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1.
Ethn Dis ; 30(3): 381-388, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32742140

RESUMEN

Structural racism is a multilevel system of ideologies, institutions, and processes that have created and reified racial/ethnic inequities. As a system, it works in concert across institutions to propagate racial injustice. Thus, efforts to address structural racism and its implications for health inequity require transdisciplinary collaboration. In this article, we begin by describing the process through which we have leveraged our discipline-specific training -- spanning education, epidemiology, social work, sociology, and urban planning -- to co-construct a transdisciplinary analysis of the determinants of racial health inequity. Specifically, we introduce the underlying theories that guide our framework development and demonstrate the application of our integrated framework through a case example. We conclude with potential research and policy implications.

2.
J Urban Health ; 2020 Aug 03.
Artículo en Inglés | MEDLINE | ID: mdl-32748284

RESUMEN

Historic disinvestment in transportation infrastructure is directly related to adverse social conditions underlying health disparities in low-income communities of color. Complete Streets policies offer a strategy to address inequities and subsequent public health outcomes. This case study examines the potential for an equity-focused policy process to address systemic barriers and identify potential measures to track progress toward equity outcomes. Critical race theory provided the analytical framework to examine grant reports, task force notes, community workshop/outreach activities, digital stories, and stakeholder interviews. Analysis showed that transportation inequities are entrenched in historically rooted disparities that are perpetuated in ongoing decision-making processes. Intentional efforts to incorporate equity into discussions with community members and representatives contributed to explicit equity language being included in the final policy. The potential to achieve equity outcomes will depend upon policy implementation. Concrete strategies to engage community members and focus city decision-making practices on marginalized and disenfranchised communities are identified.

5.
Artículo en Inglés | MEDLINE | ID: mdl-32588469

RESUMEN

The current study expands on ethnic-racial socialization (ERS) among Latinx families to include sociopolitical discussions as a way to better understand how these practices relate to adolescents' developmental outcomes, including their ethnic-racial identity (ERI) and their sociopolitical development. More specifically, we examined whether there were direct links between parental ERS practices and sociopolitical discussions at home and adolescents' emergent participatory citizenship via their ERI processes (i.e., exploration and resolution). These questions were examined using path analyses with 267 self-identified Latinx early adolescents (Mage  = 11.88, SD = 1.22; girls = 54.3%). Results revealed direct associations between sociopolitical discussions and cultural socialization at home with civic accountability. Thus, youth whose parents had engaged in more discussions with them about current political issues and who taught them about their ethnic heritage and history endorsed a greater sense of collective responsibility for helping community members in need. Additionally, preparation for bias and sociopolitical discussions at home were each uniquely associated with more ERI exploration, and each was also indirectly associated with expectations for future community involvement via youths' ERI exploration. Our findings come at a critical juncture in time, providing insight into ways we can support the positive ERI development and build the civic capacity of Latinx adolescents.

6.
Ann Intern Med ; 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32559145

RESUMEN

Racial minorities in the United States have reported experiencing widespread racism throughout all aspects of life, from housing to education to employment. Existing research has examined the role of racism, discrimination, and violence in one's interaction with the health care system and their association with poorer mental and physical health. Systemic racism that underlies the fabric of society often manifests itself in prominent institutions, such as law enforcement agencies, regardless of individual intent. Overt and covert racist laws and policies, personal implicit biases, and other factors result in Black individuals and other people of color being the subject of law enforcement violence and criminal justice system interactions at disproportionately high rates. The demonstrated association between discriminatory law enforcement practices and violence and personal and community health necessitates treating these issues as public health issues worthy of a public policy intervention. Addressing some of the sources of institutional racism and harm through transparency and accountability measures is the first of many steps required to begin correcting historical racial injustices.

