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Vulnerable Populations in the United States, 2nd Edition

Leiyu Shi, Gregory Stevens

ISBN: 978-0-470-59935-8 December 2010 Jossey-Bass 352 Pages


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, the second edition of this landmark text offers a general framework for students, researchers, practitioners, and policymakers for learning about vulnerable populations. It contains in-depth data and information on major health and health care disparities by race or ethnicity, socioeconomic status, and health insurance coverage. It is thoroughly updated to include the latest data and trends and provides a detailed synthesis of recent and increasingly expansive programs and initiatives to remedy these disparities. To keep current with recent trends it incorporates the latest Healthy People 2020 objectives, includes new sections on real-world clinical examples, and discusses the impact of health care reform on vulnerable populations. The book's Web site includes instructor's materials that may be downloaded.

Praise for the First Edition of Vulnerable Populations in the United States

"An excellent primer for undergraduates and graduate students interested in vulnerable populations and health disparities."
New England Journal of Medicine

"Combines thoughtful, coherent theory with a large amount of information available in a single source. It will prove to be a valuable resource for policymakers, researchers, teachers, and students alike for years to come."
Journal of the American Medical Association

"A very worthwhile read for health care administrators, health policy analysts, public health and health promotion practitioners, students of public health, and health researchers."

"It makes clear that, for political, social, and economic (as well as moral) reasons, the country must increasingly make vulnerable populations a national health policy priority."
Journal of Health Care for the Poor and Underserved

"I have reviewed a number of books looking for meaningful content to help my students understand and work with vulnerable populations. This is the most comprehensive, yet understandable book on the topic."
Doody's Reviews

"Provides much-needed guidance to policymakers challenged with providing solutions to this embarrassing issue in the United States."
F. Douglas Scutchfield, MD, Peter P. Bosomworth Professor of Health Services Research and Policy, University of Kentucky

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Figures, Tables, Exhibits xi

Preface xvii

The Authors xxiii

1 A General Framework to Study Vulnerable Populations 1

Learning Objectives 1

Why Study Vulnerable Populations? 3

Models for Studying Vulnerability 8

The Vulnerability Model: A New Conceptual Framework 18

Summary 33

Key Terms 33

Review Questions 34

Essay Questions 34

2 Community Determinants and Mechanisms of Vulnerability 35

Learning Objectives 35

Race and Ethnicity 36

Socioeconomic Status 49

Health Insurance 72

Multiple Risk Factors 85

Summary 90

Key Terms 91

Review Questions 91

Essay Questions 92

3 The Influence of Individual Risk Factors 93

Learning Objectives 93

Racial and Ethnic Disparities 94

Socioeconomic Status Disparities 110

Health Insurance Disparities 124

Summary 135

Key Terms 135

Review Questions 135

Essay Question 136

4 The Influence of Multiple Risk Factors 137

Learning Objectives 137

Health Care Access 141

Quality of Health Care 152

Health Status 164

Summary 176

Key Terms 176

Review Questions 177

Essay Questions 177

5 Current Strategies to Serve Vulnerable Populations 179

Learning Objectives 179

Programs to Eliminate Racial and Ethnic Disparities 185

Programs to Eliminate Socioeconomic Disparities 198

Programs to Eliminate Disparities in Health Insurance 209

Summary 217

Key Terms 218

Review Questions 218

Essay Questions 218

6 Resolving Disparities in the United States 221

Learning Objectives 221

The Healthy People Initiative 222

Framework to Resolve Disparities 230

Resolving Disparities in Health and Health Care 234

Integrative Approaches to Resolving Disparities 256

Challenges and Barriers in Implementing the Strategies 267

Course of Action for Resolving Disparities 272

Summary 281

Key Terms 281

Review Questions 282

Essay Questions 282

References 283

Index 313