Last data update: Nov 11, 2024. (Total: 48109 publications since 2009)
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Summary of Guidance for Minimizing the Impact of COVID-19 on Individual Persons, Communities, and Health Care Systems - United States, August 2022.
Massetti GM , Jackson BR , Brooks JT , Perrine CG , Reott E , Hall AJ , Lubar D , Williams IT , Ritchey MD , Patel P , Liburd LC , Mahon BE . MMWR Morb Mortal Wkly Rep 2022 71 (33) 1057-1064 As SARS-CoV-2, the virus that causes COVID-19, continues to circulate globally, high levels of vaccine- and infection-induced immunity and the availability of effective treatments and prevention tools have substantially reduced the risk for medically significant COVID-19 illness (severe acute illness and post-COVID-19 conditions) and associated hospitalization and death (1). These circumstances now allow public health efforts to minimize the individual and societal health impacts of COVID-19 by focusing on sustainable measures to further reduce medically significant illness as well as to minimize strain on the health care system, while reducing barriers to social, educational, and economic activity (2). Individual risk for medically significant COVID-19 depends on a person's risk for exposure to SARS-CoV-2 and their risk for developing severe illness if infected (3). Exposure risk can be mitigated through nonpharmaceutical interventions, including improving ventilation, use of masks or respirators indoors, and testing (4). The risk for medically significant illness increases with age, disability status, and underlying medical conditions but is considerably reduced by immunity derived from vaccination, previous infection, or both, as well as timely access to effective biomedical prevention measures and treatments (3,5). CDC's public health recommendations change in response to evolving science, the availability of biomedical and public health tools, and changes in context, such as levels of immunity in the population and currently circulating variants. CDC recommends a strategic approach to minimizing the impact of COVID-19 on health and society that relies on vaccination and therapeutics to prevent severe illness; use of multicomponent prevention measures where feasible; and particular emphasis on protecting persons at high risk for severe illness. Efforts to expand access to vaccination and therapeutics, including the use of preexposure prophylaxis for persons who are immunocompromised, antiviral agents, and therapeutic monoclonal antibodies, should be intensified to reduce the risk for medically significant illness and death. Efforts to protect persons at high risk for severe illness must ensure that all persons have access to information to understand their individual risk, as well as efficient and equitable access to vaccination, therapeutics, testing, and other prevention measures. Current priorities for preventing medically significant illness should focus on ensuring that persons 1) understand their risk, 2) take steps to protect themselves and others through vaccines, therapeutics, and nonpharmaceutical interventions when needed, 3) receive testing and wear masks if they have been exposed, and 4) receive testing if they are symptomatic, and isolate for ≥5 days if they are infected. |
Health equity in the implementation of genomics and precision medicine: A public health imperative.
Khoury MJ , Bowen S , Dotson WD , Drzymalla E , Green RF , Goldstein R , Kolor K , Liburd LC , Sperling LS , Bunnell R . Genet Med 2022 24 (8) 1630-1639 Recent reviews have emphasized the need for a health equity agenda in genomics research. To ensure that genomic discoveries can lead to improved health outcomes for all segments of the population, a health equity agenda needs to go beyond research studies. Advances in genomics and precision medicine have led to an increasing number of evidence-based applications that can reduce morbidity and mortality for millions of people (tier 1). Studies have shown lower implementation rates for selected diseases with tier 1 applications (familial hypercholesterolemia, Lynch syndrome, hereditary breast and ovarian cancer) among racial and ethnic minority groups, rural communities, uninsured or underinsured people, and those with lower education and income. We make the case that a public health agenda is needed to address disparities in implementation of genomics and precision medicine. Public health actions can be centered on population-specific needs and outcomes assessment, policy and evidence development, and assurance of delivery of effective and ethical interventions. Crucial public health activities also include engaging communities, building coalitions, improving genetic health literacy, and building a diverse workforce. Without concerted public health action, further advances in genomics with potentially broad applications could lead to further widening of health disparities in the next decade. |
Promoting health equity during the COVID-19 pandemic, United States.
