Health Policies and Black Americans (review)

422 Review HEALTH POLICIES AND BLACK AMERICANS Edited by David P. Willis. 531 pp. New Brunswick, NJ: Transaction Publishers, 1989. $23.95 (paper). Health Policies and Black Americans is a collection of 18 articles that form a comprehensive contemporary analysis of the health needs and resources of African-Americans, and of the policies that have been used to shape health interventions to this population. In their first incarnation, these articles appeared in 1987 as a spedal supplement to volume 65 of TheMUbank Quarterly. Now in a single volume, they accomplish Willis's stated intention "to examine the relationship between policy and the distribution of needs and effects in a general way." The book is arranged in seven sections, the first of which addresses the obligatory definitional dilemmas. The three articles in this initial section explore the quality of life for American blacks over the past two decades, black demographic trends, and research methods. The second section examines pertinent methodological issues involved in measuring the health status differences of blacks and whites, and then examines several studies investigating morbidity and mortality differences between blacks and whites. The third section surveys the historical funding for personal health services through private-sector options and through the federal government, with reference made to recent attempts to shift the burden of funding health initiatives to the private sedor. The remainder of the book, sections four through seven, focuses on particular policy initiatives (e.g., the community mental health movement, gaps in access and delivery of pap smears); selected high-risk populations (workers, elderly blacks, adolescent mothers); racial dimensions of attitudes and policies surrounding the AIDS epidemic, with a concentration on blacks and Hispanics; and conclusions. The authors provide a broad range of perspectives and experience. Such well-known contributors as Karen Davis, Ronald Andersen, Ruth Hanft, and Harold Neighbors join contemporary minority researchers ranging from Marsha Lillie-Blanton and Llewellyn Cornelius to Claudia Baquet and Neil Powe. The tables and graphs accompanying several articles help make figures Journal of Health Care for the Poor and Underserved, Vol. 1, No. 4, Spring 1991 ___________________________________________________________423 and relationships more easily understood. Some readers may find some of the more clinically oriented or research-related articles a little difficult to follow, but the book includes material accessible to lay readers as well. Health Policies and Black Americans provides the type of policy overview that is helpful to those who are actively involved or interested in minority health issues (e.g., graduate students, practitioners, administrators, researchers, and policy makers), from the perspectives of both health services research and health policy formulation. Articles by Doris Wilkerson and Gary King ("Conceptual and Methodological Issues in the Use of Race as a Variable: Policy Implications") and Andersen, Cornelius, and Ross Mullner ("Black-White Differences in Health Status: Methods or Substance?") should help researchers design better studies of black/ white differences in health status, which in turn should yield a more accurate picture of these discrepancies. The policy reviews provide historical background on previous policies and analyses of selected contemporary health policy interventions, indicating to readers the authors' interpretations of whether these interventions have succeeded. The concluding synthesis by S.M. Miller tackles the difficult job of addressing some of the broadest (and most controversial) questions surrounding race and health in America. One perennial issue to emerge from the debate over health status and race is the relative impact on health status of race versus social class. It is refreshing to see this book largely refrain from adopting the (in my view, narrow) approach that differences in health status between whites and blacks are really attributable to differences in class or income. Instead, the book maintains a more balanced view, acknowledging that while the effects of class do, in part, explain some portion of the differences in health status, there are also race effects exclusive of class that influence these differences. Indeed, Miller views the debate over class versus race as a "political-value issue." Implementing policy based on the dass model would focus on the education and training of blacks to mainstream them into the larger (and largely unchanged) American sodety. However, implementing policy based on the race model would involve a more...