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3365 RESENHAS BOOK REVIEWS The second section talks about specific pop- ulations and factors intervening in the quality of health services. Here is a summary of the main points per population: - African Americans Health Equity : population impacted by macrolevel structural issues; increased heart disease mortality rates with a minor role of genetics; higher stroke mortality rates; less emer- gency medical services utilization; twice as likely to be diagnosed with diabetes; lower survival rates for cancer, specifically for women; higher HIV diagno- ses and AIDS-related deaths, but not associated to individual behaviors; high perceived discrimina- tion which leads to poor medication adherence; residential segregation and minority stress. - Health Equity in U.S. Latinx Populations : larg- est foreign-born group in the U.S.; less education; economic disadvantages; racism and perceived dis- crimination; major health burdens include cancer, cardiovascular disease, diabetes, mental health, and alcohol and substance abuse; they experience worse utilization and access to services; decline in insur- ance coverage; a solution to some problems is to not lump all types of Latinx individuals together, like native-born, foreign-born, migrant workers, and undocumented. - Asian American Health Equity : Asian Ameri- cans (A.A.) are the fastest-growing minority in the U.S.; A.A.s represent the model minority group and are portrayed as a healthy minority that does not deserve or require additional research; there are several factors influencing disparities among A.A.s, including but not limited to acculturation, nativi- ty, income, educational attainment, health literacy, English proficiency, and immigration status; fortu- nately there are several organizations and programs that are working towards health equity. - American Indian and Alaska Native (AIAN) Health Equity : AIANs are given legal rights based on the forced relocation of their tribes throughout American history; however, this does not guarantee access to quality healthcare; the Indian Health Ser- vice is one of the most critically underfunded seg- ments of the government; AIANs health disparities go much further, reminiscing to sociodemographic and historical reasons; some of their most signifi- cant issues are alcohol and substance use disorders, diabetes, domestic violence, and assault. - Health Equity for k ā naka ʻō iwi, the Indige- nous People of Hawai ʻ i : compared to the U.S., this group has a disproportionately higher prevalence of chronic medical conditions, as diabetes, obesity, and cardiovascular diseases, and higher mortali- ty rates for cancer, stroke, and heart disease; be- havioral health is also a big issue, especially when Smalley KB, Warren JC, Fernandez MI, editors. Health Equity: A Solutions-Focused Approach . Berlin: Springer Publishing Company; 2020. Hugo Alberto Peña Martínez (https://orcid.org/0000-0001-7939-6455) 1 Astrid Nieto Gutiérrez (https://orcid.org/0000-0002-5795-2788) 1 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud. Monterrey Mexico. Health Equity: A Solutions-Focused Approach is a book written by K. Bryant Smalley, Jacob C. Warren, and M. Isabel Fernández 1 . Its purpose is to unmask the hidden fights that minority groups and margin- alized communities have struggled with regarding health equity and social justice. In addition, it is a homage to those who have fought for recognition, respect, and equality, neglected in the scientific liter- ature. Finally, the authors acknowledge the few and deeply navigate through the origins, demographics, and health disparities they face and come up with al- ternatives, models, and solutions to each community to decrease health disparities. The book is structured into three sections: “In- troduction and Overview”, “Population Perspectives on Health Equity”, and “The Path Forward”. The first section, “Introduction and Overview”, describes the concepts of equality, equity, and justice. Furthermore, it identifies how racism, prejudice, and discrimination affect different racial/ethnic groups in the health department. A big emphasis is made on Intersectionality Theory and how it impacts health equity and Minority Stress Theory, which explains the higher rates of health risk behaviors in these populations. It also suggests a correlation between socioeconomic belonging and privilege, some of our culture’s darkest and non-talked-about aspects. The race is a social construct that categorizes groups based on ideologies of superiority and inferi- ority related to phenotype. Racism = racial prejudice + power. It also contradicts itself in some ways; for example, Arabs and Muslims are racially considered non-White but are classified under White in the U.S. Census. Racism shapes health outcomes, particu- larly through stress, racial residential segregation, and immigration policy. Some of the best strategies to address racism and health are psychoeducation, validation, critical consciousness, and examina- tion of privilege and racial attitudes. According to the Socio-Ecological Model, there is a need for an engagement at all levels, especially to turn around health-associated racial disparities. DOI: 10.1590/1413-81232022278.19322021
3366 Resenhas Book Reviews compared to other groups in the U.S.; it is nec- essary to plan health initiatives from a Hawaiian perspective to create culturally appropriate pro- grams and materials, mainly thanks to the great diversity of languages, family structures and tra- ditions between this communities. - Women’s Health Equity : for women, both sex and gender impact their health; women live on average 5 years longer than men; the top two leading causes of death are heart disease and cancer; women have the highest morbidity rate for most illnesses; excluded from medical re- search and clinical trials, leading to men-focused treatment; women face unique consequences of reproductive health; depression and anxiety are more common in women; in recent years the gap of drug abuse has been narrowing; intimate part- ner violence increases the risk of lower self-re- ported health; changes in research policies and community-level interventions with a gender perspective can address these disparities. - Achieving Men’s Health Equity : Men live shorter lives; the “death of despair” is the drug-related, alcohol-related, liver disease, and suicide mortality in ages 45-54 with a