Information gaps in persuasion knowledge: The discourse regarding the Covid-19 vaccination.

Persuasion knowledge is personal knowledge about persuasion attempts that has an effect on the way people respond to these attempts. Persuasion attempts are made to effectively handling the Covid-19 pandemic, which is dependent on high public compliance with vaccination programs. Drawing on the idea of persuasion knowledge, we aimed at elaborating the various categories of perceived information gaps experienced by vaccine hesitants during the Covid-19 vaccination campaign. At the beginning of 2021 we conducted 20 in-depth interviews with Israelis who had decided not to be vaccinated against Covid-19. Analysis of the interviews revealed three main categories of information gaps experienced by the interviewees: missing information, manipulated information, and discrepant information. We analyzed how these are associated with distrust and may impair the persuasion efforts of governments and health authorities. Perceived information gaps, as part of persuasion knowledge, may increase negative responses, and therefore constitute an important factor in persuasion campaigns.

Layers of senses: Experiencing intercorporeality in teletherapy.

Teletherapy, namely, therapy that uses technology for communication between patients and therapists, is challenged by the impersonal nature of remote and digital communication. Using Merleau-Ponty's theoretical concept of intercorporeality, which refers to the perceived reciprocity between two people's bodies during communication, this article aims to elaborate on spiritual caregivers' experience of interacting with patients during teletherapy. Semi-structured in-depth interviews were conducted with 15 Israeli spiritual caregivers who use various forms of teletherapy (Zoom, FaceTime, phone calls, WhatsApp messages, etc.). Interviewees emphasized their physical presence with the patient as a main principle in spiritual care. They indicated the involvement of nearly all senses in physical presence therapy, which allows for joint attention and compassionate presence. When making use of various communication technologies in teletherapy, they reported the involvement of fewer senses. The more senses involved in the session and the clearer it is that space and time are shared by both caregiver and patient, the stronger the caregiver's presence with the patient. Interviewees experienced teletherapy as eroding the multisensory joint attention and intercorporeality and, hence, the quality of care. This article points at the advantages of teletherapy for therapists in general and spiritual caregivers in particular but claims, nonetheless, that it challenges the main principles of therapy. Joint attention in therapy is, fundamentally, a multisensory phenomenon that may be understood as intercorporeality. Our use of the notion of intercorporeality sheds light on the reduction of the senses involved in remote interpersonal communication and its impact on care and, more generally, the interpersonal communication experienced during telemedicine. This article's findings may also contribute to the field of cyberpsychology and to therapists engaged in telepsychology.

Vaccinated kindergartens: A community-based bottom-up initiative addressing vaccine hesitancy in Israel.

BACKGROUND: Vaccine hesitancy (VH) has grown over recent decades. While most of the strategies implemented to cope with VH are top-down interventions, the present article focuses on a unique community-based bottom-up initiative conducted in Israel: Mehusgan-the vaccinated kindergarten. OBJECTIVE: The objective of the study was to learn about the vaccinated kindergarten initiative: its implementation, benefits, and challenges as well as its broader potential impact. METHODOLOGY: During 2020, we conducted 13 semi-structured in-depth interviews with parents, kindergarten teachers and managers, and physicians. FINDINGS: The interviews revealed that parents are encouraged to complete the vaccination program as recommended; additional kindergartens join the initiative; and additional kindergartens become vaccinated. CONCLUSIONS: Mehusgan is a unique and growing initiative that leads to vaccinated kindergartens and, therefore, contributes to public health. This case study can encourage other community-based bottom-up initiatives that seek to raise vaccination rates.

Non-Vaccination Stage Model (NVST): The decision-making process among Israeli ultra-orthodox Jewish parents.

Although vaccination uptake is high in most countries, pockets of suboptimal coverage remain, such as those observed among ultra-orthodox Jews in Israel and elsewhere, posing a threat to both individual and public immunity. Drawing on the Precaution Adoption Process Model (PAPM), this study proposes a Non-Vaccination Stage Model (NVSM) to analyze the decision-making process among Non-Vaccinating Parents (NVPs), focusing on the ultra-orthodox Jewish population of Israel. In-depth interviews were conducted with 10 Israeli ultra-orthodox Jewish NVPs (mothers). The interviews revealed five stages in the participants' decision-making process: Being good mothers who vaccinate their children; Emergence of doubts regarding the risks of vaccination; Personal vaccination policy-hesitancy concerning vaccination; Decision not to vaccinate; Confirmation signs of what participants perceive as a wise decision. NVSM can help understand parents who consider non-vaccination to be healthier behavior and explore the various stages of their decision-making process. Differentiating among the various stages of NVPs' decision-making processes enables application of different intervention approaches by policymakers and healthcare practitioners.

