Antebellum period, 471, 501 of efficacy, 603-604 Anti-discrimination thesis, 722 in physician decision-making, 632-637 Anti-Semitism, 486 in social stereotypes and attitudes, 169- API. See Asian Americans and Pacific 171 Islanders Bill of Rights, 459 Archaic medical system, 498 Biological differences, that may justify defined, 522 differences in receipt of care, 138- Argon laser trabeculoplasty surgery, 71 139 Aristotle, 497-498 Biometric testing, 504 Art of Care Scale, 613 Blacks, 34, 475-477. See also African Asian American and Pacific Islander Americans Health Forum (AAPIHF), 284 defined, 32n, 34, 474, 522 Asian Americans and Pacific Islanders Blumenbach, Johann Fredreich, 500 (API), 34, 85-86, 89-90, 478-480 Boren Amendment, 675n defined, 34, 474, 522 Boys in White, 599 Assessment of Quality Improvement British Medical Journal, 441 Strategies in Health Care, 386 Brown v. Board of Education, 107 Assimilation, 475, 522 Buffon, George-Louis Leclerc, 500 identificational, 523 Bureau of Indian Affairs (BIA), 462, 488, Association of American Medical Colleges 531-532 (AAMC), 121, 421 Bureau of Justice Statistics, 654 Assumptions about racial and ethnic Bureau of Primary Health Care, 389 disparities in healthcare, 3-4, 30- Quality Center, 389 35 Bureau of Prisons, 530

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741 INDEX Bureau of the Census. See U.S. Census Catheterization, 135, 163 Bureau Causality, social structural egalitarian Bystanders as interpreters, 143 views of, 732-734 Cautions, about health systems issues and the complexities of mental health C phenomena, 618-619 CCHCP. See Cross Cultural Health Care CABG. See Coronary artery bypass graft Program CAHPS. See Consumer Assessment of CD-ROM-based instructional material, 18, Health Plans; Consumer 196-197, 387 Assessment of Health Plans CDC. See Centers for Disease Control and Survey Prevention California Children and Families CEA. See Carcinoembryonic antigen testing Commission, 226 Centers for Disease Control and Prevention California Civil Rights Initiative, 122 (CDC), 226, 243, 385-388 California Department of Health Services, Alaska Native Colorectal Cancer 225-226 Education Project, 387 California Endowment, 226 2002 Behavior Risk Factor Surveillance California Health Interview Survey (CHIS), System, 387-388 225-226 Hispanic Colorectal Cancer Outreach California Healthcare Interpreters and Education Project, 387 Association (CHIA), 193 National Breast and Cervical Cancer California Public Employees Retirement Early Detection Program System (CalPERS), 699n (NBCCEDP), 387 California Regents decision, 122 National Comprehensive Cancer Control Calman, Neil, 634 (CCC) Program, 387 CalPERS. See California Public Employees National Program of Cancer Registries, Retirement System 387 Cambodian language, 89 National Training Center, 387 Cambridge Health Alliance, 391 prostate cancer screening behaviors, 387 Camper, Petrus, 500 Racial and Ethnic Approaches to Cancer, 52-57, 298-305, 431-433 Community Health, 386-387 racial and ethnic differences in, 5 Centers for Medicare and Medicaid CAP. See Community Access Program Services (CMS), 222, 224, 388 Capitation, and DRGs, 713-715 Excellence Centers to Eliminate Ethnic/ Carcinoembryonic antigen (CEA) testing, 54 Racial Disparities, 388 Cardiac medication, 30 Reducing Health Care Disparities Cardiopulmonary resuscitation (CPR), 71 National Project, 388 Cardiovascular care, racial and ethnic Centers of Excellence, 386, 391 differences in, 5 Cerebrovascular disease, 57-58, 328-331 Cardiovascular disease, 39, 42-52, 306-325, Cesarean deliveries, 67 328-329 Changes studies of the role of financial and in concepts of race and ethnicity, 490-496 institutional characteristics, 45-48 in the ethnicity and race of medical studies to assess appropriateness of students, physicians, nurses, and services, 48-49 healthcare staff, 621 studies using administrative databases, in the healthcare arena, 534-535 42-45 CHCs. See Community health centers Carter, Michael, 646, 663 CHEF. See Catastrophic Health Emergency CASS. See Coronary Artery Surgery Study Funds Catastrophic Health Emergency Funds Chen, Jersey, 633 (CHEF), 541-542, 549

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742 INDEX CHF. See Congestive heart failure CLAS. See Culturally and linguistically CHIA. See California Healthcare appropriate services, standards Interpreters Association for healthcare Children’s health services, 68-69, 330-335 Class, defined, 522 Chinese Americans, 93-94 Clinical caretakers as discretionary actors, Chinese Exclusion Act, 459 128-130 Chinese language, 89 Clinical decision-making and the roles of CHIS. See California Health Interview stereotyping, uncertainty, and Survey bias, 236-237 CHS. See Contract Health Service Clinical discretion, 125-130 Cincinnati Children’s Hospital Center, 197 clinical caretakers as discretionary Civil Rights Act, 157, 188, 221, 507, 628-631, actors, 128-130 668, 679 patient as discretionary actor, 128 Title VI, 157, 159, 188, 192, 221, 628-631, subjectivity and uncertainty, 128-130 637-641, 668, 679 subjectivity and variability, 128 Title VII, 631 utilization managers as discretionary Civil rights dimension of racial and ethnic actors, 130 disparities in healthcare, 626-663 Clinical encounters, 160-179 defining discrimination, 629-632 healthcare provider prejudice or bias, discrimination as a root cause of 162-174 disparities, 632-649 medical decisions under time pressure using civil rights strategies to assist in with limited information, 161-162 eliminating racial and ethnic mistrust and refusal, 174-175 disparities, 649-663 patient response, 174-175 Civil Rights Division, 654 Clinical uncertainty, 9, 167-169 Civil rights enforcement, 15, 187-188 Clinician “bias,” 611-616 Civil Rights era in healthcare, 506 Clinton, William, 626, 677, 692, 705 Civil Rights Movements, 505 “Closing the Health Gap” campaign, 123 Civil rights strategies CMS. See Centers for Medicare and developing a comprehensive language Medicaid Services access agenda, 657-660 Cobb, W. Montague, 505 developing capacity and infrastructure COGME Reports, 118, 120 to address critical civil rights Cognitive shortcuts, in physician decision- questions in managed care, 662 making, 11, 160-161 fixing the Sandoval decision, 661-662 Cold War, 506 identifying and eliminating other Collecting data on healthcare access and barriers for immigrants, 660 utilization, by patient race, mandating the collection of data on race, ethnicity, socioeconomic status, ethnicity, and language of and primary language, 21-22, 233 preference, 650-655 Colonial period, 501 performing a civil rights self-assessment, Columbus, 465 662-663 Commercial capitalism and the slave preventing discrimination through society, 466-467 education of providers and Commissioned papers, 273 patients, 660-661 Commonwealth Fund, 219, 226, 421, 574 strengthening the federal, state, and Communication and clinical decision- private healthcare, 655-657 making, sociocultural differences using to assist in eliminating racial and between patient and provider ethnic disparities, 649-663 influencing, 214 Civil War, 471, 501-502 Communication style, patient satisfaction discrimination during, 103 and health outcomes, 574-575

