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404 Review HEALTH ISSUES IN THE BLACK COMMUNITY Edited by Ronald L. Braithwaite, Ph.D. and Sandra E. Taylor, Ph.D. 372 pp. San Francisco: Jossey-Bass, 1992. $39.95 (cloth) Editors Ronald BRArmwAiTE and Sandra Taylor have compiled a very valuable, easily read volume of writings on a wide range of topics related to the health of African-Americans. With chapters by well-known and wellrespected authors, including Joycelyn Elders, Deborah Prothrow-Stith, Elijah Saunders, and Faye Waddleton, the book takes the reader on an important journey laying out the statistical differences between African-Americans and whites on a variety of health conditions, and then covers causes and possible solutions for these conditions. The first section of the volume consists of four chapters providing demographic data on African-Americans and their health status today. The next two sections address virtually all of the crucial health issues which affect black Americans to a disproportionate degree, including hypertension, diabetes, homicide/violence, and AIDS. Several of these chapters provide excellent, concise coverage of important health conditions, while written in language appropriate for clinicians and interested lay readers alike. The chapters on hypertension, diabetes, lead poisoning, and sickle cell anemia are among the best and most readable discussions of all aspects of these conditions that I have seen. Another important contribution of this portion of the book is the redefinition of many important issues—issues traditionally viewed as social problems —as public health concerns. These include homelessness, substance abuse, and violence. For example, Drs. Deborah Prothrow-Stith and Howard Spivak, in their chapter on violence and homicide, make the point that the current approach of the criminal justice system to the epidemic of violenœ—responding to a violent episode after it occurs and then focusing the response on blame and punishment—simply is not working. They stress that public health strategies, including informational campaigns, educational curricula, and schoolbased prevention programs, are eminently applicable to this problem. The third portion of the book, "Health Education and Resource Development ," is a collection of disjointed but generally interesting and important chapters. Although some of these sections repeat information provided elseJournal of Health Care for the Poor and Underserved · Vol. 4, No. 4 · 1993 ___________________________________________________________405 where in the book, the chapters on health promotion strategies and community coalition-building are quite valuable. In the section on health promotion strategies, Collins Airhihenbua stresses the need to recognize that AfricanAmerican culture differs from white culture—a concept to keep in mind when devising health promotion and disease prevention programs for AfricanAmerican communities. This is an important point, for while African-American culture is certainly not monolithic, more effort needs to be made to develop culturally appropriate interventions. This point is further developed in the chapter on coalition building, where Ronald Braithwaite discusses the need for community empowerment, taking the form of involvement in the entire process of public health. He stresses the need for affected communities to be in on the development of public health policies from the beginning, playing a major role in identifying important health problems, suggesting intervention strategies, and working with health experts to implement them. Without this involvement, he stresses, success is unlikely. In all of the discussion of developing strategies for the African-American community, however, I was surprised to find no mention of the immoral Tuskeegee experiment, in which U.S. Public Health Service researchers studying the course of untreated syphilis deceptively told hundreds of syphilitic black men that they were being treated for the disease— a study that lasted for decades and did not end until 1971. The legacy of mistrust left by this study (along with other racially biased policies) still has very significant ramifications, and it would have been interesting to see this issue covered in the book. Throughout the book, black/white health disparities, many of them glaring , are generally well-supported with statistics and studies. Taken as a whole, this volume gives conclusive evidence that blacks receive less than adequate care in many areas of health, including mental health. The point is also made in several chapters that the health problems of black women have not received the attention they deserve, perhaps due in part to the fact...


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