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  • A Note from the Editor
  • Virginia M. Brennan, PhD, MA

Medically underserved populations form a heterogeneous group. Understanding what the problems of the underserved are and how to solve them requires many different tools. The prize of justice in opportunities for life and health, so intuitively desirable, eludes capture in complex and overlapping ways. Two parts of the present issue of JHCPU concern particular populations: Part 1 concerns Rural and American Indian Populations and Part 3 concerns Children and Adolescents. The other two parts relate to policy and economics: Part 2 concerns Costs of Health and Health Care and Part 4 concerns Health Policy and Care Administration. The whole forms a circle throughout which the theme of mental health recurs.

The issue begins with Heroes and Great Ideas Column from Dr. Clifton Dummett on the occasion of the American Dental Association’s Sequicentennial (150th) Anniversary. Next, the Association of Clinicians for the Underserved (ACU)’s column addresses the issue of stress in the workplace and its effect on retaining caregivers and staff in safety-net settings. Following these is a Commentary by JHCPU Editorial Board Member Bailus Walker and his colleague at Howard University College of Medicine, Charles Mouton, responding to the recent Josiah Macy Foundation report on medical education. Next, we turn to the four thematic sections of the issue.

Rural and American Indian Populations

Food insecurity occurs when people are uncertain about or limited in their ability to secure adequate nutritious food in socially acceptable ways. Perhaps surprisingly, given their often agricultural economies, rural areas have higher rates of food insecurity than non-rural areas: for example, in the year ending in September 2001, the prevalence of food insecurity was 11.5% in nonmetropolitan households, 10.7% nationally, and 7.7% in metropolitan households outside central cities.1 To explain such facts, researchers have investigated the effects of the relatively high cost of food in rural areas, the scarcity of supermarkets, a tendency for rural people not to avail themselves of assistance through the Food Stamp Program, and mothers having more chronic health conditions than average.2 Megan Lent and colleagues from Cornell University, in the present issue, report on a longitudinal study of food insecurity in 29 low-income families in rural upstate New York. The team found that, over the course of three years, families that were food-insecure tended to remain so in cases where the mother suffered from depression or another serious mental illness. The authors identify three avenues along which this correlation was effected, all relating to employment: the mother’s condition prevented her from holding a job; the mother’s condition prevented another adult in the house from securing employment; or the children’s related behavioral problems precluded placing them in day care which in turn precluded the mother from holding a job. This finding gains added force from the fact that rural residents are at a disadvantage [End Page vii] relative to others for mental health treatment, as Petterson and colleagues report here, regardless of race or ethnicity.

The scarcity of health services common in rural areas may become more pronounced as people opt in favor of non-rural hospitals, even when other factors (such as proximity, size, and number of services offered) are held constant. (See the paper by Escarce and Kapur in the present issue.)

American Indians and Alaska Natives (AI/ANs) have profiles for such serious conditions as cancer, heart disease, and stroke much worse than those of the general population. Studying a large (more than 10,000) cohort of AI/ANs, Slattery and colleagues found a connection between having a family history of a condition and behavioral risk factors: people who had family histories of one of the conditions listed also were more likely than others to have risk-related traits such as smoking cigarettes and being overweight. Another research group developed a survey, the Choctaw Nation American Indian Health Survey, and field-tested it among nearly 700 respondents, finding it had good internal consistency. (See Weidmer-Ocampo et al., this issue.)

Costs of Health and Health Care

Everyone—individuals, businesses, providers, hospitals and clinics, and the government—has problems with the costs of health and health...

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