The obesity epidemic is even more pronounced in rural America, and is a growing concern as rural adults and children are now more likely to be obese than urban adults and children. People who are overweight or obese are at increased risk for chronic disease and conditions such as hypertension, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and some types of cancers. For women, obesity also is associated with complications of pregnancy, menstrual irregularities, hirsutism, and psychological disorders such as depression. Stress has been linked to obesity in adults and in children, and rural residents are continually subject to the stresses of poverty, limited access to health care, and geographical and social isolation. In rural communities, community organizations and families need to come together to identify common goals related to obesity prevention and identify and mobilize human and community assets to implement strategies they believe will work for their community.

This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.

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.

The idea of protecting the health of rural populations, or rural public health if we will, is not new. In reality, however, most public health principles and practices are developed, applied, and evaluated in urban settings. As the field of public health grew beyond infectious disease concerns to encompass areas such as maternal and child health, chronic diseases, and mental health, the shift from an urban focus to a more inclusive view of all geographic diversities did not follow, however. Two of the most pressing challenges faced by rural residents are poverty and access to basic health services. Many researchers agree that one major complication in examining rural health outcomes is the lack of a consistent, objective measure of rurality. Because rural economies often center on agriculture, a highly volatile market, economic uncertainty is almost a staple in rural communities.

This chapter provides a review of public policy and public programs related to important aspects of the welfare state in the United States, with particular attention to the impact of various policies and programs related to income support, health care, and housing on low-income and minority Americans. It focuses on the guiding principles that motivate the various parties in today’s welfare state debates and investigate how the basic structure of the way social welfare is guaranteed in the United States affects low-income and minority individuals. The chapter also focuses on the general features of our economic, political, and social systems that place minority Americans at serious risk of poverty and ill health throughout life, including its waning years. The welfare state represents a relatively late development in human social, economic, and political history. Social Security is particularly important for minority Americans.

This chapter describes the unique issues of HIV prevention and treatment in rural areas in the United States. The associated cultural factors can serve as barriers to accessing HIV prevention and treatment services, such as lack of insurance coverage and provider shortages in rural areas. Barriers to receiving health care include provider shortages and inexperience, lack of consistent primary care provider contact despite available Ryan White funds, lack of social support, and stigma. Fear of disclosure, lack of health care and support services, and limited treatment options are barriers to effective prevention and treatment in many rural areas across the country. Rural midwestern communities are characterized by limited access to primary care, self-care education, mental health and family support services, and community educational programs. Online health promotion interventions could be particularly useful for men who have sex with men (MSM) living in rural areas who are at risk for HIV/AIDS.

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 explains the policy implications of incrementalism and its strengths and weaknesses. The person who popularized the concept of incrementalism in the U.S. policy process is Charles Lindblom. He put forth this theory of the decision-making process as both a descriptive and normative good. Incrementalism is based on building marginally on policy that already exists rather than starting from scratch or dramatically changing policy direction. One advantage of incrementalism is that the existing stakeholders are less likely to oppose a small change in the status quo as opposed to a major change. Any policy changes within the business environment, including health care, tend to realign factors that advantage some stakeholders and disadvantage others. Public health uses the precautionary principle as an important foundation for policy advocacy. Policy makers use this principle to justify decisions in situations in which there is the possibility of harm from not taking action.

This chapter examines the importance of economic evaluations of behavioral interventions and introduces the basic methods for conducting economic evaluations and the key scientific issues involved in costing behavioral interventions. A variety of factors has transpired to bring the economic evaluation of behavioral interventions to the forefront of analytic considerations. One primary reason is the reorganization of health care. The chapter shows the basic steps for completing a health economic evaluation of a behavioral intervention. The most common type of economic evaluations in practice is cost-effectiveness analysis. Cost-utility analysis represents a special case of a cost-effectiveness analysis where effectiveness is measured in terms of quality-adjusted life years (QALYs). All economic evaluations require evaluating costs. However, inclusion of outcome measures depends on the type of study being conducted. Economic evaluations conducted alongside clinical trials often suffer from inadequate statistical power.

When considering the source of rural health disparities, rural areas have a unique cultural background and heritage that can impact health behaviors and outcomes in strong and surprising ways— both for the overall population and for subpopulations within rural areas. This culture is shaped by many key factors, including remoteness and isolation, lower income, lower educational levels, increased religiosity, unique behavioral norms, increased health care stigma, increased transportation burdens, and additional distance to care. These factors combine to impact not only potential need for health care, but also the ways in which residents will seek out care, and ultimately their outcomes as well. This chapter summarizes the existing literature and discusses ways in which existing knowledge regarding general rural health can be extended into a deeper understanding of the health needs of rural gender and sexual minority (GSM) residents.