Moore JT , Luna-Pinto C , Cox H , Razi S , St Louis ME , Ricaldi JN , Liburd L . Bull World Health Organ 2022 100 (2) 171-173 The United States of America has a diverse population of over 331 million people.1 Groups historically identified as racial and ethnic minorities (which make up more than one third of the US population)1 have been economically and socially marginalized, leading to lower access to education, health care and financial capital, therefore putting some of these groups at increased risk for poor health outcomes.2 The coronavirus disease 2019 (COVID-19) pandemic has amplified existing health inequities; disparities in COVID-19 cases, hospitalizations and deaths, and now vaccination rates, have been identified.3,4 Here, we provide a high-level summary of strategies implemented by the United States Centers for Disease Control and Prevention (CDC) to address COVID-19 inequities impacting racial and ethnic minority groups. |
Pedagogy of the CDC Undergraduate Public Health Scholars (CUPS) Program: Cultivating Workforce Diversity to Address Health Disparities and Achieve Health Equity
Liburd L , Hsiang Young K , Thorpe RJ Jr . Pedagogy Health Promot 2021 7 9S-12S If current population trends continue, the U.S. population will be a “majority minority” nation in 2044 according to a report by the Brookings Institution (Frey, 2014). Based on the United States Census Bureau projections, the non-Hispanic White population will decrease by 9.5% from 2016 (61.3%) to 2060 (44.3%; Vespa et al., 2020). In 2060, those who self-identify as White will make up 68.0% (44.3% self-identifying as non-Hispanic White) of the population; these percentages are 15.0% for Black people, 9.1% for Asian people, 1.4% for American Indian and Alaska Native people, 0.3% for Native Hawaiian and Other Pacific Islander people, and 6.2% for multiracial people (Vespa et al., 2020). Hispanic people will comprise 27.5% of the population (Vespa et al., 2020). These changing demographics have implications for the practice of public health and medicine, and the composition of the workforce. Foremost in responding to the needs of an increasingly diverse U.S. population is attaining a racially and ethnically diverse workforce at the organizational and systems levels. This diverse workforce, inclusive of interdisciplinary perspectives, would need to be culturally responsive and structurally competent to inform strategies for effective public health data and action (Hansen & Metzl, 2016). Coronado et al. (2020) contend “Public health agencies that employ a diverse workforce are better positioned to implement targeted approaches in communities where they are needed, create systems to support those needs, and supply a greater variety of effective solutions to help address health disparities” (p. 390). Intentional and progressive pedagogy is needed to ensure an educational pathway for currently underrepresented students to pursue careers in public health, medicine, and other health-related fields. |
An Evaluation of a Pipeline Program to Support Diversity in the Public Health Workforce: CDC Undergraduate Public Health Scholars (CUPS) Program
Young KH , Liburd L , Penman-Aguilar A . Pedagogy Health Promot 2021 7 23S-35S Established by the Centers for Disease Control and Prevention (CDC), the goal of the CDC Undergraduate Public Health Scholars (CUPS) program is to expose students underrepresented in public health and medicine to careers in public health; ultimately, increasing the membership of these groups in these fields including biomedical sciences. CDC implemented a retrospective outcome evaluation of 1,047 students who participated in the program from 2012 to 2017. Seventy-four percent (775) of students responded to the survey that captures their academic attainment and employment status, as well as their perception of the program’s and mentors’ influence on their career path. As of 2020, 639 (83.4%) of 775 participants have enrolled in an advanced degree program, with over 80% of 639 participants pursuing degrees in biomedical sciences, public health, or health care (BSPHHC)–related fields. Two thirds (374/566) of participants who reported they had ever been employed in a career position are working/have worked in BSPHHC-related fields. Overall, 77.4% (600) of 775 participants reported either the program or the mentors, or both were extremely or very influential to their career path. Students claimed the CUPS program had “opened their eyes,” inspired their interest, cultivated their passion for the field of public health, and fueled their drive to find solutions to and in social determinants of health and contribute to health equity. The opportunity to gain work and research experience through internship placements in CUPS has “opened doors” to first jobs and advanced education and training opportunities for many students. © 2021 Society for Public. |
COVID-19-Associated Orphanhood and Caregiver Death in the United States
Hillis SD , Blenkinsop A , Villaveces A , Annor FB , Liburd L , Massetti GM , Demissie Z , Mercy JA , Nelson CA3rd , Cluver L , Flaxman S , Sherr L , Donnelly CA , Ratmann O , Unwin HJT . Pediatrics 2021 148 (6) BACKGROUND: Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. METHODS: We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data.We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. RESULTS: We found that fromApril 1, 2020, through June 30, 2021,>140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such losswas 1.1 to 4.5 times higher among children of racial and ethnicminority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in stateswith tribal areas for American Indian and/or Alaska Native populations. CONCLUSIONS: We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need tomount an evidence-based comprehensive response focused on those children at greatest risk in the statesmost affected. © 2021 American Academy of Pediatrics. All rights reserved. |
Addressing Racial and Ethnic Disparities in COVID-19 Among School-Aged Children: Are We Doing Enough?
