A selected, annotated list of materials that support the development of policies designed to reduce racial and ethnic health disparities

Abstract

Research documents the existence of racial and ethnic health disparities. As a result, policy makers are seeking to address these disparities. This list is a starting point for building or updating a collection that supports this policy development process. It is written for health policy librarians and researchers and includes annotated recommendations for books, periodicals, government publications, and Websites. Entries for print publications are primarily from 1998 to 2003.

INTRODUCTION

Increasingly, racial and ethnic health disparities are acknowledged and documented. As a result, librarians are called upon to build or update collections that support the development of policies to address these disparities. A good place to begin is Haynes's 1997 publication, Ethnic Minority Health: A Selected, Annotated Bibliography, which covers 1970 to 1995 [1]. For items after 1995, however, librarians must scan the literature and bibliographies of various fields: ethnic minority health, medical anthropology, cultural anthropology, medical sociology, medicine, nursing, general health policy, public health, public policy, medical ethics, and political science to locate materials. In an effort to eliminate this duplication of effort, the authors present a selected, annotated list that is intended to serve as a starting point for updating a collection in this topic area.

DEFINITION

According to the National Institutes of Health (NIH), health disparities are defined as “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States” [2]. The publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare states that many sources contribute to health disparities, including: “health systems, healthcare providers, patients and utilization managers” and that “bias, stereotyping, prejudice and clinical uncertainty on the part of health care providers” may also add to the problem [3].

BACKGROUND

In 1985, the United States Government, in the Secretary's Task Force on Black and Minority Health, also known as the Heckler Report, documented, in a comprehensive manner, the health status of blacks and other minorities in the United States [4]. The task force report led to the establishment of the Office of Minority Health (OMH). This office was charged with advising the secretary of health and human services on medical and public health issues affecting minorities as defined by the Office of Management and Budget Directive 15, Race and Ethnic Standards for Statistics and Administrative Reporting, otherwise referred to as OMB 15 [5]. OMB 15, developed in 1977 and revised in 1997, identified Asians/Pacific Islanders, African Americans/Blacks, Hispanics/Latinos, and American Indians/Alaska Natives as minorities [6]. With the goal of providing timely, accurate, and current information to the broader health community on issues relevant to minority health, the Office of Minority Health Resource Center (OMHRC) was created in 1987. The task force placed priority for information dissemination on those issues where existing data documented disparities: cardiovascular diseases, diabetes, cancer, violence and homicide, substance abuse, infant mortality, and low birth weight. In recent years, these topics have expanded to include HIV/AIDS, mental health, and access to health care issues [7].

In 1991, the US Government released Healthy People 2000: National Health Promotion and Disease Prevention Objectives, the nation's health improvement agenda for the last decade of the twentieth century. One of the three broad goals of Healthy People 2000 was to reduce health disparities, with a specific priority to “narrow the gap between total population and those groups with higher than average rates of death, disease and disability” [8]. Halfway through the decade, Healthy People 2000: Midcourse Review and 1995 Revisions examined new data and information that showed increased risk or disparity between the total population and people in age, sexual, racial, or ethnic minority groups that had become available since Healthy People 2000 was released in 1990 [9]. As a result, nineteen new objectives were added to the original document.

In January 2000, Healthy People 2010 was released, carrying forward the two broad goals from earlier Healthy People initiatives: (1) increasing quality and years of healthy life and (2) eliminating health disparities [10]. Sub-objectives for racial and ethnic minorities and other special populations were established to address increased health risks or disparities compared with the total population. Also, in 2000, Congress passed the Minority Health and Health Disparities Research and Education Act that created the National Center on Minority Health and Health Disparities in the National Institutes of Health. It also commissioned the Institute of Medicine (IOM) to assess the racial and ethnic disparities in health care that are not otherwise attributable to factors associated with access to care [11]. As a result, the IOM released Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care in 2002, further spotlighting minority health care issues and documenting that cultural competence affects health care [12].

In December 2000, the Office of Minority Health released the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care as guidance when developing and implementing systems of care. OMH defines the provision of culturally competent care as “the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients' social, cultural, and linguistic needs” [13]. The standards focus on the following themes: culturally competent care, language access services, and organizational supports for cultural competence [14]. Although only the language access services standards are mandated for all recipients of federal funds, the cultural competence standards are suggested as guidelines for adoption by federal, state, and national accrediting agencies. However, even though they provide a way for institutions to conceptualize the supports necessary to ensure the delivery of culturally competent care, they do not guarantee that providers actually do provide this care [15].

