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This chapter provides both an introduction to the volume and a review of literature on health disparities and social determinants.

Literature Review.

The chapter argues for the importance of greater consideration of social determinants of health disparities. This includes a consideration of race/ethnicity and socioeconomic status factors, geographic and place factors, and disparities especially linked to particular diseases.

Reviews the topic of health disparities and social determinants and previews this book.

This chapter provides an introduction to Volume 28, The Impact of Demographics on Health and Health Care: Race, Ethnicity and Other Social Factors. This chapter introduces the topic of demographic factors leading to differences and disparities in health and health care by reviewing more recent literature within sociology addressing social factors leading to differences in health and health. This chapter also serves as an introduction to the volume. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.

The purpose of this chapter is to examine geographic variations in utilization and need for mental health services. Data for this study were obtained from the 2002 National Survey of American Families. The total sample size was 23,327 adults of aged 18 years and older. Both logistic and linear regression were used to test the possibility of geographical variations. Disparities were found among the 13 U.S. states examined in this study. Results also showed that the percentage of African Americans, state mental health budgets, and mean length of stay in psychiatric hospitals in the state are important predictors of variations in mental health utilization and need variables. These findings suggest that although individual sociodemographic characteristics are important in examining mental health utilization, state characteristics (especially percentage of African Americans, state mental health laws, and mean length of stay in psychiatric hospitals) are also important predictors of variation in utilization of mental health services.

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

Purpose – To provide an overview of racial/ethnic disparities in human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer on domestic and international levels.

Design/methodology/approach – The literature, cervical cancer prevention guidelines, and Centers for Disease Control and Prevention resources were culled to aggregate information on epidemiology, racial/ethnic disparities, and knowledge and attitudes related to HPV, HPV vaccination, and cervical cancer. Original data supplement information about HPV and HPV vaccination knowledge and attitudes.

Findings – Cervical cancer is among the leading causes of female death worldwide, with substantial racial/ethnic and geographic disparities. In the United States, African American and Hispanic women suffer disproportionate cervical cancer incidence and mortality compared to their Caucasian counterparts. Globally, the greatest burden of cervical cancer (and HPV infection) is shouldered by developing regions. Prevention efforts, such as HPV vaccination and adaption of screening programs to resource-poor areas, have the potential to reduce such disparities, but cultural context is critical to successful development and implementation of such interventions.

Research limitations/implications – As this is not a systematic review, but rather a viewpoint on issues related to disparities in cervical cancer, the literature review is not exhaustive.

Practical implications – This chapter provides a context for examining cervical cancer disparities domestically and globally and serves as a starting point for formulating future research.

Originality – This perspective on HPV and cervical cancer presents disparities both within the United States and worldwide. The chapter supplements the literature with new data that provide additional insight into knowledge and attitudes about these health issues.

The North/South divide is an image frequently used to depict the territorial structure and the economic dynamism of England, and thus to describe the social and economic geography of the country. This image distinguishes a post-industrial North, which still faces economic and social difficulties, from a tertiary, rich and powerful South. It separates a central space (the South) from a periphery (the North). However, the recent economic changes in Britain question the relevance of this image, which is perhaps too simplistic to describe accurately the economic and social geography and the spatial disparities in the country.

Since the Thatcher years, this debate on the North/South divide has been constantly renewed, regardless of the political colour of the majority at Westminster, and the local and regional policy of the government in power has been systematically criticised. On the one hand, this reflects the persistence of territorial and social disparities in the United Kingdom and more specifically in England. On the other hand, this shows that the North/South divide is not just a geoeconomic question, but it also includes identity, societal and geopolitical issues.

Based on a geographical, critical geopolitical and cartographic approach, the aim of this chapter is to question the relevance and the significance of the North/South divide in 2017, after the impact of the 2008 Great Recession, as the United Kingdom is on its way to Brexit and when its unity is being challenged by Scottish nationalism. How can territorial disparities be described, evaluated and measured in England? How are they perceived by citizens and political leaders? This chapter will also study the policies proposed to close this gap and to meet the aspirations of peripheral regions.

Discussion of the 2016 electorate has centered on two poles: results of public opinion and voter surveys that attempt to tease out whether racial, cultural, or economic grievances were the prime drivers behind the Trump vote and analyses that tie major shifts in the political economy to consequential shifts in the voting behavior of certain demographic and geographic groups. Both approaches render invisible a major development since the 1970s that has been transforming the political, social, and economic landscape of wide swaths of people who do not reside in major urban areas or their prosperous suburban rings: the emergence and consolidation of the carceral state. This chapter sketches out some key contours of the carceral state that have been transforming the polity and economy for poor and working-class people, with a particular focus on rural areas and the declining Rust Belt. It is meant as a correction to the stilted portrait of these groups that congealed in the aftermath of the 2016 election, thanks to their pivotal contribution to Trump's victory. This chapter is not an alternative causal explanation that identifies the carceral state as the key factor in the 2016 election. Rather, it is a call to aggressively widen the analytical lens of studies of the carceral state, which have tended to focus on communities of color in urban areas.

To resolve an inherent dilemma in extant research on geographically dispersed research and development (R&D), this study explores interdependencies between formal and informal network structures. Firms that seek to benefit from the decentralization associated with disperse R&D must align it with an informal structure that enhances organizational members’ motivation to share and assimilate their unique knowledge and skills. On the basis of an investigation among 424 US biotechnology firms between 1973 and 2003, this study reveals the moderating effect of the firm’s informal social structure on the effect that geographically dispersed R&D personnel have on the exploration of new technological opportunities. Specifically, the higher the social network density among R&D members, the more likely geographic disparity is to affect exploration; however, this likelihood decreases with an increase in power asymmetries. These results offer insights into the conditions in which the appropriate management of geographically dispersed R&D varies.

Like many countries, the US government-imposed travel restriction policies on selected countries with a high spread of COVID-19 airports to prevent the introduction and spread of COVID-19. Between March 2020 and October 2021, travellers from China, Iran, European Schengen countries, the United Kingdom, Republic of Ireland, Brazil, South Africa and India were restricted with some exceptions. The main objective with this study was to explore the associations between COVID-19 cases and death rates, and the proximity to airports, train stations and time of public transportation. To address the study objective, the authors used the most recent JHU COVID-19 database, the American Community Survey and Airport and Amtrak data from the Bureau of Transportation Statistics from 3,132 US counties. The authors categorised the counties into three groups according to their distance from an airport: less than 25 miles, between 25 and 50 miles and more than 50 miles. The authors then ran negative binomial regressions and Cox regression models, adjusted for population density, population race/ethnicity, travel time, being close to an international airport and the main sources of commutes. The findings showed that the number of airports, the number of train station and the length of commuting time were predictors for the number of deaths and cases in a county. The authors found that counties within 25 miles of an airport had 1.372 times the rate of COVID-19 cases and 1.338 times the rate of COVID-19 deaths compared to the counties that were more than 50 miles from an airport. To prevent the introduction and spread of COVID-19 and any similar pandemic that transfers by air, the timing of the travel restriction policy is a crucial element. Policymakers and officials in transportation and public health should collaborate to promulgate policies and procedures to prevent the spread of airborne infectious diseases.

Racial and ethnic minorities utilize less healthcare than their similarly situated white counterparts in the United States, resulting in speculation that these actions may stem in part from less desire for care. In order to adequately understand the role of care-seeking for racial and ethnic disparities in healthcare, we must fully and systematically consider the complex set of social factors that influence healthcare seeking and use.

Data for this study come from a 2005 national survey of community-dwelling Medicare beneficiaries (N = 2,138). We examine racial and ethnic variation in intentions to seek care, grounding our analyses in the behavioral model of healthcare utilization. Our analysis consists of a series of nested multivariate logistic regression models that follow the sequencing of the behavioral model while including additional social factors.

We find that Latino, Black, and Native American older adults express greater preferences for seeking healthcare compared to whites. Worrying about one’s health, having skepticism toward doctors in general, and living in a small city rather than a Metropolitan Area, but not health need, socioeconomic status, or healthcare system characteristics, explain some of the racial and ethnic variation in care-seeking preferences. Overall, we show that even after comprehensively accounting for factors known to influence disparities in utilization, elderly racial and ethnic minorities express greater desire to seek care than whites.

We suggest that future research examine social factors such as unmeasured wealth differences, cultural frameworks, and role identities in healthcare interactions in order to understand differences in care-seeking and, importantly, the relationship between care-seeking and disparities in utilization.

This study represents a systematic analysis of the ways individual, social, and structural context may account for racial and ethnic differences in seeking medical care. We build on healthcare seeking literature by including more comprehensive measures of social relationships, healthcare and system-level characteristics, and exploring a wide variety of health beliefs and expectations. Further, our study investigates care seeking among multiple understudied racial and ethnic groups. We find that racial and ethnic minorities are more likely to say they would seek healthcare than whites, suggesting that guidelines promoting the elicitation and understanding of patient preferences in the context of the clinical interaction is an important step toward reducing utilization disparities. These findings also underscore the notion that health policy should go further to address the broader social factors relating to care-seeking in the first place.