"I Took the Trouble to Make Inquiries, So I Refuse to Accept Your Instructions": Religious Authority and Vaccine Hesitancy Among Ultra-Orthodox Jewish Mothers in Israel.

Voluminous scholarship has shown that religious leaders play an important role in helping patients cope with health issues. There is, however, little research on the impact of religious leaders on parents' decision-making processes pertaining to childhood vaccination. Ultra-orthodox Jewish religious leaders (rabbis) are considered authorities on health issues, and most of them encourage parents to vaccinate their children. Yet, there have been several recent outbreaks of measles in the ultra-orthodox population in Israel, as well as in other countries. The aim is to study the role played by rabbis in the decision-making process of Israeli ultra-orthodox Jewish parents with regard to vaccination. In-depth interviews were conducted during 2019 with ten Israeli ultra-orthodox Jewish mothers who do not vaccinate their children. The interviewees acknowledged that rabbis generally advocate vaccination. Yet they do not consult them and at times even disregard their instructions. The interviewees search for information on vaccination for themselves (mostly online) and decide not to vaccinate their children based on their assessment of risk. Contrary to the scholarly literature that points to the central role of religious leaders in dealing with health issues, the ultra-orthodox mothers' decision not to vaccinate their children appears to have been made despite the rabbis' instructions and not for religious reasons. These mothers' decision-making process is similar to that of mothers who do not vaccinate their children in other countries with respect to the aspect of gender, the search for information, and the reasons reported. Contacting the ultra-orthodox mothers directly and addressing their concerns about risk increase vaccination rates among the ultra-orthodox Jewish population.

Preferring patient-physician concordance: the ambiguity of implicit ethnic bias.

BACKGROUND: Much of the current literature on racial/ethnic bias in healthcare focuses on practitioners' implicit biased attitudes regarding patients, identifying it as a factor contributing to health disparities. Little attention has been paid, however, to patients' bias against practitioners from other ethnic group. AIM: To explore patients' bias towards practitioners from other ethnic group. METHOD: In-depth interviews were conducted during 2018 with 38 Israeli Jewish and Arab patients. FINDINGS: While many participants (more Jews than Arabs) reported that they perceive medical treatment as neutral and value the physician's professionalism and attitude, others (more Arabs than Jews) attested that they do prefer to be treated by physicians of their own ethnic group. Jewish patients who prefer Jewish physicians described bias against Arab physicians: Feelings of fear and distrust, particularly in light of the conflictual situation in Israel. They also considered Arab physicians less professional than Jewish ones. Arab patients who prefer Arab physicians described their need for culturally and linguistically competent healthcare and praised close informal relations with Arab physicians, contrasting them with past offensive and humiliating experiences with Jewish physicians. CONCLUSIONS: Findings reveal several factors that impact Jewish and Arab Israeli patients' preference for patient-physician concordance, some of which reflect patients' implicit bias. This phenomenon - together with practitioners' implicit bias against patients - should be recognized as contributing to the ambiguity of ethnic relations in clinical encounters, particularly in conflictual societies.

Experiences of Jewish and Arab Healthcare Practitioners Treating Terrorists in Israel.

The growing number of terror attacks worldwide draws attention to the difficulties that healthcare practitioners experience when they treat terrorists or suspected terrorists. Research literature on the challenges faced by healthcare practitioners treating terrorists in conflict areas is limited. In-depth interviews were conducted during 2016-2017 with 50 Jewish and Arab healthcare practitioners (managers, physicians, and nurses) employed in 11 public hospitals in Israel, who treat Palestinian terrorists and security prisoners, in the context of a prolonged and violent national conflict. Jewish practitioners find it emotionally difficult to treat terrorists and security prisoners. They face an ethical dilemma when called upon to save the lives of those who took life and find themselves identifying with the victims. Arab practitioners identify with both sides of the conflict. Three coping strategies were described: maintaining a humanistic standpoint; adherence to a standard of detached professionalism; and refusal to treat terrorists and security prisoners.

