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Describe Examples From Camara Phyllis and Other Sources in the Text ("Race, Ethnicity, and Health" Author Thomas A. Laveiston) How Racism Imposes an Additional Health Burden on People of Color

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The term “racial and ethnic minority groups” includes people of color with a wide variety of backgrounds and experiences. But some experiences are common to many people within these groups, and social determinants of health have historically prevented them from having fair opportunities for economic, physical, and emotional health

Inequities in the social determinants of health, such as poverty and healthcare access, affecting these groups are interrelated and influence a wide range of health and quality-of-life outcomes and risks. To achieve health equity, barriers must be removed so that everyone has a fair opportunity to be as healthy as possible.

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Building partnerships to enable patients to play a meaningful role in developing solutions. Many health care organizations partner with community advisory boards or collect patient-reported experiences and outcome measures to identify potential problems

Southern Jamaica Plain Health Center convened teen workshops to gain insights about the struggles they face, while Cone Health tapped cancer survivors’ expertise to identify ways the health system didn’t serve them. This work may lead to customized interventions rather than standardized protocols. Efforts to reduce racial disparities must go beyond cultural competency or workforce diversity initiatives. At HealthPartners, “key equity measures are built into our scorecards, our health equity sponsor group meets regularly, and equity is a standing topic at every board of directors’ quality committee meeting. That has helped keep us on track,” say Brian Lloyd, who oversees HealthPartners’ equity initiatives. The health system has trained more than 170 “equitable care champions,” employees who go through training on implicit bias and cultural humility and then take responsibility for explaining the rationale for equity initiatives to colleagues. The health system also takes advantage of opportunities to facilitate open discussions about racial bias, as it did in July 2016 after Philando Castile, a local African American man, was shot by a police officer during a traffic stop. In the end, advocates say, it’s important to realize that while racism is a large and multifaceted problem, there are concrete steps health care providers can and should take. “Because we are talking about structural racism — something that is such a broad and deep force in our society — it is tempting to say we are a small organization, what are we going to do about this? We don’t have the power to control national policy or address all these big forces,” says Tom Kieffer, executive director of Southern Jamaica Plain Health Clinic. “For us, it was important just to recognize that we can start small and be explicit about what we are trying to address.”

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Sociologists also emphasize that although the contribution of genetics to racial variations in major chronic diseases is likely to be small, research on racial differences in health should seek to understand how social exposures combine with biology to affect the social distribution of disease (Williams et al.2010). However, all conclusions about the contribution of genetics should be based on explicit tests of genetic traits. In addition, researchers should pay more attention to issues of population sampling when making inferences to larger populations about observed genetic variation and to genetic variation within race, as well as, differences across racial groups. Most importantly, sociologists and other social scientists need to devote more concerted and systematic attention to developing valid and reliable measures of the relevant aspects of the social environment for the study of gene-environment interactions. Research indicates that even in the case of single gene disorders, the severity and timing of genetic expression are affected by environmental triggers, and that established genetic risks can be exacerbated or become protective in the presence of specific environmental exposures (Shields, Fullerton and Olden 2009)

Recent sociological research illustrates how gene environment interactions can potentially shed light on the mechanisms linking the social environment to disease. For example, analysis of data for adolescents in the Add Health Study found that genetic traits interacted with family processes (e.g., daily family meals), school processes (e.g., repeating a grade) and friendship network variables (e.g., friend delinquency) to predict delinquency and violence among male adolescents (Guo and Roettger 2008).In contemporary society, racial groups differ on a broad range of social, behavioral, nutritional, psychological, residential, occupational and other variables. And given that biology is not static but is adaptive to the environmental conditions in which the human organism exists, there are likely to be interactions between the social environment with both innate and acquired biological factors. Thus, although variation in gene frequency is unlikely to play a major role in accounting for racial disparities, differences in gene expression linked to the occupancy of different environmental contexts could play a critical role.

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Ordinarily, as a strategy for health improvement, more systematic research attention needs to be given to expanding our knowledge of the individual and especially organizational interventions that can be effective in reducing the levels, determinants and consequences of interpersonal and institutional discrimination. Moreover, there is substantial progress yet to be made in dismantling the institutional structures, processes, and policies that undergird societal racism. As research continues to accumulate evidence that perceived discrimination can lead to adverse changes in health, such efforts are an increasingly necessary component of comprehensive approaches to improving the health of all in racialized societies.

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Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Williams DR, Mohammed SA, Leavell J, Collins C Ann N Y Acad Sci. 2010 Feb; 1186():69-101.

Shields Alexandra E., Fullerton Stephanie M., Olden Kenneth. Genes, Environment, and Cancer Disparities. In: Koh Howard K., editor. Toward the Elimination of Cancer Disparities. Springer Publishing; New York, NY: 2009. pp. 49–82.

Guo Guang, Roettger Michael E. The Integration of Genetic Propensities into Social-Control Models of Delinquency and Violence among Male Youths. American Sociological Review. 2008;73:543–568.

Hayward Mark D., Miles Toni P., Crimmins Eileen M., Yang Yu. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. American Sociological Review. 2000:910–930.

Heron Melonie, Hoyert Donna L., Murphy Sherry L., Xu Jiaquan, Kochanek Kenneth D., Tejada-Vera Betzaida. Deaths: Final Data for 2006. National Vital Statistics Reports. 2009;57:1–135.

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