White A , Liburd LC , Coronado F . Prev Chronic Dis 2021 18 E55 The disproportionate impact of COVID-19 and associated disparities among Hispanic, non-Hispanic Black, and non-Hispanic American Indian/Alaska Native children and teenagers has been documented. Reducing these disparities along with overcoming unintended negative consequences of the pandemic, such as the disruption of in-person schooling, calls for broad community-based collaborations and nuanced approaches. Based on national survey data, children from some racial and ethnic minority groups have a higher prevalence of obesity, asthma, type 2 diabetes, and hypertension; were diagnosed more frequently with COVID-19; and had more severe outcomes compared with their non-Hispanic White (NHW) counterparts. Furthermore, a higher proportion of children from some racial and ethnic minority groups lived in families with incomes less than 200% of the federal poverty level or in households lacking secure employment compared with NHW children. Children from some racial and ethnic minority groups were also more likely to attend school via online learning compared with NHW counterparts. Because the root causes of these disparities are complex and multifactorial, an organized community-based approach is needed to achieve greater proactive and sustained collaborations between local health departments, local school systems, and other public and private organizations to pursue health equity. This article provides a summary of potential community-based health promotion strategies to address racial and ethnic disparities in COVID-19 outcomes and educational inequities among children and teens, specifically in the implementation of strategic partnerships, including initial collective work, outcomes-based activities, and communication. These collaborations can facilitate policy, systems, and environmental changes in school systems that support emergency preparedness, recovery, and resilience when faced with public health crises. |
Counties with High COVID-19 Incidence and Relatively Large Racial and Ethnic Minority Populations - United States, April 1-December 22, 2020.
Lee FC , Adams L , Graves SJ , Massetti GM , Calanan RM , Penman-Aguilar A , Henley SJ , Annor FB , Van Handel M , Aleshire N , Durant T , Fuld J , Griffing S , Mattocks L , Liburd L . MMWR Morb Mortal Wkly Rep 2021 70 (13) 483-489 Long-standing systemic social, economic, and environmental inequities in the United States have put many communities of color (racial and ethnic minority groups) at increased risk for exposure to and infection with SARS-CoV-2, the virus that causes COVID-19, as well as more severe COVID-19-related outcomes (1-3). Because race and ethnicity are missing for a proportion of reported COVID-19 cases, counties with substantial missing information often are excluded from analyses of disparities (4). Thus, as a complement to these case-based analyses, population-based studies can help direct public health interventions. Using data from the 50 states and the District of Columbia (DC), CDC identified counties where five racial and ethnic minority groups (Hispanic or Latino [Hispanic], non-Hispanic Black or African American [Black], non-Hispanic Asian [Asian], non-Hispanic American Indian or Alaska Native [AI/AN], and non-Hispanic Native Hawaiian or other Pacific Islander [NH/PI]) might have experienced high COVID-19 impact during April 1-December 22, 2020. These counties had high 2-week COVID-19 incidences (>100 new cases per 100,000 persons in the total population) and percentages of persons in five racial and ethnic groups that were larger than the national percentages (denoted as "large"). During April 1-14, a total of 359 (11.4%) of 3,142 U.S. counties reported high COVID-19 incidence, including 28.7% of counties with large percentages of Asian persons and 27.9% of counties with large percentages of Black persons. During August 5-18, high COVID-19 incidence was reported by 2,034 (64.7%) counties, including 92.4% of counties with large percentages of Black persons and 74.5% of counties with large percentages of Hispanic persons. During December 9-22, high COVID-19 incidence was reported by 3,114 (99.1%) counties, including >95% of those with large percentages of persons in each of the five racial and ethnic minority groups. The findings of this population-based analysis complement those of case-based analyses. In jurisdictions with substantial missing race and ethnicity information, this method could be applied to smaller geographic areas, to identify communities of color that might be experiencing high potential COVID-19 impact. As areas with high rates of new infection change over time, public health efforts can be tailored to the needs of communities of color as the pandemic evolves and integrated with longer-term plans to improve health equity. |
Summary of Guidance for Public Health Strategies to Address High Levels of Community Transmission of SARS-CoV-2 and Related Deaths, December 2020.
