Abstract
This book is volume 27 in the Research in the Sociology of Health Care series. The volume includes 14 articles that reflect the developing methods and conceptual frameworks for understanding why and how personal characteristics and social location influence receipt of health care, health outcomes, and health behaviors. The introductory chapter offers a quick synopsis of theoretical views explaining why the United States has such significant health disparities and why income and education have been the focus of much sociological research in this area. It also includes a review of some of the efforts by the government and private foundations to identify health disparities in various demographic groups and how these disparities are manifested in the system (access, interaction with providers, diagnosis, quality of care, chronic illness, etc.). Kronenfeld points out that knowledge about why disparities continue to exist is still lacking, and the following four sections help move this project forward.
Section II focuses on factors related to racial and ethnic inequalities in health care. Taken together, this group of readings shows how inadequate many of our measures have been in trying to understand the role of race and ethnicity in health care encounters. The first selection raises questions about how we measure race and finds that using only self-identification measures of race may not expose the role of discrimination in clinical encounters that occur as a result of perceived race of the patient. Other readings in this section tease out the impact of subjective versus objective measures of noncompliance in various racial and ethnic groups and the reasons for deciding not to follow doctors’ recommendations; how various aspects of primary care quality are influenced by race, ethnicity, and English language proficiency in children with Medicaid insurance; and how race and class effect the use of long-lasting or short-term methods of contraception. One other piece in this section provides an overview of social factors, and the use of complementary and alternative medicine but race and ethnicity are only briefly discussed. These articles demonstrate the need to continue to refine measures and think more broadly about categories of measurement and how to untangle race and ethnicity from other related variables (education, income, insurance status, language, etc.).
The three readings in section III raise many questions about how social economic position and cultural capital are related to various aspects of health inequalities. The articles in this section can be used to expand methodological and theoretical discussions about the pieces in the previous section. The first piece is a literature review of research on the possible pathways between education and health that would be useful to consider alongside the article on education and use of long-acting contraception. Another article on cultural capital and compliance in kidney dialysis patients would pair nicely with the earlier reading on race and compliance and encourages a discussion of how race and cultural capital are linked. The third article in this section uses measures of income and occupation but not education in assessing childhood poverty on self-management of heart disease later in life, thus provoking a discussion of the importance of education as an explanatory variable.
Section IV looks at two very different aspects of how providers of care reinforce disparities in treatment. The first assesses whether high rates of deficiencies in long-term care facilities are the result of strong enforcement standards or simply ongoing poor quality. The second selection utilizes a vignette methodology to assess how patients’ social and contextual factors influence emergency room physicians’ views of them as “deserving” or “undeserving” of pain medication. This piece is nicely linked to some key concepts in sociology of inequalities and could be used for a variety of other courses.
The final section is entitled “Locally Oriented Studies in Health Disparities.” The lead article is mainly a summary of three community-based approaches for reducing health disparities. The other two selections are empirical studies on subjects that are certainly deserving of further study—rural areas and a minority community in post-Katrina New Orleans. Both of these articles illustrate many personal and structural factors that prevent or discourage even insured people from accessing care.
This volume provides a very interesting range of methodological approaches to studying health disparities and could be very useful in a class on methods of health research. Most of the empirical work is based on survey and questionnaire data, but the articles provide an interesting mix of approaches for teasing out specific aspects of disparity. Articles in this volume are appropriate for advanced undergraduate- and graduate-level students. Selected articles could also be good additions for classes such as the sociology of health care, social problems, inequalities, and gender studies.