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This chapter provides an introduction to the volume along with a very brief review of literature on underserved and socially disadvantaged groups and health and health care differentials.

This chapter uses the approach of a literature review.

The chapter argues for the importance of greater examination of underserved and socially disadvantaged groups in consideration of health and health care differentials.

The author reviews the issues of underserved and socially disadvantaged groups in consideration of health and health care differentials and previews this book.

Social and economic disparities between racial/ethnic groups are a feature of the American context into which immigrants are incorporated and a key determinant of population health. We ask whether racial/ethnic disparities in diabetes vary by nativity and whether native-immigrant disparities in diabetes vary by race and over time in the United States. Using the 2000–2015 National Health Interview Survey, we estimate logistic regressions to examine the interaction of race/ethnicity, nativity, and duration in the US in shaping diabetes patterns. Relative to their native-born co-ethnics, foreign-born Asian adults experience a significant diabetes disadvantage, while foreign-born Hispanic, Black, and White adults experience a significant advantage. Adjusting for obesity, education, and other covariates eliminates the foreign-born advantage for Black and White adults, but it persists for Hispanic adults. The same adjustment accentuates the disadvantage for foreign-born Asian adults. For Black and Hispanic adults, the protective foreign-born effect erodes as duration in the US increases. For foreign-born Asian adults, the immigrant disadvantage appears to grow with duration in the US. Relative to native-born White adults, all non-white groups regardless of nativity see a diabetes disadvantage because the racial/ethnic disadvantage either countervails a foreign-born advantage or amplifies a foreign-born disadvantage. Racial/ethnic differentials in diabetes are considerable and are influenced by each group’s nativity composition. Obesity and (for the foreign-born) time in the US influence these disparities, but do not explain them. These findings underscore the importance of unmeasured, systemic determinants of health in America’s race-conscious society.

This paper seeks to establish relationships between women's reproductive health service use, assessed longitudinally and by facility type, with service quality perceptions related to public or private health facilities.

The study was mainly secondary and quantitative in nature. It included analysing data collected by the International Institute for Population Sciences (IIPS) and The Johns Hopkins University (JHU) as a follow‐up study to the 1998‐1999 National Family Health Survey (NFHS‐2). The follow‐up survey was carried out in Tamil Nadu, Maharashtra, Bihar and Jharkhand. In 2002‐2003, these four states were selected to capture socio‐economic and demographic variations. Analysis includes composite indices and logistic regression analysis. A scale was constructed to measure utilisation levels. Dimensions include: service proximity, doctor availability, waiting time, medicines, facility cleanliness, dignified treatment, privacy, service affordability and treatment effectiveness.

Findings indicate that doctor availability, waiting time, cleanliness, privacy and affordability at private health facilities enhance the probability that a health facility will be used for any reproductive health purpose. At the combined states level, medicine availability and treatment effectiveness at public health facilities enhances service use.

The major limitation is that the study includes only selected Indian states.

The findings may enhance Indian service‐quality policy.

The paper's main contribution is that seemingly for the first time in India, healthcare service use has been measured longitudinally and then explained through service quality variables by comparing public and private health facilities.

This chapter provides an introduction to volume 27, Research in the Sociology of Health Care, Social Sources of Disparities in Health and Health Care and Linkages to Policy, Population Concerns and Providers of Care. It introduces the topic of social sources of disparities in health and health care and discusses the approach to this issue in the United States based on federal government efforts as well as based on research by medical sociologists, political scientists, epidemiologists and researchers in health care more generally, such as those in public health. This chapter serves as an introduction to the volume also. As such, the chapter explains the organization of the volume and briefly comments on each of the chapters included in the volume.

While Americans have often believed that the United States has the best health care system in the world and that, as one of the wealthiest nations, we therefore must have the best health care available to our citizens, researchers in medical sociology, public health and health services research have emphasized for decades that America tolerates extremes of wealth and poverty much greater than in many European countries. This toleration of extremes extends to the approach to the delivery of social and health services, as well as to consumer goods. Over 40 million Americans do not have health insurance and thus have limited access to expensive health care services (Morone & Jacobs, 2005b). Even more may have very poor health coverage, so that if a serious illness were to occur, the person would have a very hard time finding care and paying for that care. Even if people have coverage for major health care problems, many people do not have insurance that covers areas of health care such as vision care, dental care and audiology services. While these are not life threatening health care concerns, they are health care concerns that impact quality of life and even ability to achieve. A child who cannot see well has trouble succeeding in school. A person in pain from tooth problems has trouble concentrating on tasks, and poor oral health is one contributor to nutrition concerns among the elderly. Lack of access to hearing aids increases the social isolation of the elderly, but these services are not covered by Medicare, the federal program that does provide access to health care services for most of the elderly in the United States.

The purpose of this paper is to explore the paradoxical resistance of parent and private school food vendors to the paternalistic nature of school food policies. It develops the hypothesis that resistance, on the basis of them being “paternalistic”, is associated with implementers experiencing ethical breaches that contribute to frustration and low acceptability. This may be leading to accusations of paternalism and non-cooperation.

It takes a deontological perspective and uses Upshur’s (2002) public health ethics framework to explore the potential that parents involved in school fundraising and private school food vendors are experiencing ethical breaches associated with implementation of school food and beverage sales policies in the Canadian context.

Upshur’s (2002) harm principle highlighted how some implementers feel a loss of freedom in how they choose to function, which is perceived to be resulting in lost profits. Parents involved in fundraising activities may experience feelings of coercion. Opting out of fundraising may result in their children’s schools having fewer resources. Smaller private vendors are coerced through economic incentives while being bound by what products are available in the marketplace and the associated costs of items that comply with nutrition standards. Discussion around the reciprocity principle revealed implementers feel they are not adequately supported to implement. Transparency has been questioned where stakeholders report their perspectives are often not equally considered in decision making.

This is the first paper to explore the often cited resistance to the paternalistic nature of school food and beverage environment policies as an implementation barrier. Using a deontological ethical perspective offers an original way to discuss school food policies. This work offers potential leverage points at which policy-makers and practitioners may intervene to improve acceptability and contribute to more effective, consistent implementation.

To shed light on how gender norms are reproduced in medical training and practice through an exploration of representations of the problem of “work–life balance.” Women physicians and women physician-researchers (WPs/WPRs) in Canada and in the United States experience social and health inequities when compared to their men colleagues. Despite current medical school acceptance parity, upon entering the medical workforce, women work harder than men to succeed within the historically male-dominated structures and value system of the medical profession.

We performed a critical discourse analysis of articles retrieved from academic databases and leading Anglo-American journals that discussed “work–life balance,” to investigate how the discourse contributed to, or challenged, the reproduction of gender norms in medicine.

While the medical literature acknowledges that the social and health inequities experienced by WP/WPR result from discriminatory norms and practices, it neglects to challenge built-in gendered inequities in benchmarks for success in the profession. Instead, proposed solutions require that WP/WPR themselves learn to cope and make better lifestyle choices, including downloading domestic responsibilities on socially disadvantaged – racialized and poor – women. Authors’ gender appears to make no difference.

Our search was limited to the Anglo-American literature, often retrieved articles inaccessible via our university library, excluded informal venues (e.g., blogs), and did not include cases of same-sex couples or interviews of WP/WPR. All these may have challenged components of our argument by revealing more nuanced debates, occurring under different political, cultural, and economic contexts.

While individual choices of WP/WPR are important to the protagonists, to successfully address the very real problem of work–life balance experienced by WP/WPR, patriarchal norms should be challenged, failure to comply with these norms should be rejected as explanations for work–life balance challenges, and norms themselves should become the focus of analysis and intervention.

The medical language used by physicians of both genders normalizes gendered inequities, favoring the success of medical men over women, and reproducing the professional and personal disadvantages experienced by the latter, further burdening socially disadvantaged women.

A random sample of insured adults (n=134) tests the effects of insurance on respondents’ emotional and physical health. Results showed that being married and being widowed improved physical health while having no religious identification heralded less emotional distress. Preferred Provider Organization services satisfaction was related to better physical health. Respondents in households that restructured themselves to acquire or maintain health coverage also reported more emotional distress than those in households without such problems. Implications of our results regarding improving insurance programs and the effects of marital status and the lack of religious affiliation upon adults’ health are discussed.