An in-depth look at disparities in health and health care, fully updated for 2021
Vulnerable Populations in the United States, 3rd Edition provides a general framework for studying vulnerable populations and summarizes major health and health care disparities by race/ethnicity, socioeconomic status, and health insurance coverage. This updated contains the latest statistics and figures, incorporates new information related to Healthy People 2020, analyzes the latest data and trends in health and health care disparities, and provides a detailed synthesis of recent and increasingly expansive programs and initiatives to remedy these disparities. In addition, the Third Edition offers new coverage of health care reform, the “deaths of despair” (suicide, opioids, etc.), and the global primary care initiative.
Based on the authors' teaching and research at the Johns Hopkins Bloomberg School of Public Health and the Keck School of Medicine of the University of Southern California, this landmark text is an important resource for students, researchers, practitioners, and policymakers for learning about vulnerable populations. The book's Web site includes instructor’s materials that may be downloaded.
- Gain a general understanding of health and health care disparities related to race/ethnicity, socioeconomic status, and health insurance coverage
- Access online resources including editable PowerPoint slides, video, and more
- Delve into the programs and initiatives designed to remedy inequalities in health and health care, including Healthy People 2020 updates
- Enjoy new coverage of health care reform, the “deaths of despair” (suicide, opioids, etc.), and the global primary care initiative
End of chapter revision questions and other pedagogical features make this book a valuable learning tool for anyone studying at the advanced undergraduate or graduate levels. Additionally, it will prove useful in the field for medical professionals, social and community workers, and health educators in the public sphere.
DR. LEIYU SHI is Professor of health policy and health services research in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. He is Director of Johns Hopkins Primary Care Policy Center. Dr. Shi is also well known for his extensive research on the nation's vulnerable populations, in particular community health centers that serve vulnerable populations, including their sustainability, provider recruitment and retention experiences, financial performance, experience under managed care, and quality of care. Dr. Shi is the author of eleven textbooks and over 240 scientific journal articles.
DR. GREGORY STEVENS is Professor of public health in the Department of Public Health in the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles. His research focuses on health care and social policy, with an emphasis on health equity for vulnerable populations. Dr. Stevens is well known for his work on children's health and health care disparities, especially in the delivery of primary care and preventive services.
Figures, Tables, Exhibits xi
Preface xv
The Authors xxi
1 A General Framework to Study Vulnerable Populations 1
Learning Objectives 1
Why Study Vulnerable Populations? 3
Models for Studying Vulnerability 7
The Vulnerability Model: A New Multilevel Conceptual Framework 15
Summary 27
Key Terms 27
Review Questions 28
Essay Questions 28
2 Community Determinants and Mechanisms Of Vulnerability 29
Learning Objectives 29
Race and Ethnicity 30
Socioeconomic Status 43
Health Insurance 68
Multiple Risk Factors 81
Summary 86
Key Terms 86
Review Questions 87
Essay Questions 87
3 Influence of Individual Risk Factors 88
Learning Objectives 88
Racial and Ethnic Disparities 89
Health Care Access 89
Health Care Quality 93
Health Status 97
Socioeconomic Status Disparities 103
Health Care Access 104
Health Care Quality 105
Health Status 108
Health Insurance Disparities 114
Health Care Access 114
Health Care Quality 116
Health Status 119
Summary 123
Key Terms 123
Review Questions 123
Essay Question 123
4 Influence of Multiple Risk Factors 124
Learning Objectives 124
Health Care Access 128
Quality of Health Care 135
Health Status 144
Summary 155
Key Terms 155
Review Questions 156
Essay Questions 156
5 Current Strategies to Serve Vulnerable Populations 157
Learning Objectives 157
Programs to Eliminate Racial and Ethnic Disparities 161
Programs to Eliminate Socioeconomic Disparities 176
Programs to Eliminate Disparities by Health Insurance 186
Summary 194
Key Terms 195
Review Questions 196
Essay Questions 196
6 Resolving Disparities in the United States 197
Learning Objectives 197
The Healthy People Initiative 198
Framework to Resolve Disparities 205
Resolving Disparities in Health and Health Care 210
Integrative Approaches to Resolving Disparities 227
Challenges and Barriers in Implementing the Strategies 236
Course of Action for Resolving Disparities 241
Summary 251
Key Terms 251
Review Questions 251
Essay Questions 251
References 253
Index 281
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