Understanding Racial and Ethnic Differences in Health in Late Life A Research Agenda (2004) / Chapter Skim
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12 Interventions
12 Interventions
Pages 111-121
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From page 111... ...
We consider interventions in two categories: specific, directed interventions to change behavior and broader policy changes that may also have behavioral effects. CHANGING INDIVIDUAL BEHAVIOR Interventions to promote behavior change can play a role in improving health at older ages.
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From page 112... ...
Older persons on their own sometimes attempt to improve their health by modifying behavior, making choices about medical care, or using complementary or alternative therapies. Health promotion interventions take place in a complex environment that includes family and social relationships, economic and geographic factors, and physical barriers and opportunities, all of which influence older persons' ability to process health information and translate it into new behavior.
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From page 113... ...
It is reasonable to expect that health promotion interventions targeted at specific behaviors should have differential effects across groups, but whether those with more or less healthy behavioral profiles would be more affected is undetermined. Second, some interventions may affect socioeconomic groups differently, with some being more responsive to them because of differences in education or income.
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From page 114... ...
The answers to such questions may provide guides for the design of health promotion interventions. Subsequently, research could proceed to identify the appropriate health care seeking behavior and risk behaviors to target across different ethnic groups.
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From page 115... ...
The range of possible interventions to achieve such public health objectives includes · economic incentives and disincentives linked to health-relevant behaviors; · changes in the informational environment -- education, product labeling, and regulation of commercial speech; · direct regulation through penalties for behavior risky to oneself or others or for organizations that fail to deliver contracted health benefits; · indirect regulation through the legal tort system; and · deregulatory actions that dismantle legal barriers to desired public health behaviors (Gostin, 2001)
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From page 116... ...
It mobilized public opinion and eventually generated a variety of legislative responses, including taxes on cigarettes, restrictions on broadcast advertising, antitobacco advertising campaigns, limits on access to cigarettes, and bans on smoking in various establishments and public places. Antismoking policies have been extensively studied (Chaloupka and Warner, 2000; U.S.
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From page 117... ...
However, interventions do not necessarily have the same effect across racial and ethnic groups. For instance, long-term declines in smoking, roughly similar among whites and blacks, were paralleled among Hispanics and Asian and Pacific Islanders, but at somewhat lower levels, while declines were much more limited among American Indians and Alaska Natives.
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From page 118... ...
. Treatment may therefore be more effective at different ages for different groups; for instance, bone density testing at younger ages for white and Asian women in comparison with Hispanic and black women, mammograms at younger ages for black women, and blood pressure screening at younger ages for black men than other groups.
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From page 119... ...
Tighter controls on immigration, for instance, could increase the risks that illegal immigrants take, reduce the propensity for circular migration and therefore modify salmon bias (the return to their native countries of ill immigrants) , and make immigrants a more select group in ways that could have unpredictable implications for population health.
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From page 120... ...
When considering public health measures targeted at reducing racial or ethnic health disadvantage, therefore, one should keep in mind the ways in which other government actions, taken for a variety of extraneous reasons, can also affect racial and ethnic differences, supporting or possibly undermining measures directed at improving health. NEEDED RESEARCH Much is obviously not known about the policy possibilities for dealing with racial and ethnic differences in late-life health.
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From page 121... ...
If a premium must be paid for lean meats, reduced fat, and low-calorie foods, availability and consumption of these will be more limited at lower socioeconomic levels, with possible differential effects across racial and ethnic groups. When combined with cultural food patterns, the wide availability of high-starch and high-fat food stuffs, lack of leisure time opportunities, limited leisure time outlets, and the cheap, sedentary entertainment of television, public policies to affect health behaviors face difficult barriers (Warner, 2001)
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