It is often with the goal of addressing both racial and ethnic disparities and culturally competent care that policies are developed and examined. The following guide addresses both issues.

SCOPE AND METHOD

The list of recommended materials is intended to supplement and enhance a library collection in general health policy. Standard health policy journals and texts have been omitted, because it is assumed they are already part of the collection. Instead, the authors have selected entries that are specifically oriented to the issue of racial and ethnic health disparities. The list includes citations to books, journals, government publications, and Websites and is designed for use by those attempting to affect policy in this area.

The primary objective of the list is to provide a starting point for updating a collection that supports the development of policies that address racial and ethnic health disparities. It is not an attempt to provide a comprehensive bibliography of the topic for two reasons: the first is that the space constraints of a journal article do not permit it and the second is that Haynes's Ethnic Minority Health, A Selected and Annotated Bibliography, covering from 1970 to 1995, although selective, is quite extensive in its treatment of the topic and there was no need to duplicate his efforts.

The majority of recommended books and government documents selected for the list were published between 1998 and 2003, primarily because most social science or medical libraries do not generally purchase materials older than six years and because the objective of this list is to fill a gap in recommendations for current materials.

Similar to Haynes, the materials in the list focus on the four groups identified in OMB 15 as minorities: Asians/Pacific Islanders, African Americans/Blacks, Hispanics/Latinos, and American Indians/Alaska Natives because public policy in this area is centered on these groups. Materials that provide a broad or theoretical overview of the varied issues relating to any one of these specific groups are included with an attempt to provide at least one citation for each group. In addition, the majority of materials are analytical in nature, relying on scientific data and research and geared toward social science researchers, who often inform policy makers, or toward the policy makers themselves, rather than toward practitioners. Exceptions have been made when the material has been deemed useful to the former because of its theoretical approach to the issue. An attempt has also been made to provide a representative selection of materials covering the various aspects of the issue: transcultural health, medical sociology, cultural competence, health communication, medical history, nursing, immigrant health, and the various population groups mentioned above. Materials about the folk medicine practices of the minority groups are, however, omitted. Primary government publications that either document the disparities or speak to their elimination are included. The Websites for which links are provided either document the disparities, provide access to research about policy matters related to the disparities, or direct the reader to resources on the topic. Only sites produced by government entities, educational institutions, or nonprofit organizations have been considered.

To develop the list, the authors searched the following library catalogs: OCLC WorldCat, RLIN, the Office of Minority Health Resource Center, and LOCATORplus using either the Library of Congress subject headings or the Medical Subject Headings (MeSH) listed in Table 1by themselves or in conjunction with specific conditions or diseases.

Table 1 Library of Congress and Medical Subject Headings used in searching OCLC Worldcat, RLIN, the Office of Minority Health Resource Center, and LOCATORplus

In addition, the authors reviewed the Core Health Policy Library Recommendations from the National Library of Medicine [16], the Core Public Health Core Journal Project [17], the Brandon/Hill selected lists [18], the Cultural and Linguistic Competence Resource Database [19], and numerous other bibliographies and lists of cited references found in the various publications herein for materials related to ethnic and racial health disparities and specifically for those that met the criteria outlined above.

ANNOTATED LIST OF SOURCES

Books

Aday, LA. At Risk in America: Health and Health Care Needs of Vulnerable Populations in the United States. 2nd ed. San Francisco, CA: Jossey-Bass, 2001. $48.00. ISBN: 0-7879-4986-8. Addresses the issue of documenting health disparities in the United States. The author provides documentation on population groups and medical conditions associated with the term “health disparities,” their causes, and potential interventions. It also documents the program needs and policy changes needed to reduce disparities. The chapters cover an introduction to the topic, cross-cultural issues that have an impact on the disparities, and population-specific details about how groups are affected.

