This chapter introduces the scope of this volume by reviewing thirteen guiding principles for a new field of equity in health. The thirteen guiding principles are: The drive for a major paradigm shift, the drive for new models of health care and training, the drive for new theories, perspectives, and identities, the drive for evidence-based approaches, the drive for transdisciplinary teams and community-based participatory research, the drive for globalization and global collaboration, the drive for cultural competence and cultural appropriateness, the drive for health literacy and linguistic appropriateness, the drive to ensure the right to health, the drive for social justice and acknowledgment of forces in the social context, the drive to protect and support the most vulnerable, the drive to repair damage, restore trust, and take responsibility, and the drive to redistribute wealth and access to opportunity. These principles provide hope for a future global transformation in health.

This chapter describes the implementation and evaluation of a peer mentoring program for at-risk ninth-grade students. The program was established to ensure the academic achievement of at-risk students attending a college preparatory high school in an urban setting by connecting high-achieving high school students with at-risk ninth-grade students in mentoring relationships that included the provision of tutoring in major subject areas. Within the model implemented, school leadership also sought to collaborate with teachers in improving instruction. The chapter presents the rationale for developing a peer mentoring program, the multitude of factors operating in influencing student academic achievement, the process of developing a model peer mentoring program, and the results of a quantitative and qualitative evaluation of the program. The program is emerging as an effective intervention, especially having success in reducing academic failure in the major subject areas of math and science for Black males.

This chapter discusses new policies to counter those that have been destructive to communities, led to the incessant displacement of communities, and effectively created the social context for the emergence of health disparities. The chapter uses interviews and observations collected as part of a study of urban renewal to suggest that these seemingly discrete policies have interacted to create a set of disadvantages that contribute to the spread of AIDS and as well as other health and social problems. It proposes that incessant displacement is at the root of America’s health disparities. The chapter analyzes interviews for comments specific to the policies of segregation, redlining, urban renewal, planned shrinkage/catastrophic disinvestment, gentrification, HOPE VI, and mass incarceration. In addition, the chapter examines the movement of populations over time in the Newark, NJ area using methods from population, community, and ecosystem ecology and quantitative geography.

This chapter reviews the evidence to date from the hypertension (HTN) literature that addresses three major components of the conceptual framework described in the Institute of Medicine (IOM) report as an umbrella to frame the mechanisms for hypertension-related disparities between African Americans and Whites. Relevant patient-related factors in hypertension literature include poorer responsiveness to treatment; poorer rates of adherence to prescribed antihypertensive medications; and patient preferences and beliefs about HTN and its treatment. At provider-level, disparities may result from poor doctor-patient communication in the medical encounter due to a racial/ethnic mismatch between the patient and physician; greater rates of clinical inertia; differential rates of prescribing behavior; and stereotypic beliefs about African American patients due to low levels of cultural competency. Problems at the level of health care system include a lack of access to and quality of health care; and changes in the financing and delivery of health care services.

This chapter attempts to evaluate the expected utility of two approaches to racial disparities, one based on race as a social construct and the other based on race as a proxy for geographic ancestry and genetics. Current social and political discourse favors individual-level and technology-based solutions over extensions of social contract implicit in American politics. The first “ethnic drug”, BiDil, was approved by FDA for treatment of heart failure specifically in African Americans. Birth weight, is the most important determinant of infant mortality differences between Whites and African Americans. The chapter explores “healthy immigrant” hypothesis in a study of birth weight patterns emerging in the generation after women migrated from African or Caribbean countries. It discusses the importance of eliminating racial disparities for reducing white infant mortality. The chapter suggests that a redirection of disparities research will come as part of a more profound change involving the whole society.

This chapter offers a compelling example of the kind of new perspectives needed to guide the field of equity in health. It presents an Africanist perspective that highlights the important role of evidence-based and culturally appropriate models for reducing global health disparities. The chapter describes the PEN-3 cultural model. The model is composed of three primary domains: Cultural Identity, Relationships and Expectations, and Cultural Empowerment. When a health issue is identified, a 3 × 3 table is created to group the interaction between the domain of Relationships and Expectations with the domain of Cultural Empowerment. The chapter discusses the three categories of Relationships and Expectations: perception, enablers, and nurturers. Cultural Empowerment is an affirmation of the possibilities of culture, which ranges from positive to negative. The Cultural Empowerment domain is composed of three categories: positive, existential, and negative. The Cultural Identity domain is used to determine point of intervention entry.

This chapter describes the impact of intersecting identities that affect lesbian and bisexual (LB) women of color. It discusses the communication and legal concerns that may lead to complex and difficult diagnostic and treatment considerations and problems of access to health care, and offers recommendations for health care researchers and practitioners. The chapter refers to the concept of multiple identities or the notion that most patients have more than one important locus of identity and that they may include more than one identity that is disadvantaged. This is particularly relevant for LB women of color. The Communication and legal issues are illustrated via two brief cases, which demonstrate a number of communication issues that often arise in the acquisition of important medical information from LB women of color. Sexism and heterosexism affect women of color and White women differently. Racism affects African American heterosexual, lesbian, and bisexual women differently.

Mental health professionals play a critical role in enforcing social justice in mental health care service. This chapter discusses various characteristics of and attitudes about mental health services that may serve as barriers to parity in mental health service delivery and services among African Americans. It describes strategies for mental health providers and systems in addressing these service delivery disparities. These strategies improve the quality of mental health services for African American clients, minimize structural barriers in the receipt of mental health care among African Americans, and decreases the stigma associated with counseling use among African Americans and promote more favorable help-seeking attitudes among African Americans. Mental health professionals should work at the individual, community, and institutional levels to address external barriers, differential quality of care, and beliefs that African Americans may bring into their interactions with mental health systems.

Health professionals and consumers increasingly rely on various types of health-related data and information to support a broad range of functions ranging from public policy, research, service planning, and delivery through consumption. Informatics, the science of information management in health care, offers applications that can be used to support each of these functions and more. This chapter describes a role for health informatics and information technology (HIIT) in shaping a global research agenda to eliminate health disparities, covering international developments. HIIT can be useful in many ways to address disease burden and disparities. For example, it can support surveillance of disease and health threats, manage services and resource allocations, track service utilization, document epidemiological and etiological relationships in disease processes, facilitate clinical decision making, and organize patient health information.

This chapter calls for collaboration on national research priorities to eliminate health disparities. It provides a historical perspective on the condition of health disparities in the United States. Eliminating disparities in health will require transdisciplinary and interdisciplinary strategies with partners in and outside of government. The chapter defines health disparities and describes some of the contributors in the United States. It presents contributing factors to health disparities, including individual factors (behavioral and personal), structural or system factors, and institutional factors. The chapter describes a framework for health disparities research and summarizes some of the critical health disparities that should be addressed through research. It also describes efforts to develop health disparities research priorities. The chapter proposes a framework for establishing research priorities related to health disparities; and suggests an approach for engaging in collaborative, interdisciplinary research and next steps.