Language practice and policy in Israeli hospitals: the case of the Hebrew and Arabic languages.

BACKGROUND: Organizational language practice and policy are not neutral elements but reflect social and political power relations. The micro-level of working groups is subject to the influence of political conflicts and power relations at the macro-level. In conflict zones in particular, these involve complex considerations. Consequently, the present research sought to examine tensions arising from the language spoken among mixed Jewish-Arab teams in Israeli public hospitals. METHODS: In-depth interviews were conducted during 2016-2017, with 50 Jewish and Arab healthcare practitioners - 10 managers, 20 physicians, and 20 nurses - employed in 11 public hospitals in Israel. RESULTS: Our interviews with healthcare practitioners revealed that speaking Arabic in the presence of the patient (not with the patient) may evoke negative feelings and resentment among both Jewish patients and colleagues. Moreover, conflicting attitudes may come into play when Arab practitioners speak Arabic among themselves. Two contexts of language use in Israeli public hospitals can be noticed: the language used in the presence of the patient; and the language used among the practitioners when no patient is present. The former involves the principles of cultural and linguistic competency, and is therefore governed by clear guidelines and procedures. The latter echoes the tensions between the two ethno-national groups in Israel, Jews and Arabs, and is not regulated by a clear policy formulated by the Ministry of Health or by the hospitals' managements. CONCLUSIONS: Our analysis of language practice and policy as a multi-leveled phenomenon, where the micro-level of everyday interactions is influenced by the macro-level of political life, indicates a need for meso-level policy, led by the Ministry of Health. A policy of linguistic competency should be publicized and enforced to ensure that in the presence of the patient, practitioners speak a language s/he understands. This policy should also stipulate that among mixed teams of healthcare professionals every language is permissible, while the language spoken in a particular context should be understood by everyone present.

Patient demands for ethnic-based separation in public hospitals in Israel: patients' and practitioners' perspectives.

BACKGROUND: Segregation within the healthcare system is commonly associated with disparities in the utilization of health services and in the outcomes of medical care. In Israel, the Jewish majority and the Arab minority populations are treated in the same healthcare organizations. Nevertheless, demands for ethnic separation in inpatient rooms are raised at times by patients, despite the principle of prohibiting discrimination between patients on the grounds of religion, race, sex and nationality. The study sought to examine patients' attitudes regarding separation between Jews and Arabs in inpatients rooms, and to discover the coping strategies employed by healthcare practitioners. METHODS: A mixed methodology was employed. We conducted a survey of a representative sample of the Israeli population (N = 760); and held 50 in-depth interviews with nurses, physicians and managers employed in 11 public hospitals in Israel. RESULTS: In the representative sample survey, 30% of Jews and 21% of Arabs agree that patients should be allowed to choose to be placed in an inpatient room in which only patients of their own ethnic group are hospitalized. Among both Jews and Arabs, a high level of religiosity and a low level of education predict this position. Most Jews (80%) and Arabs (71%) do not agree that the entire healthcare system should be ethnically separated. The in-depth interviews revealed evidence of demands for ethnic separation made at times by Jewish patients, which are often met by the nurses. In some cases, nurses separate Jewish and Arab patients of their own accord. They do this either to promote cultural compatibility between patients or to avoid unnecessary tension and confrontations. In some cases, this step may constitute discrimination against Arab patients. Managers and senior physicians, for their part, are generally unaware of this ethnic separation, or deny that it takes place. CONCLUSIONS: Ethnic separation in inpatient rooms does take place some of the time and this runs contrary to the ethos of neutrality in medicine. We recommend implementation of a specific national policy that prohibits ethnic-based separation in hospitals' inpatient rooms. Better communication is required to ensure that policy decisions are clearly conveyed to the wards and that segregation does not become institutionalized.

The Secret Drama at the Patient's Bedside-Refusal of Treatment Because of the Practitioner's Ethnic Identity: The Medical Staff 's Point of View.