Honein MA , Christie A , Rose DA , Brooks JT , Meaney-Delman D , Cohn A , Sauber-Schatz EK , Walker A , McDonald LC , Liburd LC , Hall JE , Fry AM , Hall AJ , Gupta N , Kuhnert WL , Yoon PW , Gundlapalli AV , Beach MJ , Walke HT . MMWR Morb Mortal Wkly Rep 2020 69 (49) 1860-1867 In the 10 months since the first confirmed case of coronavirus disease 2019 (COVID-19) was reported in the United States on January 20, 2020 (1), approximately 13.8 million cases and 272,525 deaths have been reported in the United States. On October 30, the number of new cases reported in the United States in a single day exceeded 100,000 for the first time, and by December 2 had reached a daily high of 196,227.* With colder weather, more time spent indoors, the ongoing U.S. holiday season, and silent spread of disease, with approximately 50% of transmission from asymptomatic persons (2), the United States has entered a phase of high-level transmission where a multipronged approach to implementing all evidence-based public health strategies at both the individual and community levels is essential. This summary guidance highlights critical evidence-based CDC recommendations and sustainable strategies to reduce COVID-19 transmission. These strategies include 1) universal face mask use, 2) maintaining physical distance from other persons and limiting in-person contacts, 3) avoiding nonessential indoor spaces and crowded outdoor spaces, 4) increasing testing to rapidly identify and isolate infected persons, 5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19, 6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19, 7) protecting essential workers with provision of adequate personal protective equipment and safe work practices, 8) postponing travel, 9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and 10) achieving widespread availability and high community coverage with effective COVID-19 vaccines. In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic's economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool. Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible. |
Association Between Social Vulnerability and a County's Risk for Becoming a COVID-19 Hotspot - United States, June 1-July 25, 2020.
Dasgupta S , Bowen VB , Leidner A , Fletcher K , Musial T , Rose C , Cha A , Kang G , Dirlikov E , Pevzner E , Rose D , Ritchey MD , Villanueva J , Philip C , Liburd L , Oster AM . MMWR Morb Mortal Wkly Rep 2020 69 (42) 1535-1541 Poverty, crowded housing, and other community attributes associated with social vulnerability increase a community's risk for adverse health outcomes during and following a public health event (1). CDC uses standard criteria to identify U.S. counties with rapidly increasing coronavirus disease 2019 (COVID-19) incidence (hotspot counties) to support health departments in coordinating public health responses (2). County-level data on COVID-19 cases during June 1-July 25, 2020 and from the 2018 CDC social vulnerability index (SVI) were analyzed to examine associations between social vulnerability and hotspot detection and to describe incidence after hotspot detection. Areas with greater social vulnerabilities, particularly those related to higher representation of racial and ethnic minority residents (risk ratio [RR] = 5.3; 95% confidence interval [CI] = 4.4-6.4), density of housing units per structure (RR = 3.1; 95% CI = 2.7-3.6), and crowded housing units (i.e., more persons than rooms) (RR = 2.0; 95% CI = 1.8-2.3), were more likely to become hotspots, especially in less urban areas. Among hotspot counties, those with greater social vulnerability had higher COVID-19 incidence during the 14 days after detection (212-234 cases per 100,000 persons for highest SVI quartile versus 35-131 cases per 100,000 persons for other quartiles). Focused public health action at the federal, state, and local levels is needed not only to prevent communities with greater social vulnerability from becoming hotspots but also to decrease persistently high incidence among hotspot counties that are socially vulnerable. |
Addressing Influenza Vaccination Disparities During the COVID-19 Pandemic.
