DeHaven, Mark J., Gimpel, Nora A., and Kitzman, Heather
Journal of Evaluation in Clinical Practice. Oct2020, p1. 10p. 1 Illustration.
The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low‐income minorities (Native Americans, Hispanics, and African‐Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)—with their emphasis on health care for all, population health, and social determinants of health—requires community health scientists to develop innovative local solutions for addressing unmet community health needs.We developed a model community health science approach for improving health in fragile communities, by combining community‐oriented primary care (COPC), community‐based participatory research (CBPR), asset‐based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action.From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self‐management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high‐risk communities for hundreds of doctors in training.Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co‐develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health‐related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved. [ABSTRACT FROM AUTHOR]
SCHOOL children's clothing, COMPARATIVE historiography, AESTHETICS, and NUDITY
Appearances are deceptive, the saying goes. However, we devote much time to the presentation of ourselves, and ties and necklaces can take up more energy than other ‘substantial’ matters. This article analyzes the history of the presentation of selves in schools through the study of school uniforms. It will be claimed that modernity configured a ‘regime of appearances’ that had powerful effects on the ways that people relate to themselves and to others, and that schooling played a significant role in shaping it. The article will deal particularly with school uniforms as part of this regime of appearances, focusing on the development of vestimentary codes in Argentina and the United States of America. In Argentina, white smocks, which were adopted as the mandatory dress code around 1910 on the basis of an egalitarian rhetorics, were part of a politics of the body closely tied to Hygienism and linked to ideals of moral and racial purity. White smocks established a homogeneous and austere, monochromatic aesthetics of the school space that quickly identified transgression and indiscipline. In the US, uniforms were used for the schooling of minorities (Native Americans, women) as a way of rigorously training unruly bodies and of learning other aesthetic and bodily dispositions. Recently, urban public schools have adopted uniforms to counter-balance gangs' and rappers' dress codes. I believe that both cases show the fertility of analyzing school appearances for the history of school daily life and for understanding the effects that schooling produces in our societies. [ABSTRACT FROM AUTHOR]
Agency Role, Compliance (Legal), Definitions, Disabilities, Federal Legislation, Models, Needs Assessment, Program Development, Rehabilitation Programs, Resources, Social Agencies, State Legislation, Statewide Planning, Vocational Rehabilitation, and Wisconsin
This guide was developed to help Wisconsin agency assessment, evaluation, and planning personnel to develop a perspective on how needs assessment fits into their state's vocational rehabilitation program planning. Volume II provides state agency personnel with tools for conducting rehabilitation needs assessment. The first three chapters consider the requirements and meaning of the legislative mandates for services at both the state and federal levels; a definition of the target population or program; the vocational rehabilitation program structure in relation to the total state service delivery system; past management decisions for resource allocation relevant to program delivery; availability and quality of current information on needs; and the agency's purpose, intended use, and resources for conducting a needs assessment effort. Chapters 4-18 discuss the following topics: needs assessment, for special populations (individuals with severe handicaps, chronic mental illness, developmental disabilities, specific learning disabilities, traumatic brain injuries, blindness and visual impairments, deafness, youth in transition, minorities, Native Americans, women); and for designated services in rehabilitation facilities, supported employment, independent living, and rehabilitation engineering. Appendixes include a 174-item bibliography with a list of selected technical references, a suggested format for a needs assessment report, and the addresses and locations of clearinghouses and secondary data sources, names and telephone numbers for contact persons, and selected agencies. (KC)
COLONISTS, CIVIL rights, TAXATION, LIBERTY, LEGISLATIVE bodies, and NATURAL law
This essay examines the idea of rights advanced by the American colonists in the imperial crisis (1763-1776). It argues that the colonists viewed all English subjects as having the same fundamental rights as individuals everywhere in the empire. These individual rights (to life, liberty, and property) were in turn guaranteed by the right to consent to taxation. In the empire, the colonists insisted, these rights could only be protected by the colonial legislatures as they were not represented in the British Parliament, which in turn meant that the colonies must have the ability to govern themselves in all internal matters, a claim which ultimately led to the idea of each colony as a “free state,” independent of King and Parliament. While the colonists began by defending these rights on the basis of their legal inheritance as Englishmen, they gradually moved towards a more radical claim: that these rights were theirs based on the law of nature, and thus open to all men in principle. This move to natural rights was based in part on the colonial claim that they had migrated to America, a place inhabited by indigenous peoples whom they viewed as “savages” and thus outside of the jurisdiction of the English common law. The radical move to natural rights, however, was in tension with the loose confederation which emerged in the years after 1776 in which each colony was now a quasi-independent republican state and in which the rights of minorities—Native Americans, African Americans, religious dissenters, and Loyalists—could not be effectively protected by the federal government. [ABSTRACT FROM AUTHOR]
Black Students, Broadcast Industry, Cable Television, Communications, Communications Satellites, Computers, Higher Education, Minority Groups, Technology, and Telecommunications
Developments in communications technology should become a major concern of minorities (native Americans and Americans of African, Asian, and Hispanic racial or ethnic origin). Although minorities are disillusioned with broadcast television because television decision makers have not been sensitive to minority needs, they have shown interest recently in cable television as well as in other communication technologies--satellites, computers, fibre optics, and lasers. In order to become involved in communications on the research and policy making levels, students must be educated in communication technology, and black colleges should recognize that telecommunications can lead to a new way of generating revenue while leading to economic and community development. (JM)
Journal of the American Board of Family Medicine : JABFM [J Am Board Fam Med] 2007 Nov-Dec; Vol. 20 (6), pp. 527-32.
