Minorities in academic medicine: review of the literature.

Given the considerable demographic changes occurring in the in the United States coupled with the urgent need for the field of medicine to continue to adapt to and better align with societal needs and expectations, a growing number of leaders in academic medicine have called for academic health centers to redouble their efforts to increase the diversity of students, faculty, and staff. Although it is laudable to call for increased attention and efforts to diversify, it is of paramount importance to review and distill what we have learned from past efforts so that future energy can be spent intelligently to ensure greater impact going forward. This article reviews the literature on both the barriers and facilitators for racial and ethnic minorities in academic medical careers and offers guidance for increasing the diversity of the nation's medical school faculty members and leadership.

The Bert and Peggy DuPont lecture. "Love, death, and commitment: twenty three years of HIV and genocide prevention in Africa" or "Passionate not equal unhinged".

Over the last 20 years, HIV emerged as the #1 cause of death in African adults, and the Rwanda genocide became the most concentrated mass murder in recorded history. Though one catastrophe surfaced slowly and inexorably while the other smoldered for years before exploding in 1994, the lessons learned are similar. In both situations, the international community has combined moral bankruptcy with a spectacular display of incompetence. Genocide masterminds continue living in Michigan, Minneapolis and Boston, brazenly planning the final extermination of the Tutsi. Students of law, diplomacy and international development are astoundingly sanguine about this, as though our current abdication of responsibility today is mitigated by the centuries of unprincipled idiots who preceded us. If medicine operated this way we'd still be treating syphilis with arsenic. Unfortunately, medicine has lost the moral high ground in Africa through missed opportunities and misappropriation of resources. In the last five years we have spent 20% of the US bilateral foreign assistance budget putting 2.5 million Africans on anti-retroviral treatment (ART), while twice that number of new HIV infections occurred. We tested 50 million Africans for HIV without acting on the evidence and common sense: rather than-transmission happens between two people. Had we tested Africans as couples, a prevention strategy proven to be effective in multiple publications since the early '90s, we could have averted more HIV infections than we are now treating, and at a fraction of the cost.

Disparities in neighborhood food environments: implications of measurement strategies.

Public health researchers have begun to map the neighborhood "food environment" and examine its association with the risk of overweight and obesity. Some argue that "food deserts"­areas with little or no provision of fresh produce and other healthy food­may contribute to disparities in obesity, diabetes, and related health problems. While research on neighborhood food environments has taken advantage of more technically sophisticated ways to assess distance and density, in general, it has not considered how individual or neighborhood conditions might modify physical distance and thereby affect patterns of spatial accessibility. This study carried out a series of sensitivity analyses to illustrate the effects on the measurement of disparities in food environments of adjusting for cross-neighborhood variation in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety. The analysis used geographic information systems data for New York City supermarkets, fruit and vegetable markets, and farmers' markets and employed both kernel density and distance measures. We found that adjusting for vehicle ownership and crime tended to increase measured disparities in access to supermarkets by neighborhood race/ethnicity and income, while adjusting for public transit and traffic safety tended to narrow these disparities. Further, considering fruit and vegetable markets and farmers' markets, as well as supermarkets, increased the density of healthy food outlets, especially in neighborhoods with high concentrations of Hispanics, Asians, and foreign-born residents and in high-poverty neighborhoods.

Status homogamy in the preindustrial marriage market: partner selection according to age, social origin, and place of birth in nineteenth-century rural Sweden.

This article studies partner selection according to three dimensions: social origin, age, and place of birth. The authors use micro-level data from local population registers in five parishes in southern Sweden from 1815 to 1895. The results confirm that all three aspects were important but that socioeconomic status was the most important characteristic, structuring much of the selection process. The importance of social and age homogamy remained stable over the period, while geographic exogamy became more frequent, which could be interpreted in terms of an increasing openness of rural society. The authors also find some indications of exchange of characteristics in the partner selection process.

Dr. Anna Bayerová: The First Official Female Doctor in Bosnia and Herzegovina.

