Multicultural Medicine and Health Disparities David Satcher, Rubens J. Pamies and Nancy N. Woelfl, eds; New York: McGraw-Hill, 2006; ISBN 0-07-143680-4; $59.95
Health disparities are an acknowledged fact in American life, so much so that reducing health disparities is one of the two overarching goals in Healthy People 2010. Multicultural Medicine and Health Disparities presents 34 chapters written by a variety of guest experts which function as stand-alone essays on different aspects of health disparities in the United States. The first chapter, by Hani K. Atrash and Melissa D. Hunter, is an excellent introduction to the subject of health disparities (as defined by this volume). Topics covered include an overview of health disparities, sources of data, problems with racial and ethnic classification, factors which may be related to the observed disparities, and a review of some programs and interventions addressing health disparities. Subsequent chapters vary somewhat in content and approach but most follow the same general format: they introduce the topic, summarize relevant information and conclude with an ample reference list; many also include recommendations for reducing disparities and some include case studies. Many of the chapters cover standard topics such as black/white differences in morbidity and mortality, and the importance of cultural competence for healthcare workers. Others are more unusual, including chapters on disparities in bioterrorism preparedness, faithbased initiatives to improve health and the role of community health centers in minority health. A complete list of the chapters may be found at: http://books.mcgraw-hill. com/getbook.php?isbn=00714368 04&template=#toc.
This is an excellent reference volume and textbook. Given the definition of 'health disparities' and 'multicultural' used by the volume's editors, it's hard to think of topics which have not been included. The presentation of information is straightforward and makes excellent use of tables and graphics. My main criticism is the limited range of subject material in terms of what is considered a 'culture' and what groups are considered in defining a disparity.
A health disparity is a difference in occurrence or outcome in some health condition or health behavior among =2 groups of people. The number of possible ways to define groups for this type of comparison is virtually endless: race and ethnicity, age, gender, disability status and geographic residence are just a few of the possibilities. Multicultural Medicine and Health Disparities concentrates on disparities among population groups as defined by race and ethnicity. In this choice, it follows the frame of reference used by the Institute of Medicine's Committee on Understanding and Eliminating Racial Ethnic Disparities in Health Care, formed in 1999. Similarly, 'multicultural' within this text refers to cultures defined primarily by race and ethnicity, rather than, for instance, deafness or sexual preference.
The investigation of racial and ethnic health disparities is a worthy subject and is the easiest type of health disparity to study because of the wealth of national data available that links racial and ethnic classifications to information about health behaviors, access to healthcare, and morbidity and mortality. Because Multicultural Medicine and Health Disparities does an excellent job summarizing information concerning racial and ethnic disparities in healthcare, it will probably be the definitive statement on that topic for years to come. Unfortunately, because of its excellence, it may be seen by many as defining not just the field of racial and ethnic health disparities-but health disparities in general-so that topics omitted (for instance, inequality in healthcare for gay men and lesbians) or treated only briefly (for instance, urban/rural differences) will not be included in future discussions of health disparities.
[Author Affiliation]
Reviewed by
Sarah Boslaugh, PhD, MPH
BJC HealthCare
St. Louis, MO
