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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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