This biographical note details Anna Bayerová's (1853-1924) activities as the first female Austro-Hungarian health officer in 1878 to1918 occupied Bosnia and Herzegovina (BH). Anna Bayerová is known as a heroine of Czech feminism and the 'first Czech female physician', though she only practised in the Czech lands from 1913 to 1916. In 1891, Bayerová was enrolled as the first Austro-Hungarian female health officer and assigned to treat Muslim women in the district of Tuzla, Bosnia. She pursued this mission for the first three months of 1892, had herself transferred to Sarajevo in the summer, and soon thereafter quitted the service. Her biographers point to a series of political and personal motivations to abandon her mission in Bosnia, which, from the viewpoint of Czech feminists, included fulfilling her professional duties in an exemplary way. She spent most of her professional life as a physician in Switzerland and did not request Austrian recognition of her medical degree until 1913. Bayerová died in Prague in 1924. Conclusion. Bayerová, partly for political reasons and partly due to her panic-fuelled fear of catching tuberculosis, quitted her role as the first Austro-Hungarian female health officer in BH soon after her arrival in 1892.

Poverty, health and policy: a historical look at the South African experience.

The resurgence of interest in links between health and development raises interesting questions about the process of research, policy-making, and implementation in the field of health and poverty. To learn about the process in South Africa, we examined three commissions of inquiry relating poverty and health -- in 1929, 1942, and the early 1980s. Power relations of the players were a decisive factor and determined the type and nature of the research conducted.

Public health, racial tensions, and body politic: mass ringworm irradiation in Israel, 1949-1960.

In this essay, we analyze the case study of mass ringworm irradiation conducted in Israel during its first years of existence and its consequences. We analyzed the case study of ringworm irradiation in the framework of racial construction of illness and its treatment, showing the elasticity of race and ethnicity as medical and social categories.

["The demon that turned into worms": the translation of public health in the British Caribbean, 1914-1920]. / "O demônio que se transformou em vermes": a tradução da saúde pública no Caribe Britânico, 1914-1920.

The earliest programs of the Rockefeller Foundation's International Health Commission - IHC were pilot projects for the treatment of hookworm disease in the British colonies of British Guiana and Trinidad. These pioneering ventures into international health have often been portrayed as governed by rigid biomedical principles. In contrast to this view, the article emphasizes the degree to which the exigencies of a public health project that sought to make biomedicine intelligible within the medical systems of subject populations combined with the knowledge of local IHC staff members of Indo-Caribbean descent to generate some fascinating experiments in ethno-medical translation. One term in particular "The Demon that Turned into Worms" is focused on to show how these efforts at medical translation may have legitimized and promoted medical pluralism.

'The very pests of society': the Irish and 150 years of public health in England.

In the context of efforts to reduce health inequalities, the health status of the Irish in England should be a major subject for concern. As England's longest standing and most numerous ethnic minority, the Irish have at times been regarded as a public health threat and have repeatedly been stereotyped in literature and image. There has also been a failure to recognise and celebrate the contributions to the improvement of public health made by members of the irish community such as Kitty Wilkinson. In recent years alarming evidence has emerged that the mortality of Irish people living in England appears to have worsened in successive generations. Comparison of available data on some of the key determinants of ill health shows that the Irish in England have a worse profile than the Irish living in Ireland. A concerted programme of action is needed to investigate why the Irish should have such poor health status and to develop a programme to address it.

Kamal A. Chunchie of the Coloured Men's Institute: the man and the legend.

The lives of black communities in Britain in the inter-war period, the racial hostility faced by them, the discriminatory Coloured Alien Seamen's Order (1925), have all been documented by historians of black history. The lives of the black communities of the East End of London, and the work of organizations, notably, Harold Moody's League of Coloured Peoples, among them has also been touched on by historians. The work of other individuals and organizations among the black communities in the East End are less well known. This piece rescues and documents the work of one such individual, Pastor Kamal A Chunchie, and his organization, the Coloured Men's Institute. Kamal A. Chunchie, arriving in Britain from the trenches of the First World War, struggled for upwards of 30 years to improve the lives of the black communities in London's docklands, through social welfare and Christian fellowship, working first with the Methodists, and later as a freelance. It also examines the relationship between Chunchie and Methodism.

Eating the dead in Madagascar.

