A Note from the Editor
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As our 20th year of continuous publication as a peer-reviewed journal draws to a close, this regular issue of JHCPU appears with a lengthy supplement titled Social Determinants of Children’s Health: The Developing World, sponsored by the Kellogg Foundation. The supplement spans the globe, reaching from sub-Saharan Africa to India, Taiwan, Central America, and the Caribbean. Guest Editors Gillian Barclay (Pan American Health Organization) and Camara Jones (Centers for Disease Control and Prevention) provide an overview of that important volume.
The regular issue begins with Heroes and Great Ideas Column from Stephanie Myers Schim, describing her annual trip to the Medicaid office in Detroit on behalf of her elderly father, who is in long-term care. The piece poignantly recounts the hurdles imposed by the present U.S. system of financing care for the very old. Next, the Association of Clinicians for the Underserved (ACU)’s column addresses the centrality of primary care in health care reform.
The Commentary by Homer Venters and Allen Keller near the beginning of the regular issue addresses major problems in the health care provided in the U.S. to immigrants held in detention. The authors write from their positions at the Bellevue/NYU Program for Survivors of Torture in New York.
Following these are three pieces in the area of Medical Education, all concerning student-run clinics. First, in a Report from the Field, two students (Steven Bishop and James Edwards) and a faculty member (Mohan Nadkarni) from the Univ. of Virginia’s medical school describe a student-run outreach to people who are homeless in Charlottesville and the surrounding rural areas. Next, a team from Philadelphia medical schools led by Brent Simmons describes the gaps in medical students’ knowledge concerning health disparities and health care access prior to working in a student-run free clinic. Next, we turn to the three thematic sections of the issue.
The remainder of this regular issue falls into three parts: Race/Ethnicity and HIV/AIDS, Primary Care, and Health Policy.
Race/Ethnicity and HIV/AIDS
Lopez and colleagues from the University of Nebraska investigated the impact of race/ethnicity on survival among HIV-infected patients in care, and document a wide disparity between African Americans and Whites in the Midwest, a disparity that was not eliminated after controlling for socioeconomic factors. Kinsler and colleagues from UCLA investigate the impact of acculturation on HIV-prevention among at-risk Hispanic people in Los Angeles County, finding that low levels of acculturation were associated with reduced preventive care. Finally, George and colleagues from Drew University and other institutions in Los Angeles investigated the types of social support HIV-infected people rely upon, finding that family and friends were most often [End Page vii] the sources of emotional, financial, and household-related support, whereas clinicians provided formal, illness-specific support.
Primary Care
The Primary Care segment of this issue begins with several Reports from the Field: Richard Christensen tells the story of his own history conducting street-based psychiatric outreach to homeless people with mental illness over the past 20 years. Diana Redwood and colleagues describe a flexible sigmoidoscopy program developed for use by rural nurse practitioners and physicians’ assistants in Alaska (Alaska Natives having elevated levels of colon cancer relative to the rest of the U.S. population).
Picking up on a theme introduced in the piece on immigrants in detention, Shah and colleagues from Montefiore Medical Center report on their investigation of the impact of arrest and incarceration on primary care patients. Well over half the 118+ patients surveyed had either been incarcerated themselves or had a close family member who had been incarcerated. The authors tested the acceptability to patients of inquiring about incarceration-related family history in clinical encounters, as there is evidence that the experience is clinically relevant. As the authors put it, “Our daily experiences as clinicians in the Bronx are replete with anecdotal evidence that having an imprisoned family member can be catastrophic to the family system.”
Glasnapp and colleagues also conducted research in urban clinics, carrying out a needs assessment by means of self-administered questionnaires completed by 796 clients...
