Affirmative action, minorities, and public services in India: Charting a future research and practice agenda.

The National Health Policy in India mentions equity as a key policy principle and emphasises the role of affirmative action in achieving health equity for a range of excluded groups. We conducted a scoping review of literature and three multi-stakeholder workshops to better understand the available evidence on the impact of affirmative action policies in enhancing the inclusion of ethnic and religious minorities in health, education and governance in India. We consider these public services an important mechanism to enhance the social inclusion of many excluded groups. On the whole, the available empirical evidence regarding the uptake and impact of affirmative action policies is limited. Reservation policies in higher education and electoral constituencies have had a limited positive impact in enhancing the access and representation of minorities. However, reservations in government jobs remain poorly implemented. In general, class, gender and location intersect, creating inter- and intra-group differentials in the impact of these policies. Several government initiatives aimed at enhancing the access of religious minorities to public services/institutions remain poorly evaluated. Future research and practice need to focus on neglected but relevant research themes such as the role of private sector providers in supporting the inclusion of minorities, the political aspects of policy development and implementation, and the role of social mobilisation and movements. Evidence gaps also need to be filled in relation to information systems for monitoring and assessment of social disadvantage, implementation and evaluative research on inclusive policies and understanding how the pathways to inequities can be effectively addressed.

Leveraging Science to Advance Health Equity: A Regional Health Policy Research Center's Approach.

Advancing health equity and reducing disparities through evidence-based policy research requires the expertise, insights, and active participation of various policy stakeholders - particularly those representing vulnerable populations who may be disproportionately affected by such policies. Unfortunately, there are few sustainable settings for these diverse stakeholders to convene, share their knowledge, develop and execute research in a collaborative fashion, and effectively translate evidence-based findings. The development of a health policy-focused center supports the collaborative structure needed to present a unified, multi-disciplinary approach toward informing health policy. The Transdisciplinary Collaborative Center for Health Disparities Research (TCC) at Morehouse School of Medicine (U54MD008173) was funded in 2012 by the National Institute on Minority Health and Health Disparities (NIMHD) as an innovative approach for conducting health policy research and disseminating evidence-based science to diverse stakeholders. This article provides an overview of the research projects, pilot project programs, infrastructure cores, communications, and strategic dissemination activities supported by the TCC.

Improvements in Outcomes for Ethnic Minorities During the Share 35 Era Are Not Due to Decreased Rates of Early Graft Loss.

OBJECTIVES: Our aim was to investigate the effects of the Share 35 policy on outcomes in ethnic minorities and recipients who experienced early graft failure. MATERIALS AND METHODS: We analyzed donor and recipient data from the United Network for Organ Sharing database before (June 6, 2011 to June 18, 2013) and after (June 18, 2013 to June 30, 2015) implementation of Share 35. Graft and patient survival outcomes were compared. RESULTS: There were significant differences in 1- and 2-year graft and patient survival rates between ethnicities pre-Share 35 (P = .03, P < .001, P = .01, P < .001, respectively). There were no significant differences in 1- and 2-year graft and patient survival between ethnicities post-Share 35 (P = .268, P = .09, P = .343, P = .087, respectively). There were no differences in early graft failure rates pre- and post-Share 35 at 7 days (2.1% vs 2.0; P = .71) and 30 days (4.0% vs 3.8%; P = .47) after transplant, with a decreased early graft failure rate shown at 90 days after transplant (6.8% vs 5.8%; P = .003). When analyzed separately, the low Model for End-Stage Liver Disease (score of < 35) and the high Model for End-Stage Liver Disease recipients (score of ≥ 35) both exhibited reduced early graft failure rates post-Share 35 (6.1% vs 5.3% and 10.8% vs 7.8%, respectively; P < .05). CONCLUIONS: Share 35 was associated with a short-term reduction in ethnic disparities. Most ethnic groups experienced improved survival in the Share 35 era. Share 35 was not associated with an increase in early graft failure and is an efficacious policy with regard to short-term outcomes.

The Policy Argument for Healthcare Workforce Diversity.