Cannibalism has been poorly understood and has seldom been studied, since it was often suppressed by missionaries and colonial administrators, and very few societies still practise it. Cannibalistic practices are more complex than was originally thought. They may be supported in societies under stress or in times of famine, to reflect aggression and antisocial behaviour (in cases where the bodies of enemies killed in battle or people who have harmed the family are eaten), or to honour a dead kinsman. It was, for example, noted in Madagascar during the imperial campaigns of Ranavalona I in the period 1829 - 1853. Two types of cannibalism have been described: exocannibalism, where enemies were consumed, and endocannibalism, where dead relatives were eaten to assist their passing to the world of the ancestors, or to prolong contact with beloved and admired family members and absorb their good qualities. This article reviews some of the beliefs and motivations that surrounded the cannibalistic practices of the people of Madagascar in the 19th century. 

In God's image? The tradition of infant head shaping.

Intentional modification of the infant's head has been commonly practiced at all times and in virtually every region of the inhabited world. Motives included aesthetic perception of the human head, greater attractiveness, symbolization of ethnic identity, demonstration of noble origin or sociocultural status, and supposed health benefits. The desired shape was achieved by repeated hand massage, or by using devices like cradleboards, which were applied throughout infancy. In some regions, infant head shaping was the rule rather than the exception. Whereas chronic modification of the skull during the first year of life had no adverse effects, one-time postnatal head shaping by the midwife was a dangerous procedure. Recommended by Soran in the second century CE, it remained in practice for 17 centuries. With the advent of positional plagiocephaly following the back-to-sleep campaign, head shaping has regained acceptance and is now being widely used again.

The place of race and racism in cultural competence: what can we learn from the English experience about the narratives of evidence and argument?

This paper outlines the history of workforce strategies for providing mental health care to "black and ethnic minorities" in England. Universal mental health policies failed to deliver equity in care, and thus specific policies were launched to address ethnic inequalities in care experiences and outcomes. The emphasis on race equality rather than cultural complexity led to widespread acceptance of the need for change. The policy implementation was delivered in accord with multiple regional and national narratives of how to reduce inequalities. As changes in clinical practice and services were encouraged, resistance emerged in various forms from clinicians and policy leaders. In the absence of commitment and then dispute about forms of evidence, divergent policy and clinical narratives fuelled a shift of attention away from services to silence issues of race equality. The process itself represents a defence against the pain of acknowledging systemic inequities whilst rebutting perceived criticism. We draw on historical, psychoanalytic, and learning theory in order to understand these processes and the multiple narratives that compete for dominance. The place of race, ethnicity, and culture in history and their representation in unconscious and conscious thought are investigated to reveal why cultural competence training is not simply an educational intervention. Tackling inequities requires personal development and the emergence and containment of primitive anxieties, hostilities, and fears. In this paper we describe the experience in England of moving from narratives of cultural sensitivity and cultural competence, to race equality and cultural capability, and ultimately to cultural consultation as a process. Given the need to apprehend narratives in care practice, especially at times of disputed evidence, cultural consultation processes may be an appropriate paradigm to address intersectional inequalities.

Nationalism, racism and propaganda in early Weimar Germany: contradictions in the campaign against the "black horror on the Rhine".

During the early 1920s, an average of 25,000 colonial soldiers from North Africa, Senegal and Madagascar formed part of the French army of occupation in the Rhineland. The campaign against these troops, which used the racist epithet 'black horror on the Rhine' (schwarze Schmach am Rhein), was one of the most important propaganda efforts of the Weimar period. In black horror propaganda, images of alleged sexual violence against Rhenish women and children by African French soldiers served as metaphors for Germany's 'victimization' through the Versailles Treaty. Because the campaign initially gained broad popular and official support, historians have tended to consider the black horror a successful nationalist movement bridging political divides and strengthening the German nation state. In contrast, this essay points to some of the contradictions within the campaign, which often crystallized around conflicts over the nature of effective propaganda. Extreme racist claims about the Rhineland's alleged 'mulattoization' (Mulattisierung) increasingly alienated Rhinelanders and threatened to exacerbate traditional tensions between the predominantly Catholic Rhineland and the central state at a time when Germany's western borders seemed rather precarious in the light of recent territorial losses and separatist agitation. There was a growing concern that radical strands within the black horror movement were detrimental to the cohesion of the German nation state and to Germany's positive image abroad, and this was a major reason behind the campaign's decline after 1921/22. The conflicts within the campaign also point to some hitherto neglected affinities between the black horror and subsequent Nazi propaganda.

Residential outcomes of forced relocation: lifting a corner of the veil on neighbourhood selection.