Aguirre-Molina M, Molina CW, Zambrana RE. Health Issues in the Latino Community. San Francisco, CA: Jossey-Bass, 2001. $60.00. ISBN: 0-7879-5315-6. An in-depth examination of a broad array of health issues affecting Latino health and health care in the United States. This edited volume includes chapters on current health data about the Latino population, the effect of changes in the health care market on Latinos, Latinos through the life span, patterns of chronic diseases, occupational health, and substance abuse.

American Medical Association. Cultural Competence Compendium. Chicago, IL: American Medical Association. 1999. $49.95. ISBN: 1-579-47050-5. Cultural competence resource guide for physicians. This guide focuses on resources surrounding communication, language, and cultural issues. It lists organizations along with contact information.

Bigby J, ed. Cross-Cultural Medicine. Philadelphia, PA: American College of Physicians, 2003. $30.00. ISBN: 1-930513-02-X. Although written specifically for internists, contains a very valuable first chapter describing and explaining cultural competence. Most of the remaining chapters provide an in-depth focus on providing culturally competent care to specific populations: blacks and African Americans, Latinos, American Indians and Alaskan Natives, Asian Americans, Arab Americans, and American Muslims. Concludes with chapters on caring for immigrants, spirituality and religion, and advocating for diverse populations.

Braithwaite RL, Taylor SE, eds. Health Issues in the Black Community. 2nd ed. San Francisco, CA: Jossey-Bass, 2001. $60.00. ISBN: 0-7879-5236-2. In-depth look at a number of health issues facing the black community. It covers: health issues across the life span; social, mental, and environmental challenges; chronic disease; lifestyle behaviors, including addictions, nutrition, and exercise; and ethical, political, and ecological issues. It also offers some suggestions for closing the racial disparities gap.

Byrd MW, Clayton LA. An American Health Dilemma: The Medical History of African Americans and the Problems of Race. New York, NY: Rutledge, 2000. $35.00. ISBN: 0-415-92449-9. Billed as a comprehensive work in the documentation of the inequalities of health care for African Americans and as a follow up to An American Dilemma by Gunner Mydal (1944), which focuses on race relations. The authors document the historical impact of race and the provision of medical care. This book takes the reader from the origins of medicine to the beginning of the twentieth century. This volume was nominated for a Pulitzer Prize in 2000, and Choice magazine named it an Outstanding Academic Book in 2000.

Byrd MW, Clayton LA. An American Health Dilemma: Volume II: Race, Medicine and Health Care in the United States 1900–2000. New York, NY: Rutledge, 2002. $35.00. ISBN: 0-415-92737-4. Billed as a follow-up to the first volume. Documents and focuses on how the US health care system provides health care services to African Americans. An in-depth examination of how the current system is addressing years of unequal care for African Americans.

Campinha-Bacote J. Process of Cultural Competence in the Delivery of Healthcare Services: A Culturally Competent Model of Care. 4th ed. Wyoming, OH: Transcultural C.A.R.E., 2003. $20.00. Describes Josephina Campinha-Bacote's theory, first published in 1991, of cultural competence. The theory encompasses five constructs of cultural competence: cultural awareness, cultural knowledge, cultural skills, cultural encounter, and cultural desire.

Curtis JL. Affirmative Action in Medicine Improving Health Care for Everyone. Ann Arbor, MI: University of Michigan Press, 2003. $40.00. ISBN: 0-472-11298-8. Examines affirmative action in undergraduate and post-graduate medical education, which is important due to the impact of provider race on quality of care and outcomes. James L. Curtis, an African American, reviews the history of affirmative action and civil rights in health care, then reports on the results of a study of 2,000 minority and nonminority medical school graduates in 1973 to 1977 and thirty years later.

Gardenswartz L, Rowe A. Managing Diversity in Health Care: Proven Tools and Activities for Leaders and Trainers. San Francisco, CA: Jossey-Bass, 1998. $48.00. ISBN: 0-7879-4041-0. Explains how organizations can deliver culturally competent care, which in turn can assist in reducing health disparities. It is written for practitioners and policy makers.

Haynes C. Ethnic Minority Health: A Selected, Annotated Bibliography. Lanham, MD: Medical Library Association and Scarecrow Press, 1996. $70.00. ISBN: 0-8108-3225-9. A thorough, annotated list of monographs about ethnic minority health topics. Includes books, government documents, independent research reports, working papers, conference proceedings, contributed chapters, dedicated journal issues or supplements, and specialized bibliographies and directories. Covers 1970 to 1995. In addition to items on general topics, focuses on four major ethnic groups in the United States: Native Americans/Alaska Natives, African Americans, Hispanic Americans, and Asian/Pacific Islanders.