This perspectives article considers the potential implications an affirmative action ban would have on patient care in the US. A physician's race and ethnicity are among the strongest predictors of specialty choice and whether or not a physician cares for Medicaid and uninsured populations. Taking this into account, research suggests that an affirmative action ban in university admissions would sharply reduce the supply of primary care physicians to Medicaid and uninsured populations over the coming decade. Our article compares current conditions to the potential effect of an affirmative action ban by projecting how many future medical students will become primary care physicians for Medicaid and uninsured patients by 2025. Based on previous evidence and current medical student training patterns, we project that a ban could deny primary care access for 1.25 million of our nation's most vulnerable patients, considerably worsening existing healthcare disparities. More broadly, we argue that the effects of eliminating affirmative action would be fundamentally contrary to the Association of American Medical Colleges' stated goal of medical education-"to improve the health of all."

On Becoming Scholars and Activists for Disability Rights.

In this paper, the authors discussed the nexus between the Americans with Disabilities Act and the founding of the field of Community Psychology. Contributions of the latter and future areas of research are reviewed here in three areas of importance to both fields: Community living and participation, employment, and transition from high school. Community psychology can make potential contributions to advancing research in these three areas. Implications for future research are discussed.

"Coming Out" of Prison: An Exploratory Study of LGBT Elders in the Criminal Justice System.

This two-phase qualitative study explores the experiences of 10 formerly incarcerated LGBT elders' experiences prior to, during, and after release from prison. A core theme of self and the social mirror emerged from the data that represented LGBT elders ongoing coming-out process of unearthing their "true selves" despite managing multiple stigmatized identities or social locations, such as being LGBT, elderly, HIV positive, formerly incarcerated, and a racial/ethnic minority. These findings further our awareness of an overlooked population of LGBT who are older and involved in the criminal justice system. Recommendations that incorporate suggestions from formerly incarcerated LGBT elders for services and policy reform are presented.

Giving Economically Disadvantaged, Minority Food Pantry Patrons' a Voice: Implications for Equitable Access to Sufficient, Nutritious Food.

This study provides economically disadvantaged, minority food pantry patrons (hereafter, patrons) a meaning-ful voice by examining their experiences trying to obtain sufficient, nutritious food. Five focus groups were conducted using a semistructured discussion guide. Atlast.ti software was used to manage and analyze the data. Patrons reported that pantry staff who preserved their dignity by showing compassion were highly valued. Stigma and shame associated with pantry use were major concerns. Patrons suggested environmental and policy changes to improve their food acquisition experiences. These findings suggest that multilevel interventions addressing food access, food distribution policies, and patron-staff interactions are warranted.

Demographics.

There is a large proportion of minority youth involved in the juvenile justice system. Disproportionate minority contact (DMC) occurs when the proportion of any ethnic group is higher at any given stage in the juvenile justice process than the proportion of this group in the general population. There are several theories explaining the presence and persistence of DMC. This article reviews the history of DMC and the theories and implications of this problem. It discusses several targets for interventions designed to reduce DMC and offer resources in this area.

Black and minority ethnic pharmacists' treatment in the UK: A systematic review.

BACKGROUND: Pharmacists from black and minority ethnic (BME) backgrounds represent a significant proportion of the United Kingdom (UK) pharmacy profession. While there is evidence that BME doctors may be discriminated against in employment and regulatory practices, little is known about the treatment of BME pharmacists. OBJECTIVES: To identify published evidence on the disproportionate treatment in employment and regulatory practices of BME pharmacists in the UK. Evidence was sought in four specific domains: recruitment (into the profession); progression; retention (within sector and profession) and regulation. METHODS: The following databases were searched: Pubmed, Embase, Scopus, International Pharmaceutical Abstracts, SIGLE and Google Scholar. Inclusion criteria were: English language only, published between 1993 and 2014 and reporting UK-based findings. RESULTS: The search strategy identified 11 pertinent items; 6 peer-reviewed articles, 2 published reports, 2 conference papers and one PhD thesis. In employment practices, there was some evidence that BME pharmacists are over-represented among owners and under-represented amongst senior management in the community sector. BME pharmacists reported more difficulties in getting their first job. BME pharmacists were over-represented in disciplinary processes but there was no evidence of disproportionate treatment in the outcomes of inquiries. CONCLUSION: Only a small number of studies have been published in this area, and the evidence of disproportionate treatment of BME pharmacists is equivocal. Further research is needed to better understand the role of ethnicity in recruitment, retention, progression and regulation.