Fear of the detrimental effects of ethnic segregation has pervaded the debate on the population composition of cities and neighbourhoods. However, little is known about mechanisms underlying the spatial sorting of ethnic minorities. Hence, policies aimed at desegregation may result in exactly the opposite - that is, new ethnic concentrations and segregation. This paper studies the residential outcomes of 658 forced movers from urban restructuring areas in The Hague. Compared with "native" Dutch (those with both parents born in the Netherlands), ethnic minorities report neighbourhood improvement less often and are more likely to stay within or move into other ethnically concentrated neighbourhoods. These differences are not fully explained by differences in individual characteristics, resources, institutional factors, pre-relocation preferences or other relocation outcomes. Ethnic specificities in neighbourhood choices thus remain a pressing issue for further research.

Modeling spatial accessibility of immigrants to culturally diverse family physicians.

This article uses accessibility as an analytical tool to examine health care access among immigrants in a multicultural urban setting. It applies and improves on two widely used accessibility models­the gravity model and the two-step floating catchment area model­in measuring spatial accessibility by Mainland Chinese immigrants in the Toronto Census Metropolitan Area. Empirical data on physician-seeking behaviors are collected through two rounds of questionnaire surveys. Attention is focused on journey to physician location and utilization of linguistically matched family physicians. Based on the survey data, a two-zone accessibility model is developed by relaxing the travel threshold and distance impedance parameters that are traditionally treated as a constant in the accessibility models. General linear models are used to identify relationships among spatial accessibility, geography, and socioeconomic characteristics of Mainland Chinese immigrants. The results suggest a spatial mismatch in the supply of and demand for culturally sensitive care, and residential location is the primary factor that determines spatial accessibility to family physicians. The article yields important policy implications.

"Mr. Burk is most interested in their welfare": J.G. Burk's campaign to help the Anishinabeg of northwestern Ontario, 1923-53.

Although there is a small but growing body of literature on Euro-Canadians who acted "with good intentions" towards the First Nations (Haig-Brown and Nock 2006), precious little has been written about those within the ranks of the Department of Indian Affairs who acted benevolently towards the Aboriginal peoples. James Gerry Burk, Indian agent for the Anishinabeg of the western Lake Superior region for three decades (1923-53), was one such individual. He chose to ignore the department's prevailing racist ideology in favour of nurturing the incipient desire for industry and enterprise that he saw first-hand among the Aboriginal constituents of his agency. In the process, he was compelled to overcome numerous obstacles that Indian Affairs placed in his way. As a result, Burk's career stands as a glowing testament to the indomitable spirit of one departmental official's commitment to assisting the Aboriginal peoples.

"Because being fat means being sick": children at risk of type 2 diabetes.

This study addresses the social and cultural underpinnings that shape children's risk of type 2 diabetes, as identified by a racially and economically diverse group of parents and their children living in Anaheim, California. Based on in-depth interviews with 28 adults and 17 children, we explored how they understood what constitutes "good health" in children and the aspects of their neighborhoods and communities that acted as resources or impediments to their children's well-being. We found that parents and children employed a language of food that reflected a fear-based, medicalized orientation to food consumption. Although nearly all agreed that children should stay active, densely populated neighborhoods, apartment complexes with rigid outdoor rules, high crime rates, police surveillance, and diminished access to public parks and recreational facilities posed challenges. Similarly problematic were deficits in school lunch programs and the limited sometimes demeaning, conversations with healthcare professionals about diabetes risk and prevention. Together, these narratives identify key structural processes attendant to type 2 diabetes risk in children and call for a more politicized conversation regarding prevention strategies and public healthcare practices.

At last...?: Michelle Obama, Beyoncé, race & history.

In this essay, Griffin brings to the fore two extraordinary black women of our age: First Lady Michelle Obama and entertainment mogul Beyoncé Knowles. Both women signify change in race relations in America, yet both reveal that the history of racial inequality in this country is far from over. As an Ivy League-educated descendent of slaves, Michelle Obama is not just unfamiliar to the mainstream media and the Washington political scene; during the 2008 presidential campaign, she was vilified as angry and unpatriotic. Beyoncé, who controls the direction of her career in a way that pioneering black women entertainers could not, has nonetheless styled herself in ways that recall the distinct racial history of the Creole South. Griffin considers how Michelle Obama's and Beyoncé's use of their respective family histories and ancestry has bolstered or diminished their popular appeal.