A Note from the Editor

As the country watches the 2008 presidential campaign take shape, with health care prominent on the horizon, many people soldier on without any care or without adequate care, their health often compromised by structural factors, awaiting policy that truly addresses their needs. Among the cornerstones of public policy in this area are the constructs of Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA), first introduced by federal legislation during the 1970s. In an important paper in the present issue, Thomas Ricketts and colleagues from the Sheps Center of the University of North Carolina at Chapel Hill describe the development of a theory-based, data-driven replacement for the HPSA and MUA designation systems. The authors write in the article published here, "The proposed rule changes were approved by the Secretary of Health and Human Services on March 26, 2007 and a 'notice of proposed rulemaking' will appear in the Federal Register sometime in 2007. After a 6-month comment and review period, which may result in modifications to the proposal, the final rule is scheduled for publication in early 2008." We are proud to be publishing this important paper.

In a related paper, Jiexin Liu asks whether, in addition to having fewer doctors, people in HPSAs suffer from worse health. Using survey data of 10,940 adult West Virginians, Liu finds that living in an HPSA is indeed associated with worse general health status, poor physical health, and less access to medical services (though not to inpatient care), confirming the intuitive rationale behind the construct of HPSAs.

Another topic addressed in the present issue is what Joshua Yang and Marjorie Kagawa-Singer of UCLA call ethnicity-specific care. Their Commentary concerns the advisability and feasibility of creating ethnicity-specific subsystems of care as a strategy for increasing access to care for cultural and linguistic minorities. They recount in depth the historical experiences of the Chinese community in San Francisco on the basis of systematic exploration of archival documents and semi-structured interviews. In doing so, they reconstruct the evolution of that community's ethnicity-specific health care infrastructure, including the origin and evolution of Chinese Hospital, and create an organizational development model for ethnicity-specific health care organizations and infrastructures. The authors conclude by making policy recommendations for developing ethnicity-specific sub-systems of care.

Nathan Consedine and colleagues from Long Island University in Brooklyn delve into a related question when they investigate whether the way a message concerning breast cancer screening is framed (in terms either of what one would gain by getting screened or of what one would lose by not getting screened) is associated in any clear way with the income level and/or ethnicity or race of the person to whom the message is directed. Contrary to expectation, they find no main effect for framing condition. Income proved an important moderator of framing effects, interacting with both condition and race to influence screening.

Also from New York, on the subject of care for immigrant populations as part of medical education, Robert Karp and colleagues from the State University of New York (SUNY) Downstate Medical Center in Brooklyn report on a program addressing pediatric residents' knowledge, awareness, and practices around patients' immigration status and eligibility for government funded health and nutrition benefits. After assessment and training of the residents, the faculty used posters to remind them and their clinic's largely immigrant population about immigrants' rights to care. Another report concerning health professional students comes from Carmen Patrick Mohan and Arun Mohan. They describe the HealthSTAT model of professional development, a student-run advocacy program that uses team-based leadership and peer-to-peer learning to cultivate inter-professional collaboration and community partnership in service to the poor and underserved of Georgia. Also in the area of medical education, Mina Silberberg and colleagues from Duke University report on a clinic run by a federally-qualified health center and Duke's medical center. Showing how the clinic expands the community's primary care capacity, combining advantages of big and small settings, and of its dual affiliation, the authors present a workable system that similar town...