Hogue C, Hargraves MA, Collins KS, eds. Minority Health in America: Findings and Policy Implications from the Commonwealth Fund Minority Health Survey. Baltimore, MD: Johns Hopkins University Press, 2000. $26.95. ISBN: 0-8018-6299-X. Presents the analysis and results of a 1994 Commonwealth Fund–sponsored survey of more than 3,700 African American, Hispanic, Asian American, and white adults about their experiences with health care. Includes a description of access, use, need, and satisfaction of health care; barriers to use and access, including discrimination; impact of minority stress on mental health; and suggestions for improving minority health in the future.

Huff RM, Kline MV, eds. Promoting Health in Multicultural Populations: A Handbook for Practitioners. Thousand Oaks, CA: Sage, 1999. $49.95. ISBN: 0-7619-0183-3. Provides an overview of cultural and cross-cultural issues as they relate to disease and health, including theoretical and practical health promotion principles; an in-depth look at specific population groups (Hispanic/Latino, African American, American Indian, Alaska Native, Asian American, and Pacific Islander); a framework for cultural assessment; and some thoughts about multicultural promotion and disease prevention in the future.

Institute of Medicine, Committee on Communication for Behavioral Change in the 21st Century: Improving the Health of Diverse Populations. Speaking of Health: Assessing Health Communication Strategies for Diverse Populations. Washington, DC: National Academies Press, 2002. $44.95. ISBN: 0-309-07271-9. Written for policy makers, administrators, and practitioners. The Institute of Medicine offers an overview of health communication theory and its application including how to conduct successful health communication campaigns. The authors explore the use of technology with regard to how it can improve health communication while keeping in mind the limitations of the digital divide. A section is devoted to diversity and communications.

Leininger MM, ed. Culture Care Diversity and Universality: A Theory of Nursing. Boston, MA: Jones & Bartlett, 2001. $34.95. ISBN: 0-7637-1825-4. Examines the cultural values of twenty-three different cultures. Madeleine Leininger's theory, conceptualized in the 1950s, has been hailed as the groundwork theory on culturally congruent care. It is considered to be a vital part of any core collection to improve the health care of a culturally diverse population.

Logan SL, Freeman EM, eds. Health Care in the Black Community: Empowerment, Knowledge, Skills and Collectivism. New York, NY: Haworth, 2000. $34.95. ISBN: 0-7890-0456-9. Provides methods and models for practical health care practice and promotion in African American communities using culture-specific and holistic approaches. Includes chapters on empowerment and health prevention, strengthening of black families, coping with violence, early parenthood, black womens' health issues, and mental health needs.

Loue S, ed. Handbook of Immigrant Health. New York, NY: Plenum Press, 1998. $126.50. ISBN: 0-306-45959-0. Written by a multidisciplinary team (anthropology, epidemiology, ethics, health promotion, law, medicine, nursing, and social work) of authors to address issues in immigrant health. This anthology addresses the challenges faced by immigrants to the United States. Specific medical concerns such as substance abuse, sexuality, and aging are also addressed. Particular attention is placed on culture and language and the impact of access to health care.

Ma GX. Culture of Health: Asian Communities in the United States. Westport, CT: Bergin & Garvey, 1999. $62.95. ISBN: 0-89789-625-4. Examines the social, cultural, and economic factors that affect the health-seeking and health-service-utilization behaviors of Asian Americans. Reviews both current research regarding health beliefs of the various Asian American communities as well as the historical roots of Asian immigrants.

Ma GX, Henderson G, eds. Rethinking Ethnicity and Health Care: A Sociocultural Perspective. Springfield, IL: Charles C. Thomas, 1999. $65.95. ISBN: 0-3980-6956-5. Explores race, ethnicity, and cultural competence in health care. It includes chapters on Asian Americans, Spanish-speaking patients, Native Americans, Alaskans, and African Americans. The impact of alternative medicine in terms of race and ethnicity is covered, as well as future challenges in research methods.

Nakamura RM. Health in America: A Multicