A Note from the Editor

As we move closer to the U.S. presidential election of 2012, and work in light of the June U.S. Supreme Court decision affirming, overall, the Patient Protection and Affordable Care Act (ACA) of 2010, an army of dedicated scholars and clinicians continues its assault on inequities in health, the massive and complex set of imbalances that make this journal necessary and important. In this issue, we present work on four themes (the themes are organized only in terms of article type rather than separated into separate sections):

• Theme 1—Cross-Cultural and International Care

• Theme 2—The Safety Net

• Theme 3—Epidemiology, Measurement, and Other Public Health Topics

• Theme 4—Health Policy

Theme 1—Cross-Cultural and International Care. Six articles fit into the area of cross-cultural and international care. A Report from the Field by Weissman and colleagues describes the two-sided success of free, student-run health initiatives, which provide much needed medical care and teach students about cross-cultural caregiving and systems-based medical practice. In a Commentary, Fernando DeMaio argues for three research priorities on concerning immigrants to Canada: incorporating context into data collected, conducting comparative international studies, and refining the constructions of race and ethnicity to reflect recent developments in social theory.

In another Commentary, Perry Payne calls the question of whether the U.S. Federal government is correct in saying there are mandates to follow National Standards for Culturally and Linguistically Appropriate Services, given that they are often not followed and have even been referred to as voluntary by government officials. Having sketched out the actual state of affairs, Payne goes on to explain why such standards are indeed important, specifically for populations with limited English proficiency. In a related Brief Communication, Shippee and colleagues analyze data from nearly 2,500 Hispanic/Latino, Hmong, and Somali enrollees of public health insurance programs in Minnesota. Unsurprisingly, the Hmong and Somali people experienced much more unmet need for interpreter services than the Latinos.

Chisholm-Staker and colleagues take on the grave issue of human trafficking (or, slavery) in their report on training of emergency room (ER) providers about how to look for and probe patients who may be living as slaves. The ER, the authors convincingly argue, may be one of the few places where care providers and victims of human trafficking come face to face, and thus offers an important opportunity for righting a fundamental wrong.

Njuguna and colleagues from Kenya assessed malaria curative services in Ijara District (in the Northeast of Kenya). They report that all the facilities they studied had the recommended drugs, but only 90% had injectable quinine, and that all facilities lacked rapid diagnostic tests and several other critical components of the malaria-fighting toolkit.

Theme 2—The Safety Net. The core of this issue consists of papers about the so-called safety net, the generally uncoordinated panoply of caregivers, sites of care, and sources of financing to which people who lack private medical resources turn for preventive, maintenance, illness-induced, and catastrophic care. While this journal could hardly function without the term safety net, readers should always read it skeptically: saying there is a safety net counter-factually implies that the net (1) catches everyone who falls ill, and (2) prevents those it does catch from suffering due to their lack of other resources. It does neither. Having said that, however, the safety net does a lot of good in the U.S., and readers of this issue will learn much about its strengths and some of its weaknesses.

Masi’s Commentary on Promise Neighborhoods directs our attention to a the U.S. Department of Education’s program to provide coordinated services for children living in poverty, modeling the program after Geoffrey Canada’s ambitious Harlem Children’s Zone. Masi presents the case based on rapidly accumulating evidence that children experience health benefits when immersed in highly nurturing educational environments. Anderson and Olayiwola’s Commentary concerns patient-centered medical homes and the pressing need to strengthen the federal community health center program (as the ACA will do).

Coordination of primary care and specialty care...