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More than 2 million Americans below age 24 self-identify as being
of American Indian or Alaska Native descent. Many of the serious
behavioral, emotional, and physical health concerns facing young
people today are especially prevalent with Native youth (e.g.,
depression, violence, and substance abuse). Adolescent Native
Americans have death rates two to five times the rate of whites in
the same age group because of higher levels of suicide and a
variety of risky behaviors (e.g., drug and alcohol use,
inconsistent school attendance). Violence, including intentional
injuries, homicide, and suicide, accounts for three-quarters of
deaths for Native American youth ages 12 to 20. Suicide is the
second leading cause of death?and 2.5 times the national rate?for
Native youth ages 15 to 24. Arrayed against these health problems
are vital cultural strengths on which Native Americans can draw. At
a workshop held in 2012, by the National Academies of Sciences,
Engineering, and Medicine, presenters described many of these
strengths, including community traditions and beliefs, social
support networks, close-knit families, and individual resilience.
In May 2014, the Academies held a follow-up workshop titled
Advancing Health Equity for Native American Youth. Participants
discussed issues related to (1) the visibility of racial and ethnic
disparities in health and health care as a national problem, (2)
the development of programs and strategies by and for Native and
Indigenous communities to reduce disparities and build resilience,
and (3) the emergence of supporting Native expertise and
leadership. This report summarizes the presentations and
discussions from the workshop. Table of Contents Front Matter 1
Introduction and Themes of the Workshop 2 Voices of Native Youth 3
Contributors to Resilience 4 Health and Well-Being 5 Addressing
Health Disparities Through Education 6 Concluding Comments
References Appendix A: Workshop Agenda Appendix B: Speaker
Biographies Appendix C: Resources
Since 1965 the foreign-born population of the United States has
swelled from 9.6 million or 5 percent of the population to 45
million or 14 percent in 2015. Today, about one-quarter of the U.S.
population consists of immigrants or the children of immigrants.
Given the sizable representation of immigrants in the U.S.
population, their health is a major influence on the health of the
population as a whole. On average, immigrants are healthier than
native-born Americans. Yet, immigrants also are subject to the
systematic marginalization and discrimination that often lead to
the creation of health disparities. To explore the link between
immigration and health disparities, the Roundtable on the Promotion
of Health Equity held a workshop in Oakland, California, on
November 28, 2017. This summary of that workshop highlights the
presentations and discussions of the workshop. Table of Contents
Front Matter 1 Introduction 2 The Past and Present of U.S.
Immigration Policy 3 Immigration and the Social Determinants of
Health 4 The Voices of Immigrants 5 Reflections on the Workshop
References Appendix A: Workshop Agenda Appendix B: Speaker
Biographical Sketches Appendix C: World Caf Organizations Appendix
D: Statement of Task
Even as the U.S. population becomes steadily more diverse,
minorities and women remain underrepresented in clinical trials to
develop new drugs and medical devices. Although progress in
increasing minority participation in clinical trials has occurred,
participation rates do not fully represent the overall population
of minorities in the United States. This underrepresentation
threatens the health of both these populations and the general
population, since greater minority representation could reveal
factors that affect health in all populations. Federal legislation
has sought to increase the representation of minorities and women
in clinical trials, but legislation by itself has not been
sufficient to overcome the many barriers to greater participation.
Only much broader changes will bring about the meaningful
participation of all population groups in the clinical research
needed to improve health. To examine the barriers to participation
in clinical trials and ways of overcoming those barriers, the
National Academies of Sciences, Engineering, and Medicine held a
workshop in April 2015. This publication summarizes the
presentations and discussions from the workshop. Table of Contents
Front Matter 1 Introduction and Highlights of the Workshop 2
Historical Perspectives and Context 3 Scientific Issues: Clinically
Meaningful Inclusion 4 Recruitment and Retention Issues: Patient,
Provider, Institutional, and System Barriers 5 Potential Best
Practices and Policy Options References Appendix A: Workshop Agenda
Appendix B: Speaker Biographical Sketches Appendix C: Statement of
Task
A critical component of the nation's economic vitality is ensuring
that all Americans can contribute and prosper. Such contributions
presuppose an intentional focus on achieving the highest levels of
health possible, which requires that conditions in communities,
schools workplaces, and other settings promote health and address
the social determinants of health for all community members. Many
organizations, in both the private and public sectors, have been
establishing partnerships to further healthy workplaces and health
equity in general. Many are taking the lead in producing economic
growth that is inclusive and responsive to the nation's diverse
needs and populations. Increasingly, private?public partnerships
are emerging as ways of doing business. Additionally, a variety of
new developments in health, health care, and community benefits
obligations that are part of the Affordable Care Act have
contributed to this interest in economic growth and health and in
the creation of new partnerships. To examine past successes and
future opportunities, the National Academies of Sciences,
Engineering, and Medicine held a workshop in November 2015. The
workshop focused on the potential of the private sector to produce
a triple bottom line: economic opportunity (including workforce
development) and growth, healthy work and community environments,
and improved employee health. At the same time, participants looked
beyond the private sector to public?private partnerships and to
public-sector actions that combine opportunities for economic
growth and good health for all. This publication summarizes the
presentations and discussions from the workshop. Table of Contents
Front Matter 1 Introduction and Organization of the Workshop 2
Paying Attention to Disparities 3 Workforce Development Initiatives
in the Chicago Area 4 Health Care Opportunities 5 Community-Based
Initiatives 6 Major Topics of the Workshop Appendix A: World Caf
Models Appendix B: Workshop Agenda Appendix C: Speaker Biographical
Sketches Appendix D: Statement of Task
Health care is in the midst of a dramatic transformation in the
United States. Spurred by technological advances, economic
imperatives, and governmental policies, information technologies
are rapidly being applied to health care in an effort to improve
access, enhance quality, and decrease costs. At the same time, the
use of technologies by the consumers of health care is changing how
people interact with the health care system and with health
information. These changes in health care have the potential both
to exacerbate and to diminish the stark disparities in health and
well-being that exist among population groups in the United States.