Grohskopf LA , Liburd LC , Redfield RR . JAMA 2020 324 (11) 1029-1030 Each year, influenza poses a substantial burden on communities and health care systems. During the 3 most recent influenza seasons (2016-2017, 2017-2018, and 2018-2019), influenza is estimated to have been associated with 29 million to 45 million illnesses, 14 million to 21 million medical visits, 490 600 to 810 000 hospitalizations, and 34 200 to 61 000 deaths each season in the US.1 During the fall of 2020, both influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; the virus associated with coronavirus disease 2019 [COVID-19]) are anticipated to circulate. |
Addressing health equity in public health practice: Frameworks, promising strategies, and measurement considerations
Liburd LC , Hall JE , Mpofu JJ , Marshall Williams S , Bouye K , Penman-Aguilar A . Annu Rev Public Health 2020 41 417-432 This review describes the context of health equity and options for integrating equity into public health practice. We first discuss how the conceptualization of health equity and how equity considerations in US public health practice have been shaped by multidisciplinary engagements. We then discuss specific ways to address equity in core public health functions, provide examples of relevant frameworks and promising strategies, and discuss conceptual and measurement issues relevant to assessing progress in moving toward health equity. Challenges and opportunities and their implications for future directions are identified. Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates. |
After the bell rings: Looking beyond the classroom to reduce inequalities in educational achievement and health outcomes
Liburd LC . J Public Health Manag Pract 2019 25 (6) 581-583 The relationship between educational achievement and health outcomes is well documented but not well understood.1,2 Hahn and Truman describe education as “a process and a product,” that is, the process of education occurs in multiple settings within and outside of the classroom, and the product of the educational process is “the array of knowledge, skills, and capacities (ie, intellectual, socio-emotional, physical, productive, and interactive) acquired by a learner through formal and experiential learning.”1(p2) Education is essential to achieving health equity. | According to the Center on Society and Health at Virginia Commonwealth University, | Americans with less education are—now, more than ever—dying earlier than their peers. Between 1990 and 2008, the life expectancy gap between the most and least educated Americans grew from 13 to 14 years among males and from 8 to 10 years among females. The gap has been widening since the 1960s.3 | In addition, adults with only a high school diploma can expect to die 9 years sooner than college graduates, and adults with less education are more likely to report having diabetes and heart disease and to have worse health overall.3 These and other health outcomes are associated with educational attainment. |
Entomological investigations during early stages of a chikungunya outbreak in the United States Virgin Islands, 2014
Kenney JL , Burkhalter KL , Scott ML , McAllister J , Lang FE , Webster S , Maduro DJ , Johannes J , Liburd A , Mutebi JP . J Am Mosq Control Assoc 2017 33 (1) 8-15 During the 2014 chikungunya (CHIK) outbreak in the Caribbean, we performed entomological surveys on 3 United States Virgin Islands (USVI): St. Croix, St. Thomas, and St. John. We aimed to evaluate the potential for chikungunya virus (CHIKV) transmission in the USVI. The surveys took place between June 19, 2014, and June 29, 2014, during the dry season in USVI. A total of 1,929 adult mosquitoes belonging to 4 species - Culex quinquefasciatus (68.4%), Aedes aegypti (29.7%), Ae. mediovittatus (1.3%), and Ae. sollicitans (<1%) - were detected. Environmental investigations showed that between 73% and 87% of the homes had containers that could serve as mosquito larval habitats. In addition, 47% of the homes did not have air conditioning and between 69% and 79% of homes showed evidence of frequent outdoor activity exhibited by residents. Taken together, these observations suggest a high potential for CHIKV transmission in USVI. The relative abundance of Ae. aegypti on St. John's, St. Thomas, and St. Croix was 21.0, 11.0, and 3.0 mosquitoes/trap per day, respectively, suggesting that the former 2 islands were at the highest risk of CHIKV outbreaks. Insecticide resistance testing detected high levels of resistance to malathion and permethrin in several local populations of Ae. aegypti on St. Croix Island, which suggested that these 2 insecticides should not be used during CHIK outbreaks. |
Epilogue