Patients' refusal of treatment based on the practitioner's ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. Taking the Israeli-Palestinian conflict into account, this article aims at examining Israeli health care professionals' points of view concerning patients' refusal of treatment because of a practitioner's ethnic identity. Fifty in-depth interviews were conducted with 10 managers and 40 health care professionals, Jewish and Arab, employed at 11 public hospitals. Most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed toward nurses and junior medical staff members, especially if recognizable as religious Muslims. Refusals are often initiated by the patients' relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients' ethnic-based treatment refusals and to improve the handling of such incidents.

Tensions and Coping Strategies in Ethnically Mixed Teams: Findings from a Study in Two Emergency Departments.

Diversity of the workforce in healthcare facilities, representative of the general population's ethnic/racial composition, is an important health priority. Nevertheless, this diversity may generate tensions. The objective of the study was to assess tensions and coping strategies among ethnic minority and majority healthcare workers. A questionnaire was delivered to 60 healthcare workers employed in emergency departments in two hospitals, where Jewish majority and Arab minority workers care for a mixed Jewish and Arab population. Internal consistency reliability was assessed and the survey data were statistically analyzed. Several differences were found between Arab and Jewish healthcare workers. The questionnaire may be used to examine tensions in other healthcare systems, characterized by ethnic/racial diversity in the workforce. By exploring ethnic/racial tensions, health organizations should be able to manage them better and reduce their frequency.

Race-based experiences of ethnic minority health professionals: Arab physicians and nurses in Israeli public healthcare organizations.

Increasing workforce diversity was found to contribute to the narrowing of disparities in health. However, racism toward ethnic minority health professionals has not been adequately researched. In Israel, public healthcare organizations that serve a mixed Jewish-Arab population employ Arab minority healthcare professionals. Instances of prejudice and manifestations of racism toward them, which frequently surface in public discussion and the media, have unfortunately gained little scholarly attention. We used the intergroup contact approach and the theory of the social process of everyday racism as a theoretical framework. The objective of the research was to study race-based experiences of Israeli Arab healthcare professionals. METHODOLOGY: We used a qualitative research method that allows respondents to describe their views, experiences, beliefs and behavior in the way they think about them. During 2013 and 2014 we conducted in-depth interviews with a snowball sample of 10 Arab physicians and 13 Arab nurses who work in Israeli public hospitals. The study protocol was ethically approved. FINDINGS: Interviewees noted institutional efforts to maintain egalitarianism and equality. However, at the micro-level, interviewees, mostly nurses, reported instances that ranged from refusal to accept treatment from an Arab nurse, through verbal abuse, to the use of physical violence against them. At the meso-level, interviewees, mostly physicians, reported experiences of institutional discrimination. At the macro-level, one physician reported policy-related discrimination in the context of the immigration of Russian Jewish physicians to Israel. CONCLUSIONS: We recommend combining the intergroup contact approach with the social process theory of racism to examine minorities' subjective perceptions, especially in conflictual and violent contexts; conducting broad-based quantitative research in Israeli healthcare organizations, which may have important implications for the specific strategies to be used; and emphasizing the importance of institutional support. By reconstructing race-based experiences of ethnic minority health professionals, health organizations can better manage racial situations and reduce their frequency.

Neutrality in medicine and health professionals from ethnic minority groups: The case of Arab health professionals in Israel.

The ethos of neutrality dominates biomedicine. It has, however, been criticized for leading to a disregard for diversity in medicine. In this article we employ the 'inclusion and difference' approach to gain an understanding of why the ethos of neutrality, on the one hand, and tensions associated with race/ethnicity, on the other, are relevant to the work of ethnic minority health professionals. We sought to explore tensions associated with neutrality in medicine from the point of view of ethnic minority professionals who work in a context of political conflict. We conducted 33 in-depth interviews with Arab health professionals - physicians, nurses and pharmacists - working in Israeli health organizations. The Arab health professionals perceive medical knowledge as being politically neutral; and medical practice as being impartial, universal and humanitarian. They regard the healthcare sector as a relatively egalitarian workplace, into which they can integrate and gain promotion. Nevertheless, the interviewees experienced various instances of treatment refusal, discrimination and racism. In line with the ethos of neutrality, the Israeli medical code of ethics does not relate specifically to Arab professionals and takes their inclusion and integration in healthcare organizations for granted. The ethos of neutrality in medicine underlies the ambivalence inherent in the approach of 'inclusion and difference'. While perceptions of neutrality, alongside values such as equality, cultural competency, impartiality and humanitarian healthcare, do indeed promote the inclusion of minority professionals in health organizations, these same perceptions mask the need to address political events that impinge on the medical milieu and may present an obstacle to designing specific policies to deal with such events.

