This issue represents the second time that I have had the honor of serving as the issue editor for Family & Community Health. On both occasions, I have been fascinated by how the issue stretches and blossoms into a collection of manuscripts that are slightly different from, and often superior to, the original plans. We are pleased to present this compilation of articles that deal with health disparity issues and related innovations to use as interventions.
The seemingly intractable problem of health disparities has been comprehensively documented in numerous publications from the landmark 1985 Heckler Report1 to the 2003 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.2 There are discrepancies in the meaning of the term health disparities. However, Carter-Pokras and Baquet3 provide a definition that undergirds the articles in this issue. That is, a health disparity "should be considered a chain of events signified by differences in: 1) environment; 2) access to, utilization of, and quality of care; 3) health status; or 4) a particular health problem that deserves scrutiny."3(p428)
The articles in this issue span several areas of concern including race/ethnicity, income, geography, and age. Barriers to breast cancer control among low-income, rural African American women were qualitatively explored in the article by Avis-Williams et al. Identification of barriers such as negative attitudes toward screening and little knowledge of treatment options can assist researchers in identifying and developing innovative interventions.
Two articles addressed problems related to food insecurity and the high cost of purchasing nutritionally adequate foods. First, Biel and colleagues described a community-based collaboration between community clinics and food pantries as a mechanism to improve diet-related illnesses among low-income populations. The promising results from this study shed light on potentially effective and unique community partnerships to address health promotion and disease prevention. In the second article, Fulp et al developed and evaluated the cost of model 7-day food plans for African American senior citizens. Findings demonstrated the lack of availability of healthy and affordable food options for this population.
Over the past 30 years, the prevalence of childhood obesity has doubled among the general population and tripled among several racial/ethnic minority pediatric populations.4 Two articles in this issue focus on a review of the scientific literature regarding efficacious, community-based pediatric obesity interventions and the implementation and evaluation of a school-based program, respectively. Mayer proposes the utilization of a community-based childhood prevention environmental nutrition intervention framework to guide future research approaches. Schetzina et al describe the development, implementation, evaluation, and sustainability of a school-based obesity prevention intervention for rural elementary school students. Feasibility and acceptability assessments were conducted with students as well as teachers.
Incorporating culturally competent healthcare services to appropriately address the medical needs of diverse population groups is being increasingly recognized by healthcare accrediting bodies such as the American Medical Association. In this issue, Vaughn provides an overview of cultural competence and provides recommendations for healthcare professionals. Using a culturally tailored approach, Weathers and colleagues report the results from an observational evaluation study of religious coping strategies utilized by African American women at familial risk for breast cancer. Study outcomes reflect the importance of addressing religious coping efforts during genetic counseling with African American women. The final article addresses the complex interrelationships of quality of life of primary caregivers and their preschool children with very low birth weight, and parenting stress among Chinese families.
Eliminating health disparities requires innovative programs that are supported by all levels of government and in all sectors of society. These articles reinforce the understanding that health disparities have less to do with medicine and genetics and more to do with attitudes, conditions, policies, and practices within our society and our healthcare system. The authors go beyond simply describing programs to intervene in health disparities to explore a variety of creative and innovative approaches to addressing them. We applaud these efforts to find workable solutions to the results of health disparities, and we challenge our readers to dig deeper to reveal the root causes. We must all raise our voices in the current dialogue on health policy and healthcare reform to make sure that the issue of eliminating health disparities is a priority in the discussion.
Bettina M. Beech, DrPH, MPH
Associate Professor, Division of Internal Medicine and Public Health, Vanderbilt University School of Medicine Nashville, Tennessee
Yvonne Joosten, MPH
Executive Director, Office for Community Engagement, Institute of Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, Tennessee
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