Change and Constancy
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This issue marks the close of the 29th volume of JHCPU and the approaching close of 2018. While the policies and politics of health care in the United States keep shifting, especially as a result of the Patient Protection and Affordable Care Act of 2010 (ACA), work on the well-being of low-income and underserved populations moves steadily forward. Indeed, since the late 1980s—when the conference that gave rise to the first issue of this journal took place at Meharry Medical College (still our editorial home)—much has changed, while the fact of inequity in health and health care between marginalized and mainstream population groups persists as constantly as the Northern Star.
From our point of view, for example, HIV/ AIDS has changed dramatically as the virus has rapidly spread into low-income and minority communities that appeared early on in the epidemic to have been spared. Pharmaceutical interventions such as PrEP and PEP, as well as HAART, have also changed prevention and treatment protocols for HIV/ AIDS during the life of this journal. The paper by Tobin, Winiker, and Smith on the priorities of older Black men who have sex with men serves as an apt symbol for this whole world of changes as the felt need for HIV prevention settles in with financial stability and permanent housing as long-term requirements for healthy lives.
Increasingly, too, Transgender and Genderqueer communities are sounding the cry for reforms to the health care their members receive. The paper by Baldwin and colleagues in this issue explores the experiences of sexual minority group members in health care encounters—experiences that can very directly determine whether or not the patient continues to receive care at all, and hence the course of their health throughout the lifespan.
The ACA itself continues to evolve, but its success in shoring up care for lower-income people who newly qualify for Medicaid under its provisions appears clear: Evidence in this connection comes from Mahmoudi and colleagues who report increases in having a usual source of care, checkups, and use of preventive care among such swaths of the population.
Related to this, two papers in this issue investigate a domain left largely unchanged by the ACA: oral health, especially of older people and others in long-term care settings. Walgama and colleagues argue on the basis of their research into the oral health of people living in long-term care settings that there is a crying need for standards of oral health care in long-term-care settings that can shape both federal and state policies in this connection (policies that presently suffer from variety best described as hodge-podge). Northridge and colleagues investigate the oral health profile of people visiting senior centers (with a particular focus on people with diabetes) in terms of insurance status. The results, again, form only lightly traceable patterns and underscore the need for oral health care coverage among people qualifying for Medicaid. [End Page ix]
Two important literature reviews in this issue come to related conclusions: the research conducted in some areas must become more complex and more nuanced. Reno and Hyder find that the study of risk factors for infant mortality (IM)—a site of wide racial/ ethnic disparities in the U.S. and even wider disparities between high-income countries and low-and middle-income countries—must be enhanced by more complex system-level analyses exploring the social determinants of IM. Brown and Chatterjee, too, in studying the literature on dietary patterns of homeless families, conclude with a call for more stratified research on the topic.
In these respects, then, research as well as policy must bring more sophisticated tools to the task of studying and finally eliminating health inequities.
The papers mentioned specifically here will, we hope, encourage every reader to scan through the many other papers included in this issue for topics of special interest. They include an assessment of how a nurses' strike in Kenya affected childhood immunization rates (Njuguna) and another of why and when Guatemalans use medicinal plants to treat diabetes (Andrews). A number cast a hopeful eye on programs that are working...