high school or lower degree; this is more pronounced in ru- ral areas; men health equity includes the popu- lation-specific approach of men of the different groups and a comparative approach between man and women among the same groups; the way men negotiate their masculinity remains at the margin of men’s health. - LGBTQ Health Equity : historical injustices and discrimination along with current prejudice affect the health of LGBTQ people negatively; homosexuality used to be considered a diagnos- able mental disorder, being transgender still is; in half the states of the U.S., professionals can le- gally refuse care to patients based on their sexual orientation or identity; the most common types of discrimination are heterosexism, homopho- bia, cisgenderism, and transphobia; some of the most significant barriers to health equity in this group include obesity, cancer, mental health, substance abuse, and HIV; particular emphasis on HIV among the sexual minority men of color. - Rural, Frontier, and Appalachian Health Eq- uity : the vast majority of health promotion and prevention strategies are designed, implemented, and evaluated in urban communities; there is stigma attached to what rurality is, and people as- sociate it with remoteness, isolation, self-reliance, agriculture, poverty, religiosity, and health stig- ma; the most common rural health disparities in- clude mental and behavioral health, obesity and chronic diseases, and poor access to healthcare; the ideal method to approach the health barriers in rural communities is the use of telehealth. - Health Equity in Immigrant and Refugee Populations : immigrants, together with their U.S.-born children, constitute 28% of the pop- ulation; conditions that mainly affect this pop- ulation include tuberculosis, hepatitis, cardio- vascular disease, mental health, and infectious diseases; the immigrant health paradox explains how immigrant and refugees come to the U.S. with better health status than native-born but lose this status after some years. - Health Equity in Veteran Populations : Vet- erans, due to the nature of their military-related experiences, have increased medical and mental health risks; they are given an integrated U.S. gov- ernment healthcare system called V.A. healthcare system; there are different risks associated with their period of service, meaning that those who served during the Cold War won’t need the same service as those during the ongoing Gulf War. - Health Equity in Populations with Disabil- ities : People with disabilities face disparities among almost all health indicators; these dispar- ities are not only due to the person’s primary dis- ability itself but relates to discrimination and ex- clusion; to achieve health equity, it is proposed to improve access to healthcare, collect data to drive policies, strengthen the human services work- force capacity, including people with disabilities in public health programs, and ensure prepared- ness for emergencies. - Achieving Health Equity for Children : since 1950, infant mortality has been reduced fivefold, vaccines and antibiotics have nearly eliminat- ed significant childhood illnesses, and children born with genetic conditions are now living well into adulthood; however, not all children in the American society enjoy these privileges; health- care quality has stagnated or even declined in some population groups; being born on differ- ent race/ethnic groups relate to significant child health disparities; some essential solutions to problems involving children are high-quality health insurance coverage, and access to compre- hensive primary and preventive care. The third section, “The Path Forward”, is about the complexities of human interaction and social dynamics, relevant for everyone who inevitably interacts with diverse populations. It defines the concept of “Cultural Competence” and “Cultural Humility”. It elucidates how we, as humans, go through a process of lumping and splitting where we assume that people with sim-
3367 Ciência & Saúde Coletiva, 27(8):3365-3367, 2022 ilar physical characteristics share values, beliefs, and behaviors, even though there are many vari- ations within particular racial groups. This last section also provides solutions ap- plicable to the healthcare system to those diffi- culties that minorities struggle with in terms of medical care. For example, it describes an ed- ucational program with five intersecting core structural competencies, proposed in 2014 by Metzl and Hansen. It seeks to systematically train healthcare professionals to think about variables like race, social class, gender, religion, sexual ori- entation, etc. Furthermore, an emphasis is placed on integrating behavioral/mental health services into the preexisting physical health services, how to achieve this, and the benefits it would drive re- garding healthcare outcomes. In conclusion, the book Health Equity: A Solutions-Focused Approach has an important message; there is a need for exploring, not only acknowledging, intersectionality: how it impacts health and interventions. Reaching health equity requires more funding streams, supporting re- searchers from underrepresented backgrounds, and advancing awareness of disparities led by social injustices and imbalances of power 2 . It is the path forward to battle discrimination and marginalization that impede the development of health equity as a whole 3 . References 1. Smalley KB, Warren JC, Fernandez MI, editors. Health Equity: A Solutions-focused Approach . Berlin: Springer Publishing Company; 2020. 2. Liburd LC, Hall JE, Mpofu JJ, Williams SM, Bouye K, Penman-Aguilar A. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations. Annu Rev Public Health 2020; 41:417-432. 3. Raine R, Fitzpatrick R, Barratt H, Bevan G, Black N, Boaden R, Bower P, Campbell M, Denis JL, Devers K, Dixon-Woods M, Fallowfield L, Forder J, Foy R, Free- mantle N, Fulop NJ, Gibbons E, Gillies C, Goulding L, Grieve R, Grimshaw J, Howarth E, Lilford RJ, McDonald R, Moore G, Moore L, Newhouse R, O’Cathain A, Or Z, Papoutsi C, Prady S, Rycroft-Malone J, Sekhon J, Turner S, Watson SI, Zwarenstein M. Challenges, solutions and future directions in the evaluation of service innovations in health care and public health . Southampton: NIHR Journals Library; 2016. This is an Open Access article distributed under the terms of the Creative Commons Attribution License BY CC
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