Demographic Changes, a View from California Implications for Framing Health Disparities: Workshop Summary (2010) / Chapter Skim
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2 The Changing Face of American Communities: Implications for Framing Discussions About Health Disparities
2 The Changing Face of American Communities: Implications for Framing Discussions About Health Disparities
Pages 5-22
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Director, Center for Health Policy Research, Uniersity of California, Los Angeles According to E Richard Brown, academic researchers tend to focus on statistical outcomes and their implications, without calling attention to potential inadequacy of data needed to understand and assess policy issues.
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In both established communities and new communities, social stratification leads to health disparities between groups. There are disparities in health and health care by race and ethnicity, income, rural versus urban residential location, gender, and other social characteristics.
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This group of medically indigent adults totaled approximately 250,000 people and the counties where they resided became responsible for providing care to that population. Not surprisingly, Lurie found that the affected population of patients encountered serious adverse health affects because of the lack of funding for their health care (Lurie et al., 1984, 1986)
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Example 2: Mammogram and Pap Test Access Asian American women have the lowest cervical cancer and breast cancer screening rates among all racial and ethnic groups. Within Asian ethnic subgroups, however, there are significant differences in access to mammograms and Pap tests (Figure 2-2)
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Diabetes is a major cause of death in the United States, and diabetes is a major cause of disability and functional limitations. Diabetes can result in blindness, permanent kidney damage, cardiovascular disease, and lower limb amputations.
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All of these differences would be missed if the data were not disaggregated across geographic locations. For example, the food environment is very different in Marin County than it is in the other counties in that the population of Marin County has greater access to produce, locally grown food, and supermarkets as well as lower numbers of fast-food restaurants.
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In Seattle, Washington, which also has large Asian and Pacific Islander communities, the highest diabetes rates are found among Pacific Islanders, Native Americans, and Alaska natives. Brown responded that the CHIS does not currently have a good sample of data for Pacific Islanders, so any information about the diabetes rates in that community comes from hospitalization rates and mortality data.
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Brown said that Figure 2-4 it does have a mental health module, which includes mental health status, R01656 mental health service utilization, and access to mental health services. Workshop participant editable vectors about the new regulations Charles Vega asked in the city of Los Angeles that limit the number of fast-food establishments and convenience stores.
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One of the quotes in the article was a statement from a West African organization that described the old-line black organizations as "whiny" and that they just need to die off so that new energy can take over in Harlem. Unspoken but implicit in this statement is this: "Black people are in trouble because they don't work hard enough, because they just didn't get along, they didn't want to fit in, they didn't want to go to school." This negation of the reality of apartheid can set back the efforts and destroy the unity that is needed to end health disparities and other inequalities, Fullilove stated.
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A recent documentary called Passing Poston followed Japanese Americans who were imprisoned during World War II and who went back to visit the Poston internment camp many decades later. During World War II, Japanese American citizens were herded onto trains and interned in camps, causing them to lose their land, homes, businesses, and most importantly, their status as free people.
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Figure 2-5 R01656 uneditable bitmapped image
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Downtown Pittsburgh, Pennsylvania, is another example of how urban renewal efforts affected African Americans (Figure 2-6)
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It is, Fullilove asserted, the same pattern that urban renewal followed in the 1950s in the United States, and in the 1950s urban renewal followed the path of redlining in the 1930s that caused changes in patterns of investment, patterns of resource access, and patterns of space sharing. Fullilove stated that there are two hypotheses about this population displacement process.
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Black people, for example, believe that the government is out to get them. White people, stated Fullilove, in contrast, believe that black people whine too much (and some Africans apparently share this belief, as noted earlier in this section)
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Fullilove described her father, Ernest Thompson, who was the first full-time, paid African American organizer for his union, the United Electrical Radio and Machine Workers of America. It was his role within the union to help his colleagues understand that the oppression of minorities and women destroyed the unity of the union.
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Federal Home Loan Bank Board Home Owner's Loan Corporation. Cartographic Records, Record Group 195.3.
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2008. Collectie Consciousness and Its Discontents: Institu tional Distributed Cognition, Racial Policy and Public Health in the United States.
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