Messenger After two decades of democracy, economic inequality in South Africa remains very high. Survey comparability issues make analysing trends tricky, but it is clear that overall income inequality has not fallen; the country has long been one of the highest ranked by Gini coefficienta widely used measure of income inequality. Its peak of about 0. But some interesting sub-trends are clear to see.
All rights reserved This article has been cited by other articles in PMC. In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than nonminorities and that, patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than nonminorities.
Three studies published in this issue of the journal provide new insight to the sources of and contributing factors to racial and ethnic disparities in health care. In the first study, Trivedi and Ayanian 2 conducted a cross-sectional analysis of 54, respondents to the California Health Interview Survey to assess the relationship between perceptions of health care discrimination and use of health services.
Those that reported discrimination were less likely to receive some preventive care services; however, adjusting for perceived discrimination did not eliminate the observed racial, gender, and insurance disparities in receipt of preventive care.
The second study by Huang et al. The factor structure of the PHQ-9 was consistent across ethnic groups although there was evidence of differential item functioning for some items. The authors concluded that the PHQ-9 measures a common concept of depression and is an effective detection and monitoring tool for depression Unequal access healthcare diverse populations.
The third study by Groeneveld et al. Respondents answered questions about general innovativeness i. There were no significant racial differences in general innovativeness, but whites had higher medical innovativeness and were more likely to accept new prescription drugs than blacks.
Although the findings of these studies are highly relevant, there are inherent limitations in most research studies on ethnic differences that need to be highlighted.
There is good evidence that socioeconomic position is a stronger determinant of health-related outcomes than race.
The study of racial variations in health is driven by a genetic model that assumes that race is a valid biological category, that the genes that determine race are linked with the genes that determine health, and that the health of a population is determined predominantly by biological factors.
Methods for collecting data on race include self-report, direct observation, proxy report, and extraction from records. In general, self-reported race is most reliable and should be the preferred method. However, with the increase in the number of people that belong to multiple racial categories, it is increasingly difficult to classify individuals into 1 race category, which further complicates the interpretation of race effects in research studies.
Ethnicity is another variable that is commonly used in studies on health disparities.
The Office of Management and Budget OMB has defined minimum standards for maintaining, collecting, and presenting data on race and ethnicity. The concept of ethnicity is an attempt to further differentiate racial groups; however, like race, it carries its own historical, political, and social baggage.
In spite of these limitations, ethnicity when combined with race provides more information as long as researchers define their construction of it and justify its validity, reliability, and consistency. Acculturation is another concept related to culture that is typically used to explain ethnic disparities in health outcomes.
Acculturation as a predictive or explanatory variable is based on the assumption that culturally based knowledge, attitudes, and beliefs cause people to behave in certain ways and make specific health choices. Studies that infer that certain health behaviors or outcomes differ by race, ethnicity, culture, or degrees of acculturation may be misleading because they rarely account for the distinct differences within racial or ethnic groups or cultures.
For example, blacks that live in California may have very different cultural values from those that live in the Southeast so beliefs and perceptions about health care discrimination may be poles apart. Similarly, blacks from the Caribbean Islands or the continent of Africa who are classified as blacks for research purposes have distinct cultural values that are different from those of blacks who were born and raised in America.
Such obvious differences in beliefs, values, and practices are not accounted for with the current classification of race and ethnicity.
It is crucial that limitations in the definitions, measurement, and classification of the concepts of race, ethnicity, and culture are recognized as inferences are drawn from studies on health disparities.
Future studies on the relationship among race, ethnicity, culture, or acculturation and health outcomes need to go beyond just showing an association between these variables and health outcomes to providing a causal pathway for any such association.
The 3 studies published in this issue of the journal raise interesting points. Second, that lack of medical innovativeness may be a barrier to adoption of new technology in blacks and may explain observed differences in utilization of innovative medical technologies. As already discussed, results of these studies need to be interpreted with caution and put in the appropriate context of the conceptual limitations of the measurement and definition of race and ethnicity in the United States.
Nevertheless, the results of these studies underscore the need to continue funding research on understanding racial and ethnic differences in health outcomes.
As the United States becomes more diverse, there will be increased need to establish the validity and reliability of constructs and instruments across racial, ethnic, and cultural groups.
Researchers need to continue to examine how ethnic differences in risk aversion and patient preferences influence medical decision making and health outcomes.
In addition, perceived discrimination, racial bias, and stereotyping should remain legitimate research questions.Published in , Abortion Worldwide: Uneven Progress and Unequal Access provides the most current information on the incidence of abortion and unintended pregnancy worldwide, as well as trends since , as women and couples increasingly want smaller families.
It examines laws that regulate abortion and how they have evolved, and the current safety of abortion provision. Literature, Reports & Guidelines Resources to help you access the public health literature as well as links to titles from members of the Partners project.
Other studies demonstrate that diminished access to healthcare among blacks makes them more likely to experience preventable disabilities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.
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Unequal income distribution. Markets may result in a very wide distribution of income, such that some individuals may receive no income at all. Access to reproductive healthcare is a human right; without it, women’s health, confidence, and well-being are compromised.
Recent international conferences and protocols have acknowledged the importance of reproductive healthcare, recognizing that it is inextricably linked to other basic human rights such as the right to life, the right to.