Vulnerable Populations in the United States

Leiyu Shi is co-director, Johns Hopkins Primary Care Policy Center; director, DrPH Program Taiwan Cohort; and director, Asia MPH Program. He is also professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. Gregory D. Stevens is assistant professor of family medicine at the Keck School of Medicine of the University of Southern California.

Figures, Tables, Exhibits xi Preface xvii The Authors xxiii 1 A General Framework to Study Vulnerable Populations 1 Learning Objectives 1 Why Study Vulnerable Populations? 3 Models for Studying Vulnerability 8 The Vulnerability Model: A New Conceptual Framework 18 Summary 33 Key Terms 33 Review Questions 34 Essay Questions 34 2 Community Determinants and Mechanisms of Vulnerability 35 Learning Objectives 35 Race and Ethnicity 36 Socioeconomic Status 49 Health Insurance 72 Multiple Risk Factors 85 Summary 90 Key Terms 91 Review Questions 91 Essay Questions 92 3 The Influence of Individual Risk Factors 93 Learning Objectives 93 Racial and Ethnic Disparities 94 Socioeconomic Status Disparities 110 Health Insurance Disparities 124 Summary 135 Key Terms 135 Review Questions 135 Essay Question 136 4 The Influence of Multiple Risk Factors 137 Learning Objectives 137 Health Care Access 141 Quality of Health Care 152 Health Status 164 Summary 176 Key Terms 176 Review Questions 177 Essay Questions 177 5 Current Strategies to Serve Vulnerable Populations 179 Learning Objectives 179 Programs to Eliminate Racial and Ethnic Disparities 185 Programs to Eliminate Socioeconomic Disparities 198 Programs to Eliminate Disparities in Health Insurance 209 Summary 217 Key Terms 218 Review Questions 218 Essay Questions 218 6 Resolving Disparities in the United States 221 Learning Objectives 221 The Healthy People Initiative 222 Framework to Resolve Disparities 230 Resolving Disparities in Health and Health Care 234 Integrative Approaches to Resolving Disparities 256 Challenges and Barriers in Implementing the Strategies 267 Course of Action for Resolving Disparities 272 Summary 281 Key Terms 281 Review Questions 282 Essay Questions 282 References 283 Index 313