Liburd LC , Bouye KE , Penman-Aguilar A . MMWR Suppl 2016 65 (1) 68-9 In 1985, the Report of the Secretary's Task Force on Black and Minority Health was published after the federal government convened the first group of health experts to analyze racial/ethnic health disparities among minorities. This analysis, also known as the Heckler report, revealed higher illness and death rates among minorities. The year 2015 marks the 30th anniversary of the Heckler Report and presents an opportunity to evaluate and continue to improve minority health at the national, state, tribal, territorial, and local levels. |
Background and rationale
Penman-Aguilar A , Bouye K , Liburd L , Equity H . MMWR Suppl 2016 65 (1) 2-3 In 2011, CDC published the first CDC Health Disparities and Inequalities Report (CHDIR) (1). This report examined health disparities in the United States associated with various characteristics, including race/ethnicity, sex, income, education, disability status, and geography. Health disparities were defined as "differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes" (1). Among other recommendations, the 2011 CHDIR emphasized the need to address health disparities with a dual intervention strategy focused on populations at greatest need and on improving the health of the U.S. population by making interventions available to everyone. The 2013 CHDIR updated the 2011 CHDIR and included additional reports on social and environmental determinants of health; the supplement emphasized the importance of multisectoral collaboration, highlighting the need for a comprehensive, community-driven approach to reducing health disparities in the United States (2). A follow-up report described five interventions that were shown to be effective or demonstrated promise for reducing health disparities (3). These publications have focused attention on the need to address health disparities in the United States (4), as well as on programs and interventions that address them. This supplement describes additional interventions that address particular disparities observed by race and ethnicity, socioeconomic status, geographic location, disability, and/or sexual orientation across a range of conditions, including asthma, infection with HIV and hepatitis A, use of colorectal cancer screening, youth violence, food security, and health-related quality of life. |
Strengthening the science and practice of health equity in public health
Liburd LC , Ehlinger E , Liao Y , Lichtveld M . J Public Health Manag Pract 2016 22 Suppl 1 S1-4 Over the past decade, momentum to address social determinants of health (SDH) and health equity increased. Definitions of health equity are wide ranging. The US Department of Health and Human Services defines health equity as "attainment of the highest level of health for all people." The definition goes on to add, "Achieving health equity requires valuing everyone equally with focused an dongoing societal efforts to address avoidable inequalities, historical and contemporary injutsices, and the elimination of health and healthcare disparities." Achieving health equity then requires addressing SDH, "conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. |
Toward achieving health equity: Emerging evidence and program practice
Dicent Taillepierre JC , Liburd L , O'Connor A , Valentine J , Bouye K , McCree DH , Chapel T , Hahn R . J Public Health Manag Pract 2016 22 Suppl 1 S43-9 Health equity, in the context of public health in the United States, can be characterized as action to ensure all population groups living within a targeted jurisdiction have access to the resources that promote and protect health. There appear to be several elements in program design that enhance health equity. These design elements include consideration of sociodemographic characteristics, understanding the evidence base for reducing health disparities, leveraging multisectoral collaboration, using clustered interventions, engaging communities, and conducting rigorous planning and evaluation. This article describes selected examples of public health programs the Centers for Disease Control and Prevention (CDC) has supported related to these design elements. In addition, it describes an initiative to ensure that CDC extramural grant programs incorporate program strategies to advance health equity, and examples of national reports published by the CDC related to health disparities, health equity, and social determinants of health. |
Epilogue
Liburd LC , Campbell VA , Bouye KE . MMWR Suppl 2014 63 (1) 47-8 As racial and ethnic minorities constitute ever larger percentages of the U.S. population, the overall health statistics of the nation increasingly reflect the health status of these groups. Overcoming persistent health and health-care disparities that affect racial/ethnic minorities benefits the entire society. For example, the economic well-being of a nation relies on the health of its populace. According to one report, "The nation's dependence on an increasingly minority workforce means that healthy communities of color are vital to the nation's economic fortunes". Other U.S. population groups, such as persons with disabilities or special health-care needs, persons living in certain geographic locations, and persons with certain sexual identities or sexual orientations, also have higher rates of preventable morbidity and premature death, and efforts should be directed toward improving their health outcomes and eliminating health disparities. |