If the benefits of technology flow disproportionately to those who
already enjoy better coverage, use, and outcomes than disadvantaged
groups, heath disparities could increase. But if technologies can
be developed and implemented in such a way to improve access and
enhance quality for the members of all groups, the ongoing
transformation of health care could reduce the gaps among groups
while improving health care for all. To explore the potential for
further insights into, and opportunities to address, disparities in
underserved populations the National Academies of Sciences,
Engineering, and Medicine held a workshop in October 2014. The
workshop focused on (1) how communities are using digital health
technologies to improve health outcomes for racial and ethnic
minority populations, (2) how community engagement can improve
access to high-quality health information for members of these
groups, and (3) on models of successful technology-based strategies
to reduce health disparities. This report summarizes the
presentations and discussions at the workshop. Table of Contents
Front Matter 1 Introduction of the Workshop 2 Technology and Health
Disparities 3 Engaging Providers and Racial/Ethnic Minority
Patients in Digital Strategies 4 Examples of Engaging Racial/Ethnic
Minority Communities in Digital Health Strategies 5 Policy and
Technology Perspectives 6 Synthesis of Workshop Messages References
Appendix A: Examples of eHealth Solutions Featured at the Workshop
Appendix B: Workshop Agenda Appendix C: Speaker Biographical
Sketches
The Handbook of West European Pension Politics provides scholars,
policy-makers and students with a complete overview of the
political and policy issues involved in pension policy, and well as
case studies of contemporary pension politics (1980 to present) in
16 countries: Austria, Belgium, Denmark, Finland, France, Germany,
Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal,
Spain, Sweden, Switzerland, and the UK. The handbook is suitable as
a text for courses in comparative politics, European Studies,
social policy, comparative public policy and public administration.
Each chapter is written by an expert on pension politics and is
presented in a standardized format with standardized tables and
figures that describe: political institutions; government
coalitions, parliamentary and electoral majorities; the party
system; the pension system; proposed and enacted pension reforms.
Since its creation by the Institute of Medicine (IOM) in 2007, the
Roundtable on the Promotion of Health Equity and the Elimination of
Health Disparities has been fostering dialogue on racial and ethnic
disparities in health and health care, examining the development of
programs and strategies to reduce disparities, and encouraging the
emergence of new leadership focused on health equity. For the past
several years, a prominent topic of discussion within the
roundtable has been the Patient Protection and Affordable Care Act
(ACA). The ACA has multiple provisions specific to race, ethnicity,
and language and other provisions with significant implications for
racially and ethnically diverse populations. In April 2013, the
roundtable held a workshop to address many issues surrounding the
ACA, including expansion of coverage, delivery systems, and access
points, service delivery and payment reform, public-private
partnerships, and challenges to the safety net. This report
summarizes the presentations and discussions from the workshop.
Table of Contents Front Matter 1 Introduction and Themes of the
Workshop 2 The Potential of the ACA to Reduce Health Disparities 3
The ACA and Health Equity 4 The Patient-Centered Medical Home 5 The
Safety Net and Beyond 6 Consumer Engagement References Appendix A:
Workshop Agenda Appendix B: Speaker Biographical Sketches
The IOM held a workshop on July 28, 2008, to examine strategies for
discussing health disparities in ways that engage the public and
motivate change. Speakers focused on health disparities in
California, which continues to see dramatic demographic shifts.