Work experiences of ethnic minority nurses: a qualitative study.

BACKGROUND: Recruitment and retention of a diverse ethnic workforce in healthcare settings contribute to the provision of culturally competent care in multicultural contexts. Nevertheless, the work experiences of ethnic minority nurses, which impact the attractiveness of the occupation, job burnout and turnover intentions, are not well understood. The present exploratory research seeks to examine the work experiences of ethnic minority Arab nurses in Israeli public hospitals. Israel is an interesting case study as the number of Arab nurses operating in the Israeli workforce has risen significantly over recent decades; many of them work in mixed Jewish-Arab environments, which are affected by the Israeli-Palestinian conflict. METHODS: In-depth interviews with 13 Arab nurses working in Israeli public hospitals. RESULTS: The interviewed Arab nurses mentioned various benefits associated with the nursing profession, as well as various difficulties they encounter during their daily work, which are specific to them as ethnic minority nurses. They describe nursing as an occupation that offers numerous employment opportunities, job security, professional development and promotion. They believe that their work as a nurse contributes to the health of the Arab family and community and enhances culturally competent healthcare in Israeli hospitals. However, Arab nurses also feel they are stereotyped; they face disapproving looks, refusal to be treated by them, and incidences of hostility toward them. The dual experience of both integration and rejection shapes their coping strategies. CONCLUSIONS: The findings can inform a more systematic study that could potentially examine both nurses' and patients' conceptions of multicultural care. Action should be taken to ensure optimal working conditions for Arab healthcare professionals. Institutional policies and actions are needed to cope with their unique difficulties, such as the appointment of a functionary responsible for minimizing and coping with stereotypical and hostile attitudes.

Communication and integration: a qualitative analysis of perspectives among Middle Eastern oncology healthcare professionals on the integration of complementary medicine in supportive cancer care.

CONTEXT AND OBJECTIVES: The use of complementary and traditional medicine (CTM ) in Middle Eastern countries is widespread, including among patients with cancer. Perspectives of oncology healthcare professionals (HCPs) in this region regarding the integration of CTM within conventional supportive cancer care were explored. METHODS: An 11-item questionnaire with an open-ended question asking respondents to comment about the integration of CTM within supportive cancer care was sent to Middle Eastern oncology HCPs, using snowball sampling methodology. The narratives provided were examined using thematic analysis. RESULTS: A total of 339 oncology HCPs completed and returned the study tool (80.3 % response rate ), of which 178 from 15 Middle Eastern countries responded to the open-ended question. The majority of respondents are in favor of the integration of CTM within supportive cancer care, though ideas on how this should be implemented varied. Thematic analysis identified multifactorial barriers to integration, which focused on HCPs' perspectives (e.g., a lack of knowledge and training; a skeptical approach to CTM), attitudes of patients and caregivers (e.g., unrealistic expectations regarding the outcomes of CTM treatments) and HCP-patient communication. In order to overcome these barriers, respondents suggested education and training programs for oncology HCPs which would focus on improving patients' quality-of-life-related outcomes. CONCLUSIONS: Middle Eastern oncology HCPs support the integration of CTM within supportive cancer care, while recognizing the need for education and training in this field. A better understanding of CTM would provide the knowledge and skills which would promote a non-judgmental, evidence-based approach, fostering better communication with patients.

"It's Every Family's Dream": Choice of a Medical Career Among the Arab Minority in Israel.

Application to medical studies and the choice of medicine as a career are influenced by many factors, some internal (academic ability, intellectual curiosity, interests) and some external (parental pressure, peer pressure, teacher and school expectations). Ethnicity plays a role in motivational orientation and belonging to an ethnic minority group may influence both internal and external motives and priorities in choosing medicine as a career. In this article, we present a qualitative study of the motives that impel Arab physicians in Israel to choose a medical career. As a theoretical framework, we apply self-determination theory (SDT) (Ryan and Deci in Am Psychol 55:68-78, 2000), consisting of three principal categories situated along a continuum: Amotivation, extrinsic motivation and intrinsic motivation. We show that extrinsic motivation is dominant among Arab physicians in Israel, demonstrating specifically the unique political context and cultural characteristics of Arab society in Israel. These findings, and the attention to the unique motivations of people from different ethnic minority groups who choose medical career, may increase the number of physicians from minority groups, a step known to decrease health gaps in multi-cultural contexts.

Increasing gender and ethnic diversity in the health care workforce: The case of Arab male nurses in Israel.

BACKGROUND: Despite recent attempts at increasing health care workforce diversity, a measure that was found to reduce health disparities, men remain a minority in the traditionally female occupation of nursing. One exception to this observation is the Arab ethnic minority in Israel that includes numerous male nurses. OBJECTIVE: Determining the percentage of Arab male nurses in the Israeli health care system and understanding how they perceive and negotiate their masculinity. METHODOLOGY: We used both quantitative and qualitative methodologies. Quantitative statistics were obtained from the 2011 to 2013 Labor Force Survey conducted by the Israel Central Bureau of Statistics and qualitative data derived from 13 semi-structured, in-depth interviews with Arab nurses working in Israeli public hospitals, conducted during 2014. FINDINGS: Nursing constitutes a prominent employment path for Arab men in Israel and is more prominent as an employment path for Arab men than that for Jewish men. A total of 38.6% of all Arab nurses were men and only 7.5% of Jews and others. Quantitative data thus reveal that men do not constitute a minority among Arab nurses. Similarly, qualitative findings show that Arab male nurses do not manifest marginal masculinity but rather demonstrate many elements of hegemonic masculinity. Arab male nurses distinguish themselves and differentiate their roles from those of female nurses, expressing their motives for choosing the nursing profession in terms of hegemonic gender roles for men in Arab society in Israel. CONCLUSIONS: Although nursing is a traditionally female occupation, it offers an opportunity for Arab men to demonstrate their masculinity. Arab male nurses choose nursing as a means rather than an end, however, meaning that many of them might not remain in the profession. This observation is significant because of the importance of retaining men from ethnic minorities in nursing, especially in multicultural societies.

Living outliers: experiences, insights and narratives of exceptional survivors of incurable cancer.

AIM: Unexplained prolonged survival given a diagnosis of incurable advanced cancer is a puzzling phenomenon that recently has attracted more scientific research. The purpose of this study was to add to the understanding of how exceptional patients perceive and explain their unusual experience. METHODS: We recruited patients for interviews from a population registry, patients with advanced lung or pancreatic malignancy who experienced exceptional survival. RESULTS & CONCLUSION: In total, 15 participants were interviewed. The main recurrent themes in most of the interviews were patient-doctor communication, family support and the patient's proactive attitude. In this study, patients attribute their longevity to relationships with their doctor and their family - not the type of treatment they received. Further research on this phenomenon is needed.

Intersectionality and underrepresentation among health care workforce: the case of Arab physicians in Israel.

BACKGROUND: An intersectionality approach that addresses the non-additive influences of social categories and power structures, such as gender and ethnicity, is used as a research paradigm to further understanding the complexity of health inequities. While most researchers adopt an intersectionality approach to study patients' health status, in this article we exemplify its usefulness and importance for studying underrepresentation in the health care workforce. Our research objectives were to examine gender patterns of underrepresentation in the medical profession among the Arab minority in Israel. METHODS: We used both quantitative and qualitative methodologies. The quantitative data were obtained from the 2011 Labor Force Survey conducted by the Israeli Central Bureau of Statistics, which encompassed some 24,000 households. The qualitative data were obtained through ten semi-structured, in-depth interviews conducted during 2013 with Arab physicians and with six nurses working in Israeli hospitals. RESULTS: The findings indicate that with respect to physicians, the Arab minority in Israel is underrepresented in the medical field, and that this is due to Arab women's underrepresentation. Arab women's employment and educational patterns impact their underrepresentation in medicine. Women are expected to enter traditional gender roles and conform to patriarchal and collectivist values, which makes it difficult for them to study medicine. CONCLUSIONS: Using an intersectionality approach to study underrepresentation in medicine provides a foundation for action aimed at improving public health and reducing health disparities.