Background and rationale
Penman-Aguilar A , Bouye K , Liburd LC . MMWR Suppl 2014 63 (1) 3-4 In 2011, CDC published the first CDC Health Disparities and Inequalities Report (CHDIR). This report examined health disparities in the United States associated with various characteristics, including race/ethnicity, sex, income, education, disability status, and geography. Health disparities were defined as "differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes". Among other recommendations, the 2011 CHDIR emphasized the need to address health disparities with a dual intervention strategy that focuses on populations at greatest need and improves the health of the general population by making interventions available to everyone. The 2013 CHDIR included updates on most topics from the 2011 CHDIR and on new topics. Compared with the 2011 CHDIR, the 2013 CHDIR included more reports on social and environmental determinants of health and emphasizes the importance of multisector collaboration. The 2013 CHDIR highlights the need for a "comprehensive, community-driven approach" to reducing health disparities in the United States. |
Having their say: patients' perspectives and the clinical management of diabetes
Jack L Jr , Liburd LC , Tucker P , Cockrell T . Clin Ther 2014 36 (4) 469-76 Using an illness narratives framework, we provide 1 method that health care providers can use to obtain insight into the perceptions and experiences of their patients living with diabetes. We propose that understanding patients' cultural perspectives help explains their health behavior and can lead to more productive partnering between provider, patient, and community health resources that support adherence and improved health outcomes. We conclude with resources available to assist health care providers in their efforts to deliver culturally appropriate diabetes care and examples of culturally tailored community-based public health initiatives that have been effective in improving diabetes outcomes among African-American patients. |
Surveillance of health status in minority communities - Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009
Liao Y , Bang D , Cosgrove S , Dulin R , Harris Z , Taylor A , White S , Yatabe G , Liburd L , Giles W . MMWR Surveill Summ 2011 60 (6) 1-44 PROBLEM: Substantial racial/ethnic health disparities exist in the United States. Although the populations of racial and ethnic minorities are growing at a rapid pace, large-scale community-based surveys and surveillance systems designed to monitor the health status of minority populations are limited. CDC conducts the Racial and Ethnic Approaches to Community Health across the U.S. (REACH U.S.) Risk Factor Survey annually in minority communities. The survey focuses on black, Hispanic, Asian (including Native Hawaiian and Other Pacific Islander), and American Indian (AI) populations. REPORTING PERIOD COVERED: 2009. DESCRIPTION OF SYSTEM: An address-based sampling design was used in the survey in 28 communities located in 17 states (Arizona, California, Georgia, Hawaii, Illinois, Massachusetts, Michigan, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Virginia, West Virginia, and Washington). Self-reported data were collected through telephone, questionnaire mailing, and in-person interviews from an average of 900 residents aged ≥ 18 years in each community. Data from the community were compared with data derived from the Behavioral Risk Factor Surveillance System (BRFSS) for the metropolitan and micropolitan statistical area (MMSA), county, or state in which the community was located and also compared with national estimates. RESULTS: Reported education level and household income were markedly lower in black, Hispanic, and AI communities than that among the general population living in the comparison MMSA, county, or state. More residents in these minority populations did not have health-care coverage and did not see a doctor because of the cost. Substantial variations were identified in self-perceived health status and prevalence of selected chronic conditions among minority populations and among communities within the same racial/ethnic population. In 2009, the median percentage of men who reported fair or poor health was 15.8% (range: 8.3%-29.3%) among A/PI communities and 26.3% (range: 22.3%-30.8%) among AI communities. The median percentage of women who reported fair or poor health was 20.1% (range: 13.3%-37.2%) among A/PI communities, whereas it was 31.3% (range: 19.4%-44.2%) among Hispanic communities. AI and black communities had a high prevalence of self-reported hypertension, cardiovascular disease, and diabetes. For most communities, prevalence was much higher than that in the corresponding MMSA, county, or state in which the