The high rate of incarceration in the United States contributes
significantly to the nation's health inequities, extending beyond
those who are imprisoned to families, communities, and the entire
society. Since the 1970s, there has been a seven-fold increase in
incarceration. This increase and the effects of the
post-incarceration reentry disproportionately affect low-income
families and communities of color. It is critical to examine the
criminal justice system through a new lens and explore
opportunities for meaningful improvements that will promote health
equity in the United States. The National Academies convened a
workshop on June 6, 2018 to investigate the connection between
incarceration and health inequities to better understand the
distributive impact of incarceration on low-income families and
communities of color. Topics of discussion focused on the
experience of incarceration and reentry, mass incarceration as a
public health issue, women's health in jails and prisons, the
effects of reentry on the individual and the community, and
promising practices and models for reentry. The programs and models
that are described in this publication are all Philadelphia-based
because Philadelphia has one of the highest rates of incarceration
of any major American city. This publication summarizes the
presentations and discussions of the workshop. Table of Contents
Front Matter 1 Introduction 2 The Experience of Incarceration and
Reentry 3 Mass Incarceration as a Public Health Issue 4 Women's
Health in Jails and Prisons 5 Reentry: Effects on the Individual
and the Community 6 Promising Practices and Models for Reentry 7
The Perspective from the District Attorney's Office 8 Wrap-Up
Session Appendix A: References Appendix B: Workshop Agenda Appendix
C: Speaker Biographical Sketches Appendix D: Statement of Task
Social policy has become an increasingly prominent component of the
European Union's policy-making responsibilities. Today, for
example, a highly developed body of law regulates equal treatment
in social security and co-ordinates national security schemes;
national health services have opened up to patients and service
providers from other states; and rules govern the translation of
educational and vocational certificates across member states. This
state of affairs is all the more remarkable given the relatively
limited resources at the EU's disposal and the initial intentions
of its founders. During negotiations for the Treaty of Rome in the
1950s, social policy was viewed as the exclusive provenance of the
member states. There were to be provisions to facilitate labour
mobility within the common market, but until the 1970s social
policy making at the EU-level was modest. However, plans for the
internal market moved social policy on the EU's decision-making
agenda. The Social Chapter was adopted in 1989, and the Single
European Act expanded EU competencies in social policy. The
Treaties of Maastricht, Amsterdam and Nice all expanded
competencies further, so that by the time the heads of government
met in Lisbon in 2007 to sign the EU's latest treaty, the extent of
supranational control over important aspects of social policy
making was quite impressive. This important book provides a full
account of the evolution of social policy in the EU and of its
current reach. It examines the reasons for the increased role of
the EU in the area, in spite of formidable obstacles, and details
its effects in member states, where social provision is often the
biggest item in government budgets and a crucial issue in national
elections. Drawing on research done on welfare states around the
world and on European integration, this book provides a distinctive
and sophisticated account of social policy in Europe, showing how
it must now be understood in the context of multi-level governance
in which EU institutions play a pivotal role.
At the turn of the 21st century, several important reports and
events designed to raise awareness of health disparities and to
describe initial efforts to reduce health disparities took place.
The Surgeon General's office released several reports that showed
dramatic disparities in tobacco use and access to mental health
services by race and ethnicity. The first real legislation focused
on reducing health disparities was signed into law, creating the
National Center for Minority Health and Health Disparities within
the NIH. In 2001, the IOM released its landmark report, Crossing
the Quality Chasm: A New Health System for the 21st Century,
highlighting the importance of a focus on health care quality
rather than a focus on only access and cost issues. Building upon
these reports and events, the IOM held a workshop on April 8, 2010,
that discussed progress to address health disparities and focused
on the success of various federal initiatives to reduce health
disparities. How Far Have We Come in Reducing Health Disparities?
summarizes the workshop and explains the progress in the field
since 2000. Table of Contents Front Matter 1 Introduction 2 What
Progress in Reducing Health Disparities Has Been Made?: A
Historical Perspective 3 Healthy People 2010: How Far Have We Come
in Reducing Health Disparities? 4 Federal Perspectives on Reducing
Health Disparities 5 Promising Practices in Addressing Social
Determinants: Obesity Prevention 6 What Do We Still Need to Learn
About Reducing Health Disparities? 7 Legislative Actions to Reduce
Health Disparities Appendix A: Workshop Agenda Appendix B: Speaker
Biographical Sketches
Socioeconomic conditions are known to be major determinants of
health at all stages of life, from pregnancy through childhood and
adulthood. "Life-course epidemiology" has added a further dimension
to the understanding of the social determinants of health by
showing an association between early-life socioeconomic conditions
and adult health-related behaviors, morbidity, and mortality.