7.
Health Policy Plan ; 35(6): 718-734, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32538436

RESUMEN

Conditional cash transfer (CCT) is a compelling policy alternative for reducing poverty and improving health, and its effectiveness is promising. CCT programmes have been widely deployed across geographical, economic and political contexts, but not without contestation. Critics argue that CCTs may result in infringements on freedom and dignity, gender discrimination and disempowerment and power imbalances between programme providers and beneficiaries. In this analysis, we aim to identify the ethical concepts applicable to CCTs and to contextualize these by mapping the tensions of the debate, allowing us to understand the separate contributions as parts of a larger whole. We searched a range of databases for records on public health CCT. Strategies were last run in January 2017. We included 31 dialectical articles deliberating the ethics of CCTs and applied a meta-ethnographic approach. We identified 22 distinct ethical concepts. By analysing and mapping the tensions in the discourse, the following four strands of debate emerged: (1) responsibility for poverty and health: personal vs public duty, (2) power balance: autonomy vs paternalism, (3) social justice: empowerment vs oppression and (4) marketization of human behaviour and health: 'fair trade' vs moral corruption. The debate shed light on the ethical ideals, principles and doctrines underpinning CCT. These were consistent with a market-oriented liberal welfare regime ideal: privatization of public responsibilities; a selective rather than a universal approach; empowerment by individual entrepreneurship; marketization of health with a conception of human beings as utility maximizing creatures; and limited acknowledgement of the role of structural injustices in poverty and health. Identification of key tensions in the public health ethics debate may expose underpinning ideological logics of health and social programmes that may be at odds with public values and contemporary political priorities. Decisions about CCTs should therefore not be considered a technical exercise, but a context-dependent process requiring transparent, informed and deliberative decision-making.

8.
Environ Sci Pollut Res Int ; 27(20): 25675-25688, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32356066

RESUMEN

In China, national environmental regulations have customarily found themselves to be inhibited by local government's ostensible obedience. This research investigates how local officials, motivated and constrained by political competition, dedicate themselves to the environment and interact with each other regarding environmental regulation implementation and actual regulatory performance. Based on a spatial econometric model using data from 30 provinces from 2000 to 2016, the empirical results document the spatial dependence of environmental regulatory enforcement among provinces of similar economic levels and reveal that since 2007, there has been a performance-oriented peer competition for SO2 emission reduction but no similar competition for CO2 emission reduction. The findings indicate a transformation of the regulatory behavior of local governments from a race-to-the-bottom to strategic imitation and provide institutional insight into the spatial attributes of environmental enforcement under the impact of the political regime in China.


Asunto(s)
Conducta Imitativa , Gobierno Local , China , Análisis Espacial
9.
Curr Opin Psychol ; 35: 86-91, 2020 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-32388448

RESUMEN

This paper reviews recent literature on racially marginalized youth's sociopolitical action in the United States by highlighting three trends regarding the nature of, the factors shaping, and the implications of youth action. First, we trace the nature of racially marginalized youth's individual/interpersonal action, collective action, and digital action. Then, we describe the sociopolitical, sociocultural, and contextual domains that shape their sociopolitical action. Importantly, we examine the significant implications for the mental health of youth, particularly as these actions have both positive and negative results. Finally, we highlight recent advances in the measurement of racially marginalized youth's sociopolitical action while imploring the field for more holistic and intersectional approaches to both measurement and theory.

10.
Artículo en Inglés | MEDLINE | ID: mdl-32464657

RESUMEN

COVID-19 is not spreading over a level playing field; structural racism is embedded within the fabric of American culture, infrastructure investments, and public policy, and fundamentally drives inequities. The same racism that has driven the systematic dismantling of the American social safety-net has also created the policy recipe for American structural vulnerability to the impacts of this and other pandemics. The Bronx provides an important case study for investigating the historical roots of structural inequities showcased by this pandemic; current lived experiences of Bronx residents are rooted in the racialized dismantling of New York City's public infrastructure and systematic disinvestment. The story of the Bronx is repeating itself, only this time with a novel virus. In order to address the root causes of inequities in cases and deaths due to COVID-19, we need to focus not just on restarting the economy, but on reimagining the economy, divesting of systems rooted in racism and the devaluation of Black and Brown lives.