Cooperative Behavior, Delivery of Health Care, Humans, Poverty, Public Health, United States, Community Health Services organization administration, Family Practice organization administration, Health Promotion, Health Services Accessibility, Health Services Needs and Demand, Health Status Disparities, Leadership, and Stress, Psychological
The present health care delivery model in the United States does not work; it perpetuates unequal access to care, favors treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are minorities (Native Americans, Hispanics, and African Americans) and those of lower socioeconomic status. Because the nation's poor are most affected by built-in inequities in the health care system and because they have little political power, policy makers have been able to ignore their responsibility to this group. Family medicine leaders have an opportunity to integrate community health science into their academic departments and throughout the specialty in a way that might improve health care for the underserved. The specialty could adapt existing structures to better educate and involve students, residents, and faculty in community health. Family medicine can also involve community practices and respond to community needs through practice based research networks and community based participatory research models. It may also be possible to coordinate the community activities of family medicine organizations to be more responsive to the health crisis of those in need. More emphasis on community health science is consistent with family medicine's roots in social reform, and its historical and philosophical commitment to the principle of uninhibited access to medical care for the underserved.
NATIVE American gay people, GAY men, TWO-spirit people, NATIVE Americans' sexual behavior, HIV infection risk factors, AIDS risk factors, SAME-sex relationships, DISCRIMINATION, and NATIVE American sexual minorities
Epidemiological data indicate that HIV and AIDS are disproportionately affecting American Indians. Specific to American Indian men identifying as gay, bisexual, two-spirit or who have same-sex experiences, this study assessed HIV-risk behaviours and barriers to testing, prevention and treatment efforts. A rapid assessment model was utilised as an indigenous-supporting research design. Rigour and thoroughness were achieved via multiple validation procedures. Central themes surrounding barriers to HIV prevention included social discrimination, low self-esteem and substance use. Findings suggest the underutilisation of condoms due to ineffective placement and limited availability in popular locations among gay, bisexual and two-spirit individuals. Participants indicated that HIV testing is occurring less frequently and that testing was not available after hours or weekends. Barriers to treatment included a mistrust of the current healthcare system, a perceived lack of support from the Indian Health Service for AIDS care and a lack of transportation to healthcare appointments. Lastly, participants discussed and supported culturally-sensitive treatment services. This study calls attention to the value of an American Indian-specific HIV/AIDS service organisation, the presence of indigenous service providers in the community and culturally-sensitive healthcare providers. [ABSTRACT FROM AUTHOR]
American Journal of Public Health. Mar2009 Supplement, Vol. 99, pS144-S151. 8p. 3 Charts, 1 Graph.
IDENTITY (Psychology), GROUP identity, SELF-perception, RACE discrimination, PAIN, CHRONIC diseases, SELF-evaluation, NATIVE American sexual minorities, and ALASKA Native LGBTQ+ people
Objectives. We examined associations between racial discrimination and actualization, defined as the degree of positive integration between self-identity and racial group identity, and self-rated health and physical pain and impairment. Methods. We used logistic regressions to analyze data from 447 gay, lesbian, bisexual, and other sexual-minority American Indians/Alaska Natives. Results. Greater self-reported discrimination was associated with higher odds of physical pain and impairment (odds ratio [OR]=1.42; 95% confidence interval [CI]=1.13, 1.78); high levels of actualization were associated with lower odds of physical pain and impairment (OR=0.59; 95% CI=0.35, 0.99) and self-rated fair or poor health (OR=0.54; 95% CI=0.32, 0.90). Actualization also moderated the influence of discrimination on self-rated health (t=-2.33; P=.020). Discrimination was positively associated with fair or poor health among participants with low levels of actualization, but this association was weak among those with high levels of actualization. Conclusions. Among two-spirit American Indians/Alaska Natives, discrimination may be a risk factor for physical pain and impairment and for fair or poor self-rated health among those with low levels of actualization. Actualization may protect against physical pain and impairment and poor self-rated health and buffer the negative influence of discrimination. (Am J Public Health. 2009;99: S144-S151. doi:10.2105/AJPH.2007.126003) [ABSTRACT FROM AUTHOR]
HIV, INDIGENOUS peoples of the Americas, ALASKA Natives, DISEASE prevalence, SEXUAL dysfunction, NATIVE American sexual minorities, and ALASKA Native LGBTQ+ people
Background: American Indian and Alaska Natives suffer pervasive health disparities, including disproportionately high rates of HIV. Sexual network dynamics, including concurrency and sexual mixing patterns, are key determinants of HIV disparities.Methods: We analyzed data from the first national study of gay, lesbian, bisexual, and transgender American Indian and Alaska Natives to examine the prevalence of concurrency, sex and race of partners, and level of risk across different partnership patterns. Egocentric network data were analyzed at the level of the respondents, who were grouped according to the sex of their last 3 partners.Results: Overall rates of HIV and concurrency were high in this population. HIV prevalence (34%) and cumulative prevalence of concurrency (55%) were highest among men who had sex with only men, while women who had sex with only women reported lower concurrency and HIV. Women who had sex with women and men also had high HIV prevalence (15%) and reported slightly higher concurrency risk and low condom use, making them effective bridge populations.Conclusions: The uniformly high rates of Native partner selection creates the potential for amplification of disease spread within this small community, while the high rates of selecting partners of other races creates the potential for bridging to other groups in the transmission network. These findings provide some of the first insights into sexual networks and concurrency among Native gay, lesbian, bisexual, and transgender populations and suggest that both men and women deserve attention in HIV prevention efforts at individual, dyadic and population levels. [ABSTRACT FROM AUTHOR]
RESILIENCE (Personality trait), DISCRIMINATION, PUBLIC health research, HEALTH disparities, SOCIAL context, GROUP identity, IDEOLOGICAL conflict, SEXUAL minority youth, ALASKA Natives, YOUTH health, NATIVE American sexual minorities, and ALASKA Native LGBTQ+ people
Abstract: The public health research community has long recognized the roles of discrimination, institutional structures, and unfair economic practices in the production and maintenance of health disparities, but it has neglected the ways in which the interpretation of these structures orients people in overcoming them and achieving positive outcomes in their lives. In this call for researchers to pay more – and more nuanced – attention to cultural context, we contend that group identity–as expressed through affiliation with an oppressed group–can itself prompt meaningful role-based action. Public health''s study of resilience, then, must consider the ways that individuals understand and, in turn, resist discrimination. In this article, we briefly outline the shortcomings of current perspectives on resilience as they pertain to the study of marginalized youth and then consider the potential protection offered by ideological commitment. To ground our conceptual argument, we use examples from two different groups with whom the authors have worked for many years: indigenous and sexual minority youth. Though these groups are dissimilar in many ways, the processes related to marginalization, identity and resilience are remarkably similar. Specifically, group affiliation can provide a context to reconceptualize personal difficulty as a politicized collective struggle, and through this reading, can create a platform for ideological commitment and resistance. [Copyright &y& Elsevier]
Journal of Communication Inquiry. Oct2008, Vol. 32 Issue 4, p400-423. 24p.
TRANSGENDER people, BLOGS, CITIZEN journalists, CITIZEN journalism, HYPERLOCAL news media, INTERNET, INDIAN LGBTQ+ people (Asians), and NATIVE American sexual minorities
Queering and transgendering practices have been visible across the Internet since the time of multiuser domains (MUDs), MUD object oriented domains (MOOs), e-mail lists, and Web bulletins. This article maps some themes of queering in the Indian digital diaspora through an intergenerational lens, produced in the acts of online and offline coauthoring, weblogging, and reading of instances of such online queering relationally. By way of a dialogic encounter on their own blogs and employing performative writing that simulates the blogsphere, the authors look at the interplay of codes of identity through the employment of themes, language, symbols, and cultural influences in their writing. Examining the themes emerging from the specific blogs they study, the authors ask how power is shifted and relayered in these articulations and what the inviting interactional features of their writer-audience communities are that allow for certain kinds of self-expression while also shaping their performance of sexuality in these spaces. [ABSTRACT FROM AUTHOR]