- A Note from the Editor
This journal stands at the intersection of health sciences and social structures, making it inherently (if not transparently) political. The current issue of the Journal hits the newsstands, as it were, immediately after the hotly contested 2004 U.S. presidential election. Writing in advance of Election Day, the Journal staff bears in mind the fact that our work will proceed on course regardless of the election's outcome (a consideration that does not prevent us from wishing we could see the future).
The papers in this issue represent central areas of current interest concerning health in medically underserved communities. The lead editorial, by three members of the Journal's Editorial Board (Bailus Walker, PhD; Vickie Mays, PhD MSPH; and Rueben Warren, DDS, MPH, DrPH), sets the stage by developing the view that the elimination of racial and ethnic health status disparities requires a re-orientation of public health from the relatively narrow confines of individual behavior and access to health care to the broader landscape encompassing local and global environmental, economic, and educational factors as well.
This view is reinforced by Lu et al.'s paper, where the central finding is that health behaviors and health insurance coverage accounted for only 10-16% of the socioeconomic differences in health in the population covered by the Kentucky Behavioral Risk Factor Surveillance System for 2000. One example of another sort of factor affecting health emerges in Legg et al.'s paper, where it is reported that women with self-reported cognitive limitations were 30% less likely than their unimpaired counterparts to have gotten a mammogram in the past year. Kennedy's ACU Column makes the point that mental and physical health and health care should always be considered in tandem. The stark facts about excess deaths among African Americans in Philadelphia presented in Robbins and Webb's paper bring home strongly the message that racial and ethnic health disparities must be addressed more effectively than they presently are.
Another member of our Editorial Board, Daniel Blumenthal, MD, MPH, joins Erwin and colleagues to report on a collaboration among academic and community partners in Atlanta to develop an academic pipeline to funnel more African American students into the health professions, where they are strongly underrepresented nationally. Reed and Davis, in their article on Chicago's Jane Dent Home, delve into the history of one African American community, drawing on oral history and primary written records to tell the story of how a home for the aged was founded in 1893, was sustained by the community for nearly one hundred years, and finally closed under the combined pressures of increased regulation and competition from for-profit nursing home ventures seeking to take advantage of newly available Medicaid payments. Reed and Davis go on to lay out the differences between contemporary neighborhoods in the Chicago area where for-profit and not-for-profit nursing homes are located. [End Page v]
Another set of articles in this issue concerns community-level efforts to address health-related problems of the medically underserved. Goepp et al. report on messages received from members of the community where they were attempting to employ community health workers to alter a pattern of low-acuity use of emergency departments, concluding that intangible psychosocial factors and practical complexities of poverty were powerful promoters of low-acuity visits. The messages from the community led the authors to re-think their own starting assumption (one that is widely made) that the pattern of low-acuity use of the emergency department is a case of misuse of the health care system.
Soller and Osterberg report on the strong desire for more patient education and social worker consultation among patients at one free clinic and develop ideas for taking advantage of the opportunity such desires present to the clinician. Mott Keis et al. describe the patient population at three free community clinics in Massachusetts, reporting that the majority are low-income, uninsured and female; that the majority used the free clinic because of lacking insurance; and that the majority would not know where to go if the clinic were not available. The problem, Mott Keis et...