11.
Artículo en Inglés | MEDLINE | ID: mdl-32378929

RESUMEN

OBJECTIVES: The present mixed-methods study examines allyship as a politicized collective identity and its associations with ethnic identity, personality traits, and sociopolitical engagement among IPPOC. METHOD: Participants in two samples in 2016 (n = 256) and 2017 (n = 305) completed measures of ally identity, ethnic identity, personality traits, and political engagement. RESULTS: Results indicate two factors of ally identity (ally beliefs and behaviors). Quantitative findings suggest a) ethnic identity exploration predicts ally beliefs and behaviors, b) extraversion predicts ally behaviors, while agreeableness and neuroticism predicts ally beliefs, and c) ally beliefs and behaviors predict awareness, while ethnic identity exploration predicts involvement in political action, even when personality traits are considered. Thematic analysis findings suggest IPPOC allies are politically engaged through social media, individual actions, protests, and civic engagement. CONCLUSIONS: Ethnic and ally identity provide different paths to sociopolitical awareness and involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

12.
J Med Humanit ; 2020 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-32378066

RESUMEN

A romance with the concept of community has long characterized activist healthcare movements and has more recently been taken up by academic medical centers (AMCs) as a sign of virtuous civic engagement. During the late 1960s, the word community, as deployed by administrators at prestigious AMCs, became increasingly politicized, commodified and racialized. Here, we analyze how the concept of community was initially framed in the 1963 Community Mental Health Centers Act, the first legislation to establish community mental health centers in America. We then examine the Health Policy Advisory Center's analysis of the proposed Washington Heights Community Mental Health Center to be run by Columbia University's College of Physicians and Surgeons, an institution that had historically neglected residents' health needs. Community pushback against Columbia's plan to build a multi-block center, amplified by medical students and residents critical of the professionalized community mental health movement, escalated in the late 1960s, leading the city's planning board to reject Columbia and approve a community council's plan for preventive and rehabilitative local services. These conflicting overtones of "community" still inform understandings of the word in medicine today; thus, a critical historical analysis of "community" is warranted.

13.
PLoS One ; 15(3): e0230302, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32226045

RESUMEN

In recent years, the reach and influence of far-right ideologies have been extended through online communities with devastating effects in the real world. In this research, we examine how far-right online communities can be empowered by socio-political events that are significant to them. Using over 14 years of data extracted from an Australian national sub-forum of a global online white supremacist community, we investigate whether the group cohesion of the community is affected by local race riots. Our analysis shows that the online community, not only became more cohesive after the riots, but was also reinvigorated by highly active new members who joined during the week of the riots or soon after. These changes were maintained over the longer-term, highlighting pervasive ramifications of the local socio-political context for this white supremacist community. Pre-registered analyses of data extracted from other white supremacist online communities (in South Africa and the United Kingdom) show similar effects on some of the indicators of group cohesion, but of reduced magnitude, and not as enduring as the effects found in the context of the Australian far-right online community.


Asunto(s)
Conducta de Masa , Política , Racismo/psicología , Medios de Comunicación Sociales/estadística & datos numéricos , Australia , Procesos de Grupo , Humanos
15.
J Gerontol Soc Work ; 63(4): 354-370, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32338585

RESUMEN

Older adults from racial and ethnic minority groups are likely to face disparities in their health as well as care experiences in long-term care facilities such as nursing homes and assisted living facilities just as they do in the United States as a whole. Policymakers in the United States face concerns around long-term services and supports to address the growing demands of a rapidly aging population through public and private sector initiatives. It is important to create inclusive and culturally responsive environments to meet the needs of diverse groups of older adults. In spite of federal policy that supports minority health and protects the well-being of long-term care facility residents, racial and ethnic disparities persist in long-term care facilities. This manuscript describes supports and gaps in the current United States' federal policy to reduce racial and ethnic disparities in long-term care facilities. Implications for social workers are discussed and recommendations include efforts to revise portions of the Patient Protection and Affordable Care Act of 2010, amending regulations regarding long-term care facilities' training and oversight, and tailoring the Long-Term Care Ombudsman Program's data collection, analysis, and reporting requirements to include racial and ethnic demographic data.

