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      Improving the health of African Americans in the USA: an overdue opportunity for social justice

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          Abstract

          Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

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          Most cited references77

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          Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

          Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.
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            Heart disease and stroke statistics--2014 update: a report from the American Heart Association.

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              Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.

              In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.
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                Author and article information

                Contributors
                eduardo.velasco@tu.edu
                Journal
                Public Health Rev
                Public Health Rev
                Public Health Reviews
                BioMed Central (London )
                0301-0422
                2107-6952
                3 October 2016
                3 October 2016
                2016
                : 37
                : 12
                Affiliations
                [1 ]United States Public Health Services, Hunt Valley, Maryland, 21030 USA
                [2 ]Touro University California College of Osteopathic Medicine, 1310 Johnson Lane, Vallejo California, 94592 USA
                [3 ]GRID grid.260238.d, ISNI 0000000122244258, Morgan State University School of Community Health and Policy, ; 4530 Portage Avenue Campus, 1700 E. Cold Spring Lane, Baltimore, MD 21251 USA
                Article
                25
                10.1186/s40985-016-0025-4
                5810013
                29450054
                1cd8c4e9-3dec-4704-9b72-a7d24e36908d
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 11 April 2016
                : 7 September 2016
                Categories
                Review
                Custom metadata
                © The Author(s) 2016

                ethnicity and health,african americans,health disparities,social justice,social determinants of health

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