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743 INDEX Community Access Program (CAP), 388-389 impact on racial and ethnic disparities in Community Action Grant Program, 390 healthcare, 699-721 Community and Migrant Health Centers managed competition, 705-706 Program, 112 racial and ethnic disparities, 706 Community health centers (CHCs), 112, supply-side approaches, 703-705, 712-718 114, 506 Cowan v. Myers, 678n impact on healthcare in minority and CPR. See Cardiopulmonary resuscitation medically underserved areas, 112, Criminal justice, racial discrimination in, 114 100-101 Community Health Representatives, 548 Criteria for literature review, 40-41 Community health workers, 17-18, 21, 193- ranking of studies, 41 195 review papers, 41 increasing racial and ethnic minorities’ search keywords, 40 access to healthcare, 195 “threshold” criteria, 40 Compacting, improvement in quality of Critical analysis of the culture of medicine, care, 543-545 620-621 Competitive racism, 493 Cross-cultural approach, 206-207 Concentration of poverty, in 100 largest Cross-cultural communication, links to U.S. cities, 688 racial/ethnic disparities in Concepts of race and ethnicity, 490-496 healthcare, 200-201 on ethnic groups, 495-496 Cross-cultural curricula, in undergraduate on racial groups and hierarchies, 490-493 medical education, 202 racial models as tools for analysis and Cross-cultural education understanding, 493-495 challenges and opportunities, 211-212 Congestive heart failure (CHF), 72 cultural sensitivity/awareness approach, Constructionist thinking, 496 203-204 defined, 522 developing the field, 211 Consumer Assessment of Health Plans evaluation, 209-211 Survey (CAHPS), 69, 223, 711 focus on attitudes, 203-204 Consumer information, 711-712 focus on knowledge, 204-206 Consumer Perspective, Clinical Guidelines focus on skills, 206-207 for Providers, and Provider and foundation and emergence of, 201-203 System Competencies for in the health professions, 19-20, 199-214 Training, 390 improving healthcare professionals’ Contract Health Service (CHS), 536, 539, ability to provide quality care, 214 541-543, 549 multicultural/categorical approach, 204- Contracting, improvement in quality of 206 care, 543-545 provider perspectives, 211 Control, over key clinical characteristics, teaching methods and opportunities, 380-383 207-209 Cook v. Ochsner Foundation Hospital et al., in the training of health professionals, 682n 214 Cooper-Patrick, Lisa, 635 Cross Cultural Health Care Program Coronary artery bypass graft (CABG), 30, (CCHCP), 385 43-49, 137-140, 149-150, 425, 427- Cuban Americans, 87 430 Cultural sensitivity/awareness approach, Coronary artery disease, 425-431 203-204 Coronary Artery Surgery Study (CASS), 419 Culturally and linguistically appropriate Cost containment strategies, 700-706 services (CLAS), standards for demand-side approaches, 701-702, 706- healthcare, 181-183, 192 712

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744 INDEX Culturally appropriate patient education data needs and recommendations, 232- programs, increasing patients’ 234 knowledge of accessing care and data sources to assess healthcare participating in treatment disparities, 223-226, 271-284 decisions, 198 federal role in racial, ethnic, and primary Culture language health data, 219-223 defined, 522 Home Mortgage Disclosure Act expression of mental illness, 614 (HMDA), 651-653 “Culture, Communication, and Health” models of measuring disparities in course, 209 healthcare, 226-232 Culture of medicine, 594-625 in mortgage lending, 651-653 addressing healthcare disparities obstacles to racial/ethnic data collection, through the training of healthcare 217-219 professionals, 606-611 standardizing, 215 African Americans and the “over- Data Council, 221 diagnosis” of schizophrenia, 612- Data needs and recommendations, 232-234 613 Data sources to assess healthcare bias of efficacy, 603-604 disparities, 223-226, 271-284 case analyses of disparities in mental California Health Interview Survey health services, 611-612 (CHIS), 225-226 cautions about health systems issues and commissioned papers, 273 the complexities of mental health Consumer Assessment of Health Plans phenomena, 618-619 Survey (CAHPS), 223 “clinician bias,” “aversive racism,” and focus groups and roundtable misdiagnosis, 614-616 discussions, 278, 284 culture and the expression of mental Health Plan Employer Data and illness, 614 Information Set (HEDIS), 220, 225 disruptions in the medical machine, 600- literature review, 271, 273 603 Medical Expenditure Panel Survey insights from physicians in academic (MEPS), 223-224 teaching hospitals, 598-600 Medicare Current Beneficiary Survey needed research, 619-621 (MCBS), 224-225 political correctness, the medical Medicare’s Enrollment Database, 224 machine and the meaning of bias, public workshops, 273-277 604-606 study committee, 271 race, perceptions of violence, study components and timeline, 272 involuntary commitment, and technical liaison panels, 278-283 diagnosis of schizophrenia, 616- “De-fragmentation” of healthcare financing 618 and delivery, 13, 182-184 Current Population Survey, 463 Death Registration Area (DRA) system, 488 Cuvier, Georges, 500-501 Demand-side approaches, 701-702, 706-712 consumer information, 711-712 patient cost sharing, 706-711 D Demographics of healthcare providers, 114- 116. See also Patient Daniels, Norman, 727 sociodemographics; Physician Darwin, Charles, 501 sociodemographic characteristics Darwinism, 504 distribution of registered nurse Data collection and monitoring, 21-22, 215- population in geographic areas by 234 racial/ethnic background, 117 assessment of federal policies and nurses, 116 practices, 220-221 physicians, 114-115

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745 INDEX Demography, defined, 465, 522 DRGs. See Diagnosis-related groups Department for the Diseases of Children, DSM-III, 615 484 DSM-IV, 608 Destabilization, patchy, 508 Duke University Medical Center, 140, 429 DHHS. See U.S. Department of Health and Dyads, race-discordant, 574 Human Services Diabetes, 64, 336-337 E Diagnoses cancer, 431-433 Economics, role of, 395 coronary artery disease, 425-431 ED. See Emergency department services general medical and surgical care, 422- EEOC. See Equal Employment Opportunity 425 Commission HIV/AIDS, 437-439 Egalitarian theories, 726-728 implications for change, 442-444 Elder Care Initiative, 389 improper, 397-398 Emergency department (ED) services, 153 overall pattern of evidence, 439-440 Emergency Detention Order, 546 racial and ethnic disparities in care, 441- Emergency Medical Treatment and Active 442 Labor Act (EMTALA), 156-157 renal disease and kidney Emergency services, 71-74, 336-339 transplantation, 435-437 Employment, racial discrimination in, 100 review of the evidence and a EMTALA. See Emergency Medical consideration of causes, 417-454 Treatment and Active Labor Act stroke, 434-435 Enalapril, racial and ethnic differences in Diagnosis-related groups (DRGs), 703, 713- responses to, 7, 138 715 End-stage renal disease (ESRD), 45, 58-60, Differences, defined, 126, 159 68, 435-437 Directory of Health and Human Services Data English Americans and Anglo-Protestant Resources, 223 culture, 483-484 Disadvantaged neighborhoods, 100 English common law, 458 Discrimination English proficiency, limited, 640-642 concerns unique to immigrant Enlightenment principles, 458 populations, 647-649 Epidemics, 470 defined, 4, 159-160, 475, 523, 629-632 Equal Employment Opportunity explaining racial and ethnic disparities Commission (EEOC), 650 in health, 637 Equality, 458 institutional, 95 Erasistratos, 498 preventing through education of ESRD. See End-stage renal disease providers and patients, 660-661 Ethical analysis of racial and ethnic Discrimination as a root cause of disparities in healthcare disparities, 632-649 implications for physicians, nurses, and literature review, 632-637 other providers of health care Title VI enforcement history, 638-649 services, 737 Disparities, defined, 3-4, 32, 126, 159 the neutrality thesis and the anti- Disruptions, in the medical machine, 600- discrimination thesis, democratic 603 political theory, 728-729 Diversity, of U.S. population, growing, 181 relevance of causal stories, 729-736 Diversity Rx, 123 when and how they matter, 722-738 DoD. See U.S. Department of Defense Ethnic American, defined, 523 Dominant group, defined, 458, 523 Ethnic categories for federal data Dominative racism, 494 Hispanic or Latino (“Spanish origin”), 34 DRA. See Death Registration Area system not Hispanic or Latino, 34

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746 INDEX Ethnic groups, 495-496 Executive Office of the President, 384 defined, 523 Office of Management and Budget, 384 Ethnicity, defined, 462, 474, 523 Executive Orders, 657 Eugenics, 504 Eye care, 71-74, 338-341 European American, defined, 523 Evidence-based cost control, 15-16, 189-190 F Evidence-based guidelines, promoting the consistency and equity of care Fadiman, Anne, 605 through the use of, 16, 20, 189-190 Failed reform and corporate takeover, 508 Evidence of race-concordance Fair Housing Act, 98-99 consequences for the Federal Employees Health Benefits Plan communication process, 574 (FEHBP), 699n Evidence of racial and ethnic disparities in Federal Financial Institutions Examination healthcare, 5-6, 38-77 Council (FFIEC), 652 analgesia, 64-66, 290-295, 326-327 Federal healthcare financing programs asthma, 62-63, 296-297 supported through direct public cancer, 52-57, 298-305 funding. See also Medicaid; cardiovascular disease, 39, 42-52, 306- Medicare; State Children’s Health 325, 328-329 Insurance Program (SCHIP) cerebrovascular disease, 57-58, 328-331 health disparities and Medicare and children’s health services, 68-69, 330-335 Medicaid administration, 681-693 diabetes, 64, 336-337 health problems and long-term care emergency services, 71-74, 336-339 needs of minority and non- extent of, 76-77 minority individuals, 671 eye care, 71-74, 338-341 issues in the design, structure, and gallbladder disease, 71-74, 340-341 administration of, 664-698 HIV/AIDS, 61-62, 342-343 overview, 667-673 maternal and infant health, 66-68, 344- poverty rates among minority and non- 349 minority individuals, 672 mental health services, 69-71, 348-353 racial and ethnic minority Americans as needed research, 75-76 a share of the elderly population, other clinical and hospital-based 671 services, 71-74 supplemental insurance coverage among patient perceptions, 71-74, 358-359 minority and non-minority peripheral vascular disease, 71-74, 352- Medicare beneficiaries, 672 355 Federal-level and other initiatives to pharmacy services, 71-74, 352-355 address racial and ethnic physician perceptions, 71-74, 354-359 disparities in healthcare, 235, 384- radiographic services, 71-74, 360-361 391 rehabilitative services, 66, 360-363 Cambridge Health Alliance, 391 renal transplantation, 58-60, 362-365 Department of Health and Human use of services and procedures, 71-74, Services (DHHS), 384-391 364-377 Department of Veterans Affairs, 391 vaccination, 71-74, 374-375 Executive Office of the President, 384 women’s health services, 376-379 Federal policies and practices, assessment EXCEED. See Excellence Centers to of, 220-221 Eliminate Ethnic/Racial Federal Register, 640, 651 Disparities Federal role in racial, ethnic, and primary Excellence Centers to Eliminate Ethnic/ language health data, 219-223 Racial Disparities (EXCEED), 388 Federally Qualified Health Center, 536 Exclusion, defined, 475 Fee-for-service health systems, 75, 705

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747 INDEX FEHBP. See Federal Employees Health Glazer, Nathan, 496 Benefits Plan Great Chain of Being, 497 FFIEC. See Federal Financial Institutions Great Depression and World War II, 505 Examination Council Greco-Roman world, 498 Financial incentives in healthcare, 16-17, GSS. See General Social Survey 190-191 Guidance on Aggregation and Allocation Financing challenge, critical, 658-659 of Data on Race for Use in Civil Flexner, Abraham, 105, 458 Rights Monitoring and Focus Enforcement, 384 on attitudes, 203-204 on knowledge, 204-206 H on skills, 206-207 Focus group findings about racial and Hafferty, Fred, 599 ethnic disparities in healthcare, Harlem Hospital, 661 392-405 Harvard Medical Practice Study, 598 identifying racial and ethnic Harvard Medical School, 599, 633 discrimination, 398-402 Harvard School of Public Health, 489, 633 inclusion of and respect for culture in HCFA. See Health Care Financing healthcare experiences, 403-405 Administration institutional discrimination in Health, defined, 523 healthcare, 402-403 “Health Accountability 36,” 226-228 stories of racial discrimination in Health Care Divided, Race and Healing a healthcare practice, 392-398 Nation, 638 Focus groups, roundtable discussions, 278, Health Care Financing Administration 284 (HCFA), 222-223, 389, 418, 420, Folk illnesses and healing practices, 205 436, 536-537 Ford Foundation, 421 database of, 423 Fragmentation of healthcare systems, 147- Health deficit, defined, 525 148 Health disparities and Medicare and along socioeconomic lines, avoiding, 13, Medicaid administration, 548, 20, 184 681-693 Freedmen’s Bureau, 502-503 choices in establishing conditions of participation and quality of care management, 690-691 G choices in provider payment, 687-689 Galen, 498-499 choices in setting eligibility standards Gallbladder disease, 71-74, 340-341 and enrollment arrangements, Gamble, Vanessa, 634 685-687 GAO. See General Accounting Office choices in the design of managed care Geiger, Jack, 627n, 660 systems, 691-693 General Accounting Office (GAO), 687 concentration of poverty, in 100 largest General medical and surgical care, 422-425 U.S. cities, 688 General Social Survey (GSS), 93 conditions of physician participation, Geographic factors, 117, 144, 286, 488n 683-684 George Washington University Center for issues underlying racial disparities, 684- Health Services Research and 685 Policy, 690 separate SCHIP programs, 689-690 German Americans, 484 Health insurance coverage. See also German Dispensary, 484 Insurance status of racial and German hospitals, 484 ethnic groups Glaucoma, 71 among Latino subgroups, 88

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748 INDEX by Asian-American and Pacific Islander Healthcare disparities subgroups vs. whites, 86 addressing through the training of by race and ethnicity, 679-680 healthcare professionals, 606-611 Health Insurance Portability and among non-African American minority Accountability Act (HIPAA), 217, groups, 240 220, 222, 243 improving research on, 242-243 Health maintenance organizations (HMOs), sources of, 125-130 54, 63, 75, 704-705, 715-716 Healthcare dollars, 536-537 mandatory enrollment in, 8 Healthcare environment, 80-124 staff-model, 115 brief history of legally segregated Health Plan Employer Data and healthcare facilities, 103-108 Information Set (HEDIS), 220, 225, contemporary de facto segregation, 103-108 231, 234, 711 health status of racial and ethnic Health plan payments minority populations, 81-83 to primary care physicians, 704 healthcare professions workforce in to specialists, 704 minority and medically Health plans, disclosing clinical protocols underserved communities, 114- of, 16 120 Health professionals, increasing the historical determinants of contemporary proportion of underrepresented minority health professions U.S. racial and ethnic minorities workforce, 105-108 among, 14, 20, 186 historical overview of healthcare Health Resources and Services delivery for racial and ethnic Administration, 385, 388-389 minority patients, 102-103 Community Access Program (CAP), 388- insurance status of racial and ethnic 389 minority populations, 83-87 Measuring Cultural Competence in linguistic barriers of racial and ethnic Health Care Delivery Settings, 388 minority populations, 87-90 Oral Health Initiative, 389 participation of racial and ethnic Provider’s Guide to Quality and Culture, minorities in health professions 389 education, 120-123 Health Security Act, 705 racial attitudes and relations, 91-95 Health services, defined, 31 racial discrimination, 95-101 Health status of racial and ethnic minority relationship to broader racial attitudes populations, 81-83 and discrimination, 6-7, 101-102 age-adjusted death rates for all causes of settings in which racial and ethnic death by race and Hispanic minorities receive healthcare, 108- origin, 82 114 age-adjusted death rates for selected Healthcare facilities, producing unique causes of death by race and scores for, 229 Hispanic origin, 83 Healthcare professions workforce in Health system interventions, 15-18, 188-196 minority and medically community health workers, 17-18, 193- underserved communities, 114- 195 120 evidence-based cost control, 15-16, 189- demographics of healthcare providers, 190 114-116 financial incentives in healthcare, 16-17, impact of international medical 190-191 graduates (IMGs) on the interpretation services, 17, 191-193 workforce in minority multidisciplinary teams, 195-196 communities, 116-120 Healthcare, defined, 31, 523 top 10 countries with highest proportion of medical graduates, 119

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749 INDEX Healthcare providers, 89-90 Hip fractures, 66 biases in social stereotypes and attitudes, Hippocratic Oath, 497-498 169-171 Hispania, 480 clinical uncertainty, 167-169 Hispanic Americans, 87-88, 480-482 consequences of stereotypes, 171-172 defined, 32n, 34, 463, 523 functions of stereotypes and attitudes, 169 subgroups, 482 prejudice, 10-11, 162-174 Hispanic Colorectal Cancer Outreach and provider beliefs and stereotypes, 169 Education Project, 387 stereotypes and healthcare disparities, Hispanic Medical Association (HMA), 421 172-174 Historical determinants, of contemporary Healthcare services, defined, 31 minority health professions Healthcare settings, 400 workforce, 105-108 influence on care for minority patients, Historical perspective, on inequities and 237-239 bias, 496-497 Healthcare systems-level factors, 8-9 Historical thinking, 496 Healthcare systems-level variables, 140-159 History of racial and ethnic disparities in availability and access to services, 143- healthcare, 102-103, 455-527 144 American Indians or Alaska Natives, fragmentation of healthcare systems, 477-478, 528-534 147-148 American racial and ethnic relations, language barriers, 141-143 458-460 legal and regulatory policy and Asian Americans or Pacific Islanders, healthcare disparities, 155-159 478-480 managed care revolution, 150-154 Blacks or African Americans (not of maneuvering through clinical Hispanic origin), 475-477 bureaucracies, 144-145 changing concepts of race and ethnicity, referral patterns and access to specialty 490-496 care, 145-146 dynamics of the U.S. racial and ethnic shedding some negative aspects of the group interaction, 473-475 past, 508-510 English Americans and Anglo-Protestant supply-side cost containment and culture, 483-484 demand for clinical services, 154- German Americans, 484 155 Hispanics, 480-482 U.S. Department of Defense and immigration, racial and ethnic groups, Veterans Administration health and healthcare, 464-465, healthcare systems, 148-150 470-473 Healthcare workforce, 80 Irish Americans, 485 “Healthy Families” programs, 90 Italian Americans, 485-486 Healthy People 2000, 226 Jewish Americans, 486 Healthy People 2010, 37, 385 North American health and health care, Heckler, Margaret, 487 466-469 HEDIS. See Health Plan Employer Data and Polish Americans, 486-487 Information Set racial and ethnic data collection and Henry J. Kaiser Family Foundation, The, definitions, 460-464 123, 421 racial and ethnic health and healthcare Herophilos, 498 disparities and their Herzog, Maximillian, 484 documentation in the U.S., 487- HHS. See U.S. Department of Health and 489 Human Services white non-Hispanic ethnic groups, 482- HHS-wide initiatives, 384-385 483 Hill-Burton Act, 631, 682n HIV/AIDS, 61-62, 342-343, 437-439

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754 INDEX N Meriam Report, 477, 531 Merton, Robert K., 599 NAACP, 505 Metaracism, 494 NACHM. See National Advisory Mexican Americans, 87, 614 Commission on Health MI. See Myocardial infarction Manpower Middle Ages, 498-499 NALS. See National Adult Literacy Survey Minority, defined, 524 Namias, Barbara, 536 Minority Health, 528 National Adult Literacy Survey (NALS), Minority HIV/AIDS initiative, 384-385 571 Minority patients National Advisory Commission on Health mistrust and experiences of Manpower (NACHM), 118 discrimination, 135-136 National Alliance for Hispanic Health, 387 preferences regarding providers and National Board of Medical Examiners, 209 racial concordance, 132-135 National Breast and Cervical Cancer Early Minority stereotype, defined, 524 Detection Program (NBCCEDP), Minority youth, in the juvenile justice 387 system, 100-101 National Cancer Institute (NCI), 53, 226 “Misanthropy Scale,” 209 National Center for Vital and Health Misdiagnosis, 614-616 Statistics, 81 Mistrust, 174-175 National Center on Minority Health and MMIA. See Massachusetts Medical Health Disparities (NCMHD), Interpreter Association 390, 420, 597 Model minority stereotype, defined, 524 National Committee for Quality Assurance Models for measuring disparities in (NCQA), 225, 227, 231, 233-234, healthcare, 226-232 711 “Health Accountability 36,” 226-228 State of Managed Care Quality report, 231 integrated approaches, 227, 229-231 National Committee on Vital and Health reporting of racial and ethnic disparities Statistics (NCVHS), 219, 222 using existing data sets, 231-232 National Comprehensive Cancer Control Monitoring healthcare disparities, 241 (CCC) Program, 387 Monitoring progress, toward elimination of National Consumer Assessment of Health healthcare disparities, 21-22, 234 Plans (CAHPS), 69 Moon, Marilyn, 667, 694 National Council of Urban Indian Health, Moral foundations, 724-729 536 Mortgage lending, racial discrimination in, National Council on Interpretation in 96 Healthcare, 193 Morton, Samuel George, 501 National Diabetes Program, 389 MOS. See Medical Outcomes Study National Health Interview Surveys, 429 Mt. Sinai Hospital, 486 National Health Law Program (NHeLP), Multicultural/categorical approach, 204- 219-222, 656 206 National Health Service (NHS), 112, 441 Multidisciplinary treatment and preventive National Hospital Discharge Survey care teams, implementing, 18, 21, (NHDS), 43 195-196 National Indian Council on Aging Multinational capitalism, advanced, 468- (NICOA), 537 469 National Indian Health Board, 531, 534, 537 Muslim culture, 205, 498 National Institute of Mental Health Myocardial infarction (MI), 43-45, 59, 71, (NIMH), 617 134, 137 Epidemiological Catchment Area Myrdal, Gunnar, 417, 444 studies, 617

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755 INDEX National Institutes of Health (NIH), 63, 243, NIH. See National Institutes of Health 385, 389-390, 420, 597, 600 NIMH. See National Institute of Mental National Center on Minority Health and Health Health Disparities, 390 NMA. See National Medical Association strategic research agenda on health NNRTI. See Nonnucleoside reverse disparities, 389-390 transcriptase inhibitors National League for Nursing, 203 Noeggerath, Emil, 484 National Medical Association (NMA), 108, Non-hospital facilities, site of care in, 111 421, 503, 643, 662 Non-physician health professionals, 239- National Program of Cancer Registries, 387 240 National Quality Forum (NQF), 216, 219, 226 Nonnucleoside reverse transcriptase National Training Center, 387 inhibitors (NNRTI), 61 National Vital Statistics report system, 226 NQF. See National Quality Forum Native Hawaiian, 34 Nurses, 116 defined, 34 Naturalization Law of 1790, 459 O Navajo language, 89 NBCCEDP. See National Breast and Obstacles to racial/ethnic data collection, Cervical Cancer Early Detection 217-219 Program OCR. See Office of Civil Rights NCI. See National Cancer Institute OEO. See Office of Economic Opportunity NCMHD. See National Center on Minority Office for Civil Rights (OCR), 15, 157, 187, Health and Health Disparities 192, 218, 385-386, 630-631, 638- NCQA. See National Committee for 649, 656 Quality Assurance Limited English Proficiency Guidelines, NCVHS. See National Committee on Vital 695 and Health Statistics Office of Economic Opportunity (OEO), “Negro medical ghetto,” 503, 505 531 Neighborhood health centers (NHCs), 506 Office of Indian Affairs, 530 Neighborhoods, systematically Office of Management and Budget, 32, 227, disadvantaged, 100 234, 384, 461, 463 NEJM. See New England Journal of Medicine Guidance on Aggregation and Neutrality thesis, 722 Allocation of Data on Race for Neutrality thesis and the anti- Use in Civil Rights Monitoring discrimination thesis and Enforcement, 384 democratic political theory, 728-729 Standards for the Classification of differences between, 723-724 Federal Data on Race and Egalitarian theories, 726-728 Ethnicity, 32 Libertarian theories, 725-726 Office of Minority Health (OMH), 181, 192, moral foundations for, 724-729 218, 385, 420 New England Journal of Medicine (NEJM), Resource Center, 385 419, 594, 606, 632 Office of the Secretary of DHHS, 385-386 New Jersey State Police, 654 Cross Cultural Health Care Program, 385 New York Medical College, 484 Healthy People 2010, 37, 385 Newsday, 646 Office for Civil Rights (OCR), 385-386 NHCs. See Neighborhood health centers Office of Minority Health (OMR), 385 NHDS. See National Hospital Discharge Office on Women’s Health, 385 Survey Ohio State University Medical Center, 197 NHeLP. See National Health Law Program OJJDP. See U.S. Office of Juvenile Justice NHS. See National Health Service and Delinquency Prevention NICOA. See National Indian Council on OMH. See Office of Minority Health Aging

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756 INDEX Opioid supplies, availability of, 8 evidence of race-concordance Oral Health Initiative, 389 consequences for the Other, the, 609 communication process, 574 “Overcompensation,” 134 implications for physician training and Overuse of clinical services, by white patient activation to improve patients, 139-140 patient-physician communications within culturally diverse populations, 575-577 P nature and consequences of broad normative expectations, bias, and Pacific Business Group on Health, 711 racial stereotyping by providers Pacific Islander, 34 and patients, 556-557 defined, 34, 522 needed research, 577-579 Page Act of 1875, 459 physician role obligations and Paired testing strategies, 188n medicine’s unwritten social Pap smears, 194 contract, 556 Paperwork Reduction Act, 217 relationship between communication Participation, of racial and ethnic style and patient satisfaction and minorities in health professions health outcomes, 574-575 education, 120-123 role and impact of patient Participatory decision-making (PDM), 132, sociodemographics on medical 559, 572-574 communication, 562-572 Paternalistic racism, 493 role of cross-cultural training for Patient- and system-level factors, 125-159 healthcare professionals, 579-580 Patient education programs, implementing, role of physician sociodemographic 19, 21, 198 characteristics on the medical Patient-level variables, 7-8, 131-140, 237 dialogue, 558-564 biological differences that may justify scope of topic, 553-555 differences in receipt of care, 138- Patient sociodemographics 139 age, 565-567 minority patient mistrust and gender, 565 experiences of discrimination, health status, 569-570 135-136 literacy, 570-572 minority patient preferences regarding race and ethnicity, 562-565 providers and racial concordance, social class, 567-569 132-135 Patients overuse of clinical services by white appearance, 399 patients, 139-140 cost sharing by, 706-711 patient refusal of recommended as discretionary actors, 128 treatment, 136-138 economic/insurance status, 399-400 patients’ preferences, 131-135 education and empowerment, 18-19, 196- role of preferences, treatment refusal, 198 and the clinical appropriateness of perceptions, 71-74, 358-359 care, 7-8 preferences, 131-135 Patient-provider communication, 552-593 protecting, 14-15, 186-187 consequence of race concordance on refusal of recommended treatment, 136- patient reports of physician 138 participatory decision-making response by, 12, 174-175 (PDM) style and other aspects of role and impact on medical communication, 572-574 communication, 562-572 correlates of communication, 557-558

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757 INDEX Patients and Healers in the Context of Culture, Practice arrangements, of minority 607 physicians, 621 PCP. See Pneumocystis carinii pneumonia Pre-Columbian and North American PDM. See Participatory decision-making development, 466-467 Percutaneous transluminal coronary Preferences, defined, 4n angiography (PTCA), 44-49, 139- Prejudice, defined, 524 140, 149-150 “Prejudice-related conflict,” 616 Peripheral artery disease, 74 Prescription services, 73 Peripheral vascular disease, 71-74, 352-355 Prichard, James Cowles, 501 Personally mediated racism, defined, 524 Primary care visits, made to primary care Pew Health Professions Commission, 203 delivery sites by health insurance Pharmacy services, 71-74, 352-355 payer and race/ethnicity, 113 PHS. See U.S. Public Health Service Professional interpretation services, Physician “gag” clauses, banning, 14 increasing linguistic diversity in Physician role obligations, medicine’s the U.S. requires increase in, 193 unwritten social contract, 556 Proficiency, limited, in English, 640-642 Physician sociodemographic characteristics Program successes redressing imbalances gender, 559-560 in care, assessment of, 621 race and ethnicity, 558-559 Prostate cancer screening behaviors, 387 social class, 560-562 Protease inhibitors (PI), 61 Physicians, 114-115 Providers perceptions by, 71-74, 354-359 beliefs and stereotypes, 169 role in the medical dialogue, 558-564 perspectives, 211 Physician’s fees, low, 712-713 Provider’s Guide to Quality and Culture, PI. See Protease inhibitors 389 Pittsburgh Police Department, 654 PTCA. See Percutaneous transluminal Plato, 497-498 coronary angiography Pneumocystis carinii pneumonia (PCP), 61- Public Health Institute, 225 62 Public Health Service Act, 680 Pneumonia, 72 Public workshops, 273-277 Pocket guide and desk reference, 390 PUBMED database, 285 Polish Americans, 486-487 Puerto Rican Americans, 87 Political correctness, 604-606 Political economy, of cultural practices in Q medicine, 621 “Polygenism,” 501 Quality Compass database, 231 Populations. See also Current Population Quality of care Survey; Measures of Quality of defined, 31 Care for Vulnerable Populations received by tribal communities, 539-543 defined, 31 elderly, 671 growing diversity of U.S., 181 R health status of, 81-83 immigrant, 647-649 Race insurance status of, 83-87 defined, 490, 524-525 nurses, 117 ethnicity and immigration with equal access to healthcare, 4, 33 advanced industrial (multinational) Positron tomography, 129 capitalism, 468-469 Postmodernism, 495n commercial capitalism and the slave Poverty rates, among minority and non- society, 466-467 minority individuals, 672 industrial capitalism, 466-469

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758 INDEX North American health and health populations with equal access to care, 466-469 healthcare, 4, 33 pre-Columbian and North American relationship of health status to, 35-36 development, 466-467 relationship to broader racial attitudes perceptions of violence, involuntary and discrimination, 101-102 commitment, and diagnosis of revised standards for the classification of schizophrenia, 616-618 federal data on race and ethnicity, Race-discordant dyads, 574 34 Racial and Ethnic Approaches to their documentation in the U.S., 487-489 Community Health (REACH), Racial and ethnic minority groups 386-387 defined, 32-33 Racial and ethnic disparities in healthcare share of the elderly population, 671 assessing potential sources of, 7-12 Racial attitudes assumptions, 3-4, 30-35 discrimination in the United States, 6-7 background and history, 455-527 relations, 91-95 bias, stereotyping, prejudice, and clinical Racial categories for federal data uncertainty on part of healthcare American Indian or Alaska Native, 34 providers contributing to, 12, 19, Asian, 34 178 Black or African American, 34 civil rights dimension of, 626-663 Native Hawaiian or other Pacific culture of medicine and, 594-625 Islander, 34 data collection and monitoring, 21-22, White, 34 215-234, 460-464 Racial discrimination, 95-101 defining, 3-4 in criminal justice, 100-101 diagnosis and treatment of, 417-454 minority youth in the juvenile justice ethical analysis of when and how they system, 100-101 matter, 722-738 defined, 95-96 evidence of, 5-6, 38-77 in employment, 100 existence and unacceptability of, 6, 19, 79 in housing, 96-100 federal-level and other initiatives to in mortgage lending, 96 address, 235, 384-391 Racial groups focus group findings, 392-405 defined, 525 global problem, 441-442 hierarchies, 490-493 health disparities and Medicare and Racial models, as tools for analysis and Medicaid administration, 681-693 understanding, 493-495 healthcare environment and its relation Racial profiling, the importance of data to, 80-124 collection, 654-655 impact of cost containment efforts on, Racism, 491 699-721 aversive, 494 importance of, 36-38 competitive, 493 interventions to eliminate, 13-20 dominative, 494 many sources contributing to, 12, 19, 159 ideological, 523 minority patients more likely than white individual, 493 patients to refuse treatment, 8, 19, institutionalized, 494 179 internalized, 494, 524 occurring in the context of broader paternalistic, 493 historic and contemporary social personally mediated, 494, 524 and economic inequality, 6-7, 19, scientific, 501, 504, 525 123 societal, 493 patient-provider communication, 552- Racism in Medicine: An Agenda for Change, 593 441

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759 INDEX Radiographic services, 71-74, 129, 360-361 implementing multidisciplinary RAND criteria, 45, 48, 57, 139, 143, 149 treatment and preventive care RAND Health Insurance Survey, 702, 707, teams, 18, 21, 196 709-710 implementing patient education Rationing of healthcare for American programs to increase patients’ Indians/Alaska Natives, 528-551 knowledge of how to best access addressing health disparities, 548 care and participate in treatment changes in the healthcare arena, 534-535 decisions, 19, 21, 198 compacting/contracting and including measures of racial and ethnic improvement in quality of care, disparities in performance 543-545 measurement, 21-22, 233-234 effect of discrimination on quality of care increasing awareness of racial and ethnic for tribal members, 545-548 differences in healthcare among healthcare dollars, 536-537 healthcare providers, 6, 20, 124 history of health disparities among increasing awareness of racial and ethnic American Indians/Alaska differences in healthcare among Natives, 528-534 the general public and key interviews, 539 stakeholders, 6, 20, 124 quality of healthcare received by tribal increasing the proportion of communities, 539-543 underrepresented U.S. racial and tribal/consumer perspectives, 537-539 ethnic minorities among health Rawls, John, 726-728 professionals, 14, 20, 186 REACH 2010. See Racial and Ethnic integrating cross-cultural education into Approaches to Community training of all current and future Health health professionals, 20-21, 214 Recommendations monitoring progress toward elimination applying same managed care protections of healthcare disparities, 21-22, to publicly funded HMO 234 enrollees, 15, 20, 187 promoting the consistency and equity of avoiding fragmentation of health plans care through the use of evidence- along socioeconomic lines, 13, 20, based guidelines, 16, 20, 189-190 184 providing greater resources to the U.S. collecting and reporting data on DHHS Office for Civil Rights to healthcare access and utilization enforce civil rights laws, 15, 20, by patient race, ethnicity, 188 socioeconomic status, and reporting racial and ethnic data by primary language, 21-22, 233 federally defined categories, 21- conducting further research to identify 22, 234 sources of radial and ethnic strengthening the stability of patient- disparities and assessing provider relationships in publicly promising intervention strategies, funded health plans, 14, 20, 185 23, 242-243 structuring payment systems to ensure conducting research on ethical issues an adequate supply of services to and other barriers to eliminating minority patients, 17, 20, 190-191 disparities, 23, 243 supporting the use of community health enhancing patient-provider workers, 18, 21, 195 communication and trust by supporting the use of interpretation providing financial incentives for services where community need practices that reduce barriers, 17, exists, 17, 20, 193 20, 191 Reconstruction, in Black health, 509

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760 INDEX Redlining, 642-643 healthcare disparities among non- Reducing Health Care Disparities National African American minority Project, 388 groups, 240 Reductionism, defined, 525 identification of successful interventions Reductionist thinking, 496 and programs in medical and Referral patterns, access to specialty care, nursing education, 621 145-146 improving research on healthcare Refusal of service, 174-175 disparities, 242-243 Registered nurse population, distribution influence of healthcare systems and in geographic areas by racial/ settings on care for minority ethnic background, 117 patients, 237-239 Rehabilitative services, 66, 360-363 monitoring healthcare disparities, 241 Relevance of causal stories, 729-736 patient-level influences on care, 237 brute luck and social structural political economy of cultural practices in Egalitarian views of causality, medicine, 621 732-734 practice arrangements of minority Libertarian views of the relevance of physicians, 621 causal explanations, 730-732 roles of non-physician health relevance of individual causal professionals, 239-240 responsibility, 734-736 studies of DoD and VA systems, 238 Renaissance, 499 studies within healthcare plans, 237-238 Renal disease, 30, 435-437 types of hospital or clinic and racial and Renal transplantation, 58-60, 362-365, 435- ethnic disparities in care, 238-239 437 Respect, lack of, 396-397 Reporting data on healthcare access and Retrenchment era in healthcare, 507-508 utilization, by patient race, Revascularization, 74, 427 ethnicity, socioeconomic status, Revised standards for the classification of and primary language, 21-22, 233 federal data on race and ethnicity, Reporting racial and ethnic data by 34 federally defined categories, 21- Revolutionary War, 470, 489 22, 234 Robert Wood Johnson Foundation, 421, 620 Reporting racial and ethnic disparities Roman Empire, 498 using existing data sets, 231-232 Republican period, 501 S Research needed, 22-23, 235-243, 619-621 assessment of program successes Sacher, David, 611, 620 redressing imbalances in care, 621 St. Francis Hospital, 485 changes in the ethnicity and race of St. Vincent’s Hospital, 485 medical students, physicians, SAMHSA. See Substance Abuse and Mental nurses, and healthcare staff, 621 Health Services Administration clinical decision-making and the roles of San Diego County Sheriff’s Department, stereotyping, uncertainty, and 655 bias, 236-237 Sandoval decision. See Alexander v. Sandoval contribution of healthcare to health Sanitary Commission Anthropometric outcomes and the health gap Study, 502 between minority and non- Scala natura, 497 minority Americans, 241-242 SCHIP. See State Children’s Health critical analysis of the culture of Insurance Program medicine, 620-621 Schizophrenia, African Americans and the effectiveness of intervention strategies, “over-diagnosis” of, 612-613 240-241 Schulman, Kevin, 635

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761 INDEX Scientific racism, 501, 504 Sources of medical care, those having no defined, 525 usual, 109 Search keywords, 40 Sources of racial and ethnic disparities in Segregation, contemporary de facto, 103-108 healthcare Sen, Amartya, 728 assessing potential, 7-12 Service use, 71-74, 364-377 clinical encounter, 160-179 SES. See Socioeconomic status clinical uncertainty, 9 Settings in which racial and ethnic healthcare provider prejudice or bias, 10- minorities receive healthcare, 108- 11 114 healthcare systems-level factors, 8-9 impact of community health centers on implicit nature of stereotypes, 10 healthcare in minority and medical decisions under time pressure medically underserved areas, 112, with limited information, 11-12 114 patient- and system-level factors, 125-159 primary care visits made to primary care patient-level variables, 7-8 delivery sites by health insurance patient response, 12 payer and race/ethnicity, 113 role of bias, stereotyping, and site of care in hospital settings, 110 uncertainty, 9-12 site of care in non-hospital facilities, 111 Southwest Native American Cardiology site of usual source of care, by health Program, 389 insurance payer and race/ Sowell, Thomas, 496 ethnicity, 111 Spanish heritage, 480-481, 564 those having no usual source of medical “Spanish Language and Cultural care, 109 Competence Curriculum,” 209 Shalala, Donna, 626, 657, 659 Special Programs Development Branch, 391 SHIRE. See Summit Health Institute for Specialized HIV/AIDS outreach and Research and Education, Inc. substance abuse treatment, 390 Site of usual source of care, by insurance Spirit Catches You and You Fall Down, The, and race/ethnicity, 111 605 Slave health deficit, defined, 525 SSA. See Social Security Administration Slave health subsystem, 470-471 Staff-model HMOs, 115 defined, 525 Standardizing data collection, 215 Slave trade, 499-500 Standards, Training and Certification (STC) Slavery, 458 Committee, 193 Smedley, Audrey, 490 Standards for the classification of federal Smith, Charles Hamilton, 501 data on race and ethnicity, 34 Smith, David Barton, 638 American Indian or Alaska Native, 34 Smith, Sally, 531 Asian, 34 Snyder Act of 1921, 532-533 Black or African American, 34 Social Security Act, Title XXI, 680-681 Hispanic or Latino (“Spanish origin”), 34 Social Security Administration (SSA), 220, Native Hawaiian or other Pacific 223, 649, 668 Islander, 34 “Enumeration at Birth” program, 649 not Hispanic or Latino, 34 Master Beneficiary Record database, 224 White, 34 Social structural Egalitarian views of Standards of mental healthcare, for Latinos, causality, brute luck and, 732-734 390 Societal racism, 493 Standards on Cultural and Linguistic Sociocultural thinking, 496 Competence in 2000, 660 Socioeconomic status (SES), 68, 75, 166-167, State Children’s Health Insurance Program 286, 557-558, 595, 635 (SCHIP), 68, 220, 222, 629, 651, Sources of health insurance by race and 659-660, 673-681 ethnicity, 84 applying for, 637, 648

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762 INDEX STC. See Standards, Training and Community Action Grant Program, 390 Certification Committee pocket guide and desk reference, 390 Stereotypes Special Programs Development Branch, defined, 475, 525 391 effect of, 392-393 specialized HIV/AIDS outreach and healthcare disparities, 172-174 substance abuse treatment, 390 implicit nature of, 10 standards of mental healthcare for minority, defined, 524 Latinos, 390 Stinson, Nathan, 528 Summit Health Institute for Research and Stories about misdiagnosis or improper Education, Inc. (SHIRE), 219-222 treatment, 401-402 Sunshine Amendment, 654 Stories of racial discrimination in Supplemental insurance coverage, among healthcare practice, 392-398 minority and non-minority effect of stereotyping, 392-393 Medicare beneficiaries, 672 improper diagnosis or treatment, 397- Supplemental Security Income, 675 398 Supply-side approaches, 703-705, 712-718 lack of respect, 396-397 capitation and DRGs, 713-715 language barriers, 393-395 cost containment and demand for role of economics, 395 clinical services, 154-155 Strategic Research Agenda, 390 health plan payments to primary care Strengthening physicians, 704 doctor-patient relationships, 13-14, 184- health plan payments to specialists, 704 186 low physician fees, 712-713 federal, state, and private healthcare, supply, technology, and expenditure 655-657 controls, 717-718 stability of patient-provider relationships utilization review and practice in publicly funded health plans, guidelines, 716-717 14, 20, 185 Supreme Court. See U.S. Supreme Court Stroke, 434-435 decisions Structural thinking, 496 Surgeon General, 611, 614 Structuring payment systems to ensure an System strategies, 180-198 adequate supply of services to Systema Naturae, 499 minority patients, 17, 20, 190-191 Systematically disadvantaged Student Physician, 599 neighborhoods, 100 Studies assess appropriateness of services, 48-49 T DoD and VA systems, 238 healthcare plans, 237-238 Task Force on Black and Minority Health, role of financial and institutional 417 characteristics, 45-48 Teaching methods and opportunities, 207- using administrative databases, 42-45 209 Subculture, defined, 525-526 Technical liaison panels, 278-283 Subjectivity Terry, Robert W., 493 uncertainty, 128-130 Test of Functional Health Literacy variability, 128 Assessment (TOFHLA), 570-571 Subordinate group, defined, 458, 526 Thai language, 89 Substance Abuse and Mental Health Therapeutic cardiac procedures, 149 Services Administration “Therapeutic social control,” 616 (SAMHSA), 385, 390-391 Third World IMGs, 116-120 American Indian and Alaskan Native TIA. See Transient ischemic attack Planning Grants, 391

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763 INDEX Title VI, 157, 159, 188, 192, 221, 628-631, Understanding and Eliminating Minority 637-641, 668, 679. See also Civil Health Disparities Initiative, 386 Rights Act Unfulfilled potential of Title VI, 157-159 access to medical treatment, 645-647 United Hospital Fund, 658 discrimination concerns unique to United Network for Organ Sharing, 436 immigrant populations, 647-649 United States-United Kingdom enforcement history and the types of Collaborative Initiative on Racial discrimination, 638-649 and Ethnic Health, 441 intentional discrimination, 639-640 United States v. Albank, 653 limited English proficiency, 640-642 United States v. Decatur Federal Savings and managed care, 643-645 Loan, 653 redlining, 642-643 University of California at Davis, 596 Title VII, 631 University of New Mexico School of TOFHLA. See Test of Functional Health Medicine, 597 Literacy Assessment University of Southern California Medical Tools, Robert, 2 School, 634 Transient ischemic attack (TIA), 57, 434-435 Urban Institute, 96 Translating Research into Practice (TRIP), URM. See Underrepresented minority 386 students Treatment U.S. Census Bureau, 81, 199, 461-463, 475, cancer, 431-433 479, 481, 488 coronary artery disease, 425-431 U.S. Civil Rights Commission, 684 general medical and surgical care, 422- U.S. Constitution, 459 425 U.S. Department of Agriculture, 648 HIV/AIDS, 437-439 U.S. Department of Defense (DoD), implications for change, 442-444 healthcare systems, 51, 148-150, improper, 397-398 431, 433 overall pattern of evidence, 439-440 U.S. Department of Education, 571, 650 racial and ethnic disparities in care, 441- National Adult Literacy Survey (NALS), 442 571 renal disease and kidney U.S. Department of Health, Education, and transplantation, 435-437 Welfare, 531. See also U.S. review of the evidence and a Department of Health and consideration of causes, 417-454 Human Services stroke, 434-435 U.S. Department of Health and Human Triage scoring, 153 Services (DHHS), 15, 123, 157, 159, Tribal/consumer perspectives, 537-539 187, 192-193, 216-224, 226, 227n, TRIP. See Translating Research into Practice 232, 234, 384-391, 487-488, 630, Trujillo, Michael, 530 650, 657-660 Tuskeegee Syphilis Study, 131, 205 Agency for Healthcare Research and Quality (AHRQ), 386 Centers for Disease Control and U Prevention (CDC), 386-388 Centers for Medicare and Medicaid UCLA Center for Health Policy Research, Services (CMS), 388 225 “Closing the Health Gap” campaign, 123 UCLA criteria, 48, 139 Data Council, 221 UCLA Medical Center, emergency Directory of Health and Human Services department, 65 Data Resources, 223 Underrepresented minority (URM) Health Resources and Services students, 121-122 Administration, 388-389

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764 INDEX V Healthy People 2000, 226 HHS-wide initiatives, 384-385 Vaccination, 71-74, 374-375 Indian Health Service (IHS), 389 Van Ryn, Michelle, 635 Minority HIV/AIDS initiative, 384-385 Veterans Administration (VA) health monitoring by, 158 system, 56-57, 71, 79, 85, 136-137, National Institutes of Health (NIH), 389- 148-150, 430, 438, 530 390 Vietnamese Americans, 194, 479 Office for Civil Rights (OCR), 15, 157, Vietnamese language, 90 187, 192, 218, 630-631, 638-649 Office of Minority Health (OMH), 181, 192, 218, 420 W Office of the Secretary, 385-386 standards for culturally and War on Poverty, 531 linguistically appropriate services, Washington Civil Rights Initiative, 122 182-183 WASP. See White Anglo-Saxon Protestant Substance Abuse and Mental Health Westat Corporation, 278 Services Administration White, Charles, 501 (SAMHSA), 390-391 White Anglo-Saxon Protestant (WASP), 483 U.S. Department of Housing and Urban White Christians, 498 Development (HUD), 99 White non-Hispanic ethnic groups, 482-483 Housing Discrimination Study, 99 Whites, 34 U.S. Department of Justice, 653-654 defined, 34, 474, 526 Bureau of Justice Statistics, 654 Wickline v. State of California, 684n Civil Rights Division, 654 Williams, David, 621 Office for Civil Rights (OCR), 656 W.K. Kellogg Foundation, 421 U.S. Department of the Interior, 530-531 Women’s health services, 376-379 U.S. Department of Veterans Affairs, 391, World Health Organization, 464 418. See also Veterans World War I, 504 Administration (VA) health World War II, 474, 486, 495, 506 system Worldview, defined, 490, 526 Centers for Excellence, 391 U.S. Department of War, 530 U.S. Office of Juvenile Justice and X Delinquency Prevention (OJJDP), 101 X-ray tomography, 129 U.S. population, growing diversity of, 181 U.S. Public Health Service (PHS), 531 U.S. Supreme Court decisions, 107, 121, 158-159, 693 Utilization managers, as discretionary actors, 130 Utilization review and practice guidelines, 716-717