Which Sámi? Sámi inclusion criteria in population-based studies of Sámi health and living conditions in Norway - an exploratory study exemplified with data from the SAMINOR study.

BACKGROUND: In a situation where national censuses do not record information on ethnicity, studies of the indigenous Sámi people's health and living conditions tend to use varying Sámi inclusion criteria and categorizations. Consequently, the basis on which Sámi study participants are included and categorized when Sámi health and living conditions are explored and compared differs. This may influence the results and conclusions drawn. OBJECTIVE: To explore some numerical consequences of applying principles derived from Norway's Sámi Act as a foundation for formalized inclusion criteria in population-based Sámi studies in Norway. DESIGN: We established 1 geographically based (G1) and 3 individual-based Sámi example populations (I1-I3) by applying diverse Sámi inclusion criteria to data from 17 rural municipalities in Norway north of the Arctic Circle. The data were collected for a population-based study of health and living conditions in 2003-2004 (the SAMINOR study). Our sample consisted of 14,797 participants aged 36-79 years. RESULTS: The size of the individual-based populations varied significantly. I1 (linguistic connection Sámi) made up 35.5% of the sample, I2 (self-identified Sámi) made up 21.0% and I3 (active language Sámi) 17.7%. They were also noticeably unevenly distributed between the 5 Sámi regions defined for this study. The differences for the other characteristics studied were more ambiguous. For the population G1 (residents in the Sámi language area) the only significant difference found between the Sámi and the corresponding non-Sámi population was for household income (OR=0.69, 95% CI: 0.63-0.74). For the populations I1-I3 there were significant differences on all measures except for I2 and education (OR=1.09, 95% CI: 0.99-1.21). CONCLUSIONS: The choice of Sámi inclusion criterion had a clear impact on the size and geographical distribution of the defined populations but lesser influence on the selected characteristics for the Sámi populations relative to the respective non-Sámi ones.

Race and imprisonments: vigilante violence, minority threat, and racial politics.

The effects of lynchings on criminal justice outcomes have seldom been examined. Recent findings also are inconsistent about the effects of race on imprisonments. This study uses a pooled time-series design to assess lynching and racial threat effects on state imprisonments from 1972 to 2000. After controlling for Republican strength, conservatism, and other factors, lynch rates explain the growth in admission rates. The findings also show that increases in black residents produce subsequent expansions in imprisonments that likely are attributable to white reactions to this purported menace. But after the percentage of blacks reaches a substantial threshold­and the potential black vote becomes large enough to begin to reduce these harsh punishments­reductions in prison admissions occur. These results also confirm a political version of racial threat theory by indicating that increased Republican political strength produces additional imprisonments.

Truth, healing, and systems change: the Maine Wabanaki-state child welfare truth and reconciliation commission process.

Maine state child welfare staff understand the Indian Child Welfare Act requirements, yet their knowledge of Wabanaki history is limited because it has excluded the voices of the Wabanaki people. A group of Native people and state representatives are creating a truth and reconciliation commission process in Maine, designed to reckon with this history as a way of improving the child welfare system and promoting healing for Wabanaki children and families.

Findings from a national needs assessment of American Indian/Alaska native child welfare programs.

The National Child Welfare Resource Center for Tribes, a member of the Children's Bureau Child Welfare Training and Technical Assistance Network, conducted a national needs assessment of tribal child welfare. This assessment explored current practices in tribal child welfare to identify unique systemic strengths and challenges. A culturally based, multi-method design yielded findings in five areas: tribal child welfare practice, foster care and adoption, the Indian Child Welfare Act, legal and judicial, and program operations.

Continuum of readiness for collaboration, ICWA compliance, and reducing disproportionality.

From 2008-2010, a California Breakthrough Series Collaborative (BSC) addressed the disproportionality of African American and American Indian/Alaska Native (AI/AN) children in public child welfare services in partnership with the Annie E. Casey Foundation, Casey Family Program, the Child and Family Policy Institute of California, and the California Department of Social Services. The result was the development of the Continuum of Readiness, to be utilized by California counties to make strategic decisions to achieve Indian Child Welfare Act (ICWA) compliance and address AI/AN dis-proportionality through collaboration with tribes and urban Indian communities.