A Note from the Editor
Buy Issue for $25 at JHUPThe end of this month marks one year since Hurricane Katrina hit land in the United States and opened a window for the world on the country's bedeviling social imbalances, most striking with respect to race, all of which bear on public health. We would like to remind readers that the deadline for submissions to our special issue on the theme of Hurricanes Katrina, Rita, and Wilma and their Public Health Implications is September 1st. We welcome your papers (to JournalSubmission@mmc.edu) and your questions (to JournalQuestion@mmc.edu). Our hope is that this volume of research papers, essays, and reports will stand for many years to come as a collection reflecting what scholars, providers, and national leaders learned in the year since the disaster and the opportunities that it continues to present for improving public health.
Social groupings of many sorts are the focus of the present volume. Several important papers concern African Americans centrally. In a comparative analysis of two large datasets (the Harlem Household Survey and the Pitt County, North Carolina Study of African American Health) Geronimus and colleagues investigate why impoverished African American youth living in rural areas in the U.S. have a dramatically better chance of living until age 65 years than their counterparts living in cities. Perhaps surprisingly, they find that the two groups have similar chronic disease profiles and that comparable proportions take up smoking. However, the rural youth are better off in that they have better access to health care and private insurance than their urban counterparts and in that they are more likely to quit smoking.
A paper from the San Francisco Department of Public Health also concerns diminished life expectancy for a particular African American population, in this case African Americans with HIV/AIDS in comparison with people with HIV/AIDS of other races and ethnicities. Jain, McFarland, and colleagues, analyzing mortality data for people with AIDS in San Francisco between 1996 and 2002, report that the gap in life expectancy separating African Americans from people of other races/ethnicities (Whites, Latinos, and Asians/Pacific Islanders) has widened since the inception of widespread use of highly active antiretroviral therapy (HAART) during the period studied. Importantly, many of the causes of this disparity (e.g., differences in the availability of HAART, availability of private insurance, early and frequent testing for HIV, and aggressive case management) are amendable to intervention.
Racial/ethnic and sex disparities in heart disease treatment (specifically, the decision to conduct coronary revascularization or not) provide the topic of Barnhart et al.'s paper. After a careful analysis of provider's perceptions of heart disease patients, the authors conclude that complex social interactions, influenced by both the physician and the patient, contribute to disparities in cardiac care. To cite just [End Page v] one example, family medicine and female physicians perceived variables pertaining to patients' socioeconomic status or lifestyle (e.g., financial barriers, being unlikely to adopt healthy behaviors) as precluding some patients from being revascularized. The authors model beautifully how to treat some of the complex yet subtle origins of health disparities in this paper.
In a study of African American subjects, Laurence and colleagues investigate the relationship between a person's sense that others control their dental health (external dental locus of control) and dental health, finding that the higher an individual's sense that the control is external, the greater the likelihood that the person would suffer from untreated tooth decay. The study group included people with sickle cell disease (SCD) and the control group people without SCD; both groups patterned the same with respect to the study question.
Long and colleagues, like Geronimus, study urban-rural differences, in their case looking at access to and use of health care among Medicaid beneficiaries and low-income privately insured patients. With data from three years of the National Survey of...