Sensitive and critical periods of development, such as the prenatal
period and early childhood, present significant opportunities to
influence lifelong health. Yet simply intervening in the health
system is insufficient to influence health early in the life
course. Community-level approaches to affect key determinants of
health are also critical. Many of these issues were raised in the
1995 National Academies book, Children's Health, the Nation's
Wealth. The present volume builds upon this earlier book with
presentations and examples from the field. Focusing on Children's
Health describes the evidence linking early childhood life
conditions and adult health; discusses the contribution of the
early life course to observed racial and ethnic disparities in
health; and highlights successful models that engage both community
factors and health care to affect life course development. Table of
Contents Front Matter 1 Introduction 2 Disparities in Children's
Health: Major Challenges and Opportunities 3 Investing in
Children's Health 4 From Policy to Practice: How Policy Changes Can
Affect Children's Lives 5 Community Development Approaches:
Overcoming Challenges, Striving for Change 6 Do Businesses Have a
Role Improving Communities or Improving Children's Lives? 7 Closing
Comments Appendix A: Workshop Agenda Appendix B: Biosketches of
Presenters and Authors Appendix C: Resources Appendix D: Special
Presentation: Unnatural Causes Appendix E: Clinical Health Care
Practice and Community Building: Addressing Racial Disparities in
Healthy Child Development
Health Politics in Europe: A Handbook is a major new reference
work, which provides historical background and up-to-date
information and analysis on health politics and health systems
throughout Europe. In particular, it captures developments that
have taken place since the end of the Cold War, a turning point for
many European health systems, with most post-communist transition
countries privatizing their state-run health systems, and many
Western European health systems experimenting with new public
management and other market-oriented health reforms. Following
three introductory, stage-setting chapters, the handbook offers
country cases divided into seven regional sections, each of which
begins with a short regional outlook chapter that highlights the
region's common characteristics and divergent paths taken by the
separate countries, including comparative data on health system
financing, healthcare access, and the political salience of health.
Each regional section contains at least one detailed main case,
followed by shorter treatments of the other countries in the
region. Country chapters feature a historical overview focusing on
the country's progression through a series of political regimes and
the consequences of this history for the health system; an overview
of the institutions and functioning of the contemporary health
system; and a political narrative tracing the politics of health
policy since 1989. This political narrative, the core of each
country case, examines key health reforms in order to understand
the political motivations and dynamics behind them and their impact
on public opinion and political legitimacy. The handbook's
systematic structure makes it useful for country-specific,
cross-national, and topical research and analysis.
Leveraging Culture to Address Health Inequalities: Examples from
Native Communities is the summary of a workshop convened in
November 2012 by the Roundtable on the Promotion of Health Equity
and the Elimination of Health Disparities of the Institute of
Medicine. The workshop brought together more than 100 health care
providers, policy makers, program administrators, researchers, and
Native advocates to discuss the sizable health inequities affecting
Native American, Alaska Native, First Nation, and Pacific Islander
populations and the potential role of culture in helping to reduce
those inequities. This report summarizes the presentations and
discussion of the workshop and includes case studies that examine
programs aimed at diabetes prevention and management and cancer
prevention and treatment programs. In Native American tradition,
the medicine wheel encompasses four different components of health:
physical, emotional, mental, and spiritual. Health and well-being
require balance within and among all four components. Thus, whether
someone remains healthy depends as much on what happens around that
person as on what happens within. Leveraging Culture to Address
Health Inequalities addresses the broad role of culture in
contributing to and ameliorating health inequities. Table of
Contents Front Matter 1 Introduction and Themes of the Workshop 2
Culture as a Social Determinant of Health 3 Why Culture Matters in
Addressing Health Inequities 4 Cultural Sensitivity in Health Care
Delivery and Research 5 Diabetes Prevention in Native Communities 6
Cancer Prevention and Treatment in Native Communities 7 Reflections
on the Workshop References Appendix A: Culture as a Social
Determinant of Health Appendix B: Agenda Appendix C: Speaker
Biographies (in order of appearance)
The Handbook of West European Pension Politics provides scholars,
policy-makers and students with a complete overview of the
political and policy issues involved in pension policy, and well as
case studies of contemporary pension politics (1980 to present) in
16 countries: Austria, Belgium, Denmark, Finland, France, Germany,
Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal,
Spain, Sweden, Switzerland, and the UK. The book is suitable as a
text for courses in comparative politics, European Studies, social
policy, comparative public policy and public administration. Each
chapter is written by an expert on pension politics and is
presented in a standardized format with standardized tables and
figures that describe: political institutions; government
coalitions, parliamentary and electoral majorities; the party
system; the pension system; proposed and enacted pension reforms.
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