16.
Soc Sci Res ; 87: 102412, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32279863

RESUMEN

We draw on institutional theory to examine the connection between state-level regulation of equal employment and political cultures and race/ethnic minority presence in managerial positions in private U.S. workplaces. Analyses examining managerial diversity at upper- and lower-levels show that expanded state EEO posting requirements are associated with a greater presence of nonwhite managers at both levels, while weak state EEO compliance penalties are related to fewer nonwhite lower-level managers. State-level EEO recordkeeping requirements that exceed federal law are unassociated with nonwhite managerial presence at either lower- or upper-levels. Early adoption of fair employment practices agencies (FEPA) is positively associated with only lower-level managerial diversity, whereas progressive state government ideology is negatively related to top managerial diversity. Our findings highlight the complexity of state government regulation, oversight, and culture in shaping managerial racial/ethnic diversity. We discuss the implications of our results for future research and policy aimed at diversifying private workplaces.

17.
J Glob Health ; 10(1): 010807, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257170

RESUMEN

Background: The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants' utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods: Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results: Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants' utilization of essential public health services. Conclusions: The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud , Seguro de Salud/estadística & datos numéricos , Migrantes , Adulto , Anciano , Grupo de Ascendencia Continental Asiática , China/epidemiología , Empleo , Femenino , Humanos , Renta , Masculino , Persona de Mediana Edad , Características de la Residencia , Población Rural , Apoyo Social , Población Urbana
18.
J Health Polit Policy Law ; 45(4): 547-566, 2020 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-32186349

RESUMEN

The political processes surrounding the Affordable Care Act (ACA) offer valuable lessons about race and politics in the United States. In particular, the ACA underscores a critical tension between politics and policy in a racialized polity: even when policies are intended to target and address racial disparities, politics can undermine the steps necessary to do so. Close scrutiny of the ACA during its first decade reveals how race intersects with politics to render public policy less equitable and more vulnerable to erosion. Ultimately, this analysis points to the ways that racialized political processes are formidable barriers to equitable material outcomes. By examining such processes and making them visible, this article elucidates the possibilities, limits, and contours of public policy as a mechanism for achieving racial justice.

19.
Artículo en Inglés | MEDLINE | ID: mdl-32193757

RESUMEN

Although the literature is growing regarding large-scale, system-wide implementation programs, the broader political and social contexts, including race and ethnicity, are frequently ignored. Using the Policy Ecology of Implementation framework (Raghavan et al., Implement Sci 3:26, 2008), Minnesota's CEMIG is examined to investigate the role of social and political contexts in the implementation process and the barriers they create. Data from 22 interview transcripts from DHS administrators, agency grant managers, university educators, advocacy group representatives, and mental health board members, along with more than 1000 grant documents were qualitatively analyzed using content analysis to reveal three themes concerning how the participants experienced program implementation: invisibility, isolation, and inequity. Findings demonstrate the participants perceived that the grant program perpetuated inequities by neglecting to promote the program, advocate for clinicians of color, and coordinate isolated policy ecology systems. Strategies for future large-scale, system-wide mental health program implementation are provided.

20.
J Am Med Inform Assoc ; 27(5): 717-725, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32150259

RESUMEN

OBJECTIVE: This study aimed to explore the association between demographic variables, such as race and gender, and patient consent policy preferences for health information exchange as well as self-report by VHA enrollees of information continuity between Veterans Health Administration (VHA) and community non-VHA heath care providers. MATERIALS AND METHODS: Data were collected between March 25, 2016 and August 22, 2016 in an online survey of 19 567 veterans. Three questions from the 2016 Commonwealth Fund International Health Policy Survey, which addressed care continuity, were included. The survey also included questions about consent policy preference regarding opt-out, opt-in, and "break the glass" consent policies. RESULTS: VHA enrollees had comparable proportions of unnecessary laboratory testing and conflicting information from providers when compared with the United States sample in the Commonwealth Survey. However, they endorsed medical record information being unavailable between organizations more highly. Demographic variables were associated with gaps in care continuity as well as consent policy preferences, with 56.8% of Whites preferring an opt-out policy as compared with 40.3% of Blacks, 44.9% of Hispanic Latinos, 48.3% of Asian/Pacific Islanders, and 38.3% of Native Americans (P < .001). DISCUSSION: Observed large differences by race and ethnicity in privacy preferences for electronic health information exchange should inform implementation of these programs to ensure cultural sensitivity. Veterans experienced care continuity comparable to a general United States sample, except for less effective exchange of health records between heath care organizations. VHA followed an opt-in consent policy at the time of this survey which may underlie this gap.

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