community was located. The median percentages of persons who knew the signs and symptoms of a heart attack and stroke were consistently lower in all four minority communities than the national median. Variations were identified among racial/ethnic populations in the use of preventive services. Hispanics had the lowest percentages of persons who had their cholesterol checked, of those with high blood pressure who were taking antihypertensive medication, and of those with diabetes who had a glycosylated hemoglobin (HbA1C) test in the past year. AIs had the lowest mammography screening rate within 2 years among women aged ≥40 years (median: 72.7%; range: 69.4%-76.2%). A/PIs had the lowest Pap smear screening rate within 3 years (median: 74.4%; range: 60.3%-80.8%). The median influenza vaccination rates in adults aged ≥65 years were much lower among black (57.3%) and Hispanic communities (63.3%) than the national median (70.1%) among the 50 states and DC. Pneumococcal vaccination rates also were lower in black (60.5%), Hispanic (58.5%), and A/PI (59.7%) communities than the national median (68.5%). INTERPRETATIONS: Data from the REACH U.S. Risk Factor Survey demonstrate that residents in most of the minority communities continue to have lower socioeconomic status, greater barriers to health-care access, and greater risks for and burden of disease compared with the general populations living in the same MMSA, county, or state. Substantial variations in prevalence of risk factors, chronic conditions, and use of preventive services among different minority populations and different communities within the same racial/ethnic population provide opportunities for public health intervention. These variations also indicate that different priorities are needed to eliminate health disparities for different communities. PUBLIC HEALTH ACTION: These community-level survey data are being used by CDC and community coalitions to implement, monitor, and evaluate intervention programs in each community. Continuous surveillance of health status in minority communities is necessary so that community-specific, culturally sensitive strategies that include system, environmental, and individual-level changes can be tailored to these communities. |
Foreword. REACH U.S. in action: inspiring hope, rewarding courage
Liburd LC . Fam Community Health 2011 34 Suppl 1 S2-6 I am writing this foreword just days after returning from the 20th International Union for Health Promotion and Education World Conference on Health Promotion in Geneva, Switzerland (July 11-15, 2010). The primary goals of the conference were to “build bridges between sustainable development and health promotion, the outreach of health in all policies, and the transfer of knowledge with long-term impact” (http://www.iuhpe.org). More than 2200 health promoters from 123 countries and all continents contemplated how we might achieve health equity and sustainable development in a global environment of overtaxed natural resources, struggling political economies, and competing ideologies about the way forward. Notable speakers from around the world described the interconnectedness between how we use the finite resources of the planet; policies governing globalization; social, political, and economic inequality within and between nation-states; and the people's health. Promising strategies were showcased, and provocative conversations reframing more traditional approaches to protecting the public's health were presented. Translate this broad thinking to the community level, and we see a snapshot of the day-to-day realities, experience, leadership, and community-based participatory approaches of Racial and Ethnic Approaches to Community Health Across the United States (REACH U.S.) in eliminating racial and ethnic health disparities. | This special issue of the Journal of Family and Community Health provides a much needed collection of community voices describing how they are working to transform their social environments—one victory at a time—to improve health outcomes in communities that are disproportionately affected by preventable premature death and treatable disability. In preparing the reader for this special issue, I first of all situate the work of REACH U.S. in the global movement to reduce health inequalities through attention to the social determinants of health. I describe how the REACH experience in addressing the social determinants of health reflects a familiar clash of interests of people at the nexus of industry (including art), politics, and science. In these articles, we discover through detailed case studies how local communities resolved some of these competing interests. At the end, I briefly broach the issue of culture as a social determinant of health, and how community health workers have been vital resources in eliminating health disparities as both cultural translators and frontline advocates for health equity. |
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