Page 241 - Encyclopedia of Nursing Research

208 n HeAlTH DISpArITIeS IN rAcIAl AND eTHNIc MINOrITIeS

care quality and access remained unchanged means by which health disparities develop.
or worsened for poor and racial and eth- Additionally, biological and other social the-
H nic minority populations (2008 National ories have been proposed to further exam-
Healthcare Quality and Disparities report). ine the disparate health outcomes between
The complexity in identifying the root cause Whites and racial and ethnic minorities
of health disparities include several social (e.g., Krieger, 2005), using frameworks that
factors (e.g., living in hazardous environ- have examined psychosocial stressors (e.g.,
ments, limited educational opportunities, Williams & Mohammed, 2009), allostatic
lack of employment, and linguistic and load, and “weathering” (Geronimus, Hicken,
other cultural barriers; Adler & Newman, Keene, & Bound, 2006; Juster, Mcewen, &
2002; Adler & rehkopf, 2008; laVeist, 2005; lupien, 2010).
Williams, Neighbors, & Jackson, 2008). In The social determinants of health frame-
addition to societal barriers, additional bar- work proposed by laVeist provides a suitable
riers related to the health care system exist. lens in which to examine multiple theoretical
These include barriers to access, differen- frameworks that have been grouped together
tial treatment courses, biases and prejudices on a continuum across the life span. There
among consumers and providers, and insti- has been an increasingly growing body of
tutional racism within the health care system literature within the fields of sociology, psy-
as a whole, all of which disproportionately chology, and public health that are using
affect the health of poor and racial and ethnic social determinants of health as a framework
minority populations (Jones, 2000; Smedley, to examine health disparities (laVeist &
Stith, & Nelson, 2003). lebrun, 2010; Marmot & Bell, 2009; Smedley,
The challenge in addressing racial and 2006; Williams & Mohammed, 2009). As a
ethnic disparities in health and health care result of consistent findings and worsening
is in part due to methodological concerns disparities in health among the poor and
of measuring health disparities and consis- racial and ethnic minorities, there have been
tency of language. For example, health indi- initiatives by the World Health Organization,
cators are usually measured in terms of rates, the U.S. federal government, the federal and
percentages, proportions, means, and other private funding agencies, such as the NIH,
quantifiable measures, such as infant mortal- and the robert Wood Johnson Foundation to
ity (Keppel et al., 2005; Murray et al., 2006). make the elimination of health disparities a
Additionally, health disparities are typically high priority.
measured from a specific point of reference Using social determinants of health as a
or using models, such as demographic facts framework in nursing research can be useful
(e.g., age), individual behaviors, health indi- for extending existing nursing knowledge
cators (e.g., Healthy people 2010), and health and care beyond the traditional nurse–cli-
care system (Hebert et al., 2008; Keppel et al., ent relationship because it assumes a holis-
2005; laVeist, Nuru-Jeter, & Jones, 2003). tic approach to examining the impact of
eliminating health disparities will socioenvironmental factors that contribute
require an understanding of not only health to health disparities, thus moving us from
but also the social environment, political description of the conditions of individuals
systems, norms, and policies, which impact with disparate health, to making visible the
the health of individuals, families, and com- social processes that contribute to them, and
munities. Frameworks grounded in critical consequently engaging nurses to become
social theory (Mohammed, 2006) and crit- advocates for change in health and social
ical race theory (Delgado & Sefancic, 2001, policies (lynam et al., 2008).
as cited in Ford & Airhihenbuwa, 2010) have The challenge for nurses in addressing
sought to address many of the structural racial and ethnic disparities in health and