Book Review
Minority Health in America: Findings and policy implications from the Commonwealth Fund Minority Health Survey
N Engl J Med 2000; 343:669August 31, 2000
- Article
Minority Health in America: Findings and policy implications from the Commonwealth Fund Minority Health Survey
Edited by Carol J. Hogue, Martha A. Hargraves, and Karen Scott Collins. 344 pp. Baltimore, Johns Hopkins University Press, 2000. $22.50 (paper); $49.95 (cloth). ISBN: 0-8018-6299-X (paper); 0-8018-6298-1 (cloth).Attempts to provide an intellectual framework for an understanding of minority health are challenged by the vast socioeconomic complexities that contribute to variations in health status. The Commonwealth Fund's survey provides that framework in a tightly woven series of relatively focused analyses. The authors have produced a useful reference manual for all members of the health care professions and a valuable tool for those who are making and implementing health care policies.
The information in this book supports many widely held generalizations concerning the large disparities in access to and use of health care between minority and majority populations. Differences in socioeconomic status contribute strongly to the differences in access and use in our health care systems, but they are exacerbated by the present and past effects of discrimination against various minority groups.
This report reaffirms the findings that Hispanic and black Americans are more likely than non-Hispanic whites to receive poor health care and this increased risk is due in large measure to the fact that fewer options are available to these populations. This lack of options has been aggravated by the increasing growth of managed care. The impact of health maintenance organizations appears to be mixed, with some members of society having profited from the focus of many health maintenance organizations on preventive care, even though minorities' access to care has decreased in many instances.
The analyses of the results of the Commonwealth Fund's survey have been organized into four primary components: a description of health care access and use by minority populations, a discussion of barriers to access and use, a determination of the link between health care delivery and the health of the various populations, and a proposal to improve the health care provided to these groups.
One of the valuable aspects of these analyses is the cross-cultural comparison of the survey data and the efforts to evaluate hypotheses that attempt to explain the anomalous patterns of health care use among the various groups. An example of this is the examination of the negative effects of past and ongoing discrimination on minority populations. However, the authors conclude that the results do not appear to be as grave as one might expect, and they suggest that minority cultures have developed coping mechanisms that could improve the health of the total population. This aspect of the overall effort does, however, point to one of the deficiencies of the initial survey and, as a consequence, of the analyses. The survey did not address the importance of alternative medicine in the health care of minority populations; this information could have provided additional insights to an understanding of the general landscape of minority health.
These analyses succeed in organizing a large body of data into a coherent presentation. Nevertheless, some conclusions do not appear to be derived strictly from the data as presented and the survey results. An example of this is the conclusion that “more minorities than white respondents indicated that they did not receive the health care that they felt they needed.” Although this difference is reflected in the data comparing Hispanics with non-Hispanic whites, it did not appear to be reflected in the comparisons of blacks with whites. However, these problems are relatively minor and do not detract from the value of this book and the effort to present a complete synthesis of the numerous factors that affect minority health in America.
J. Tyson Tildon, Ph.D.
University of Maryland School of Medicine, Baltimore, MD 21212- Citing Articles (1)
Citing Articles
1
Cirila Estela Vasquez Guzman, Gilbert Mireles, Neal Christopherson, Michelle Janning. 2010. Class and race health disparities and health information seeking behaviors: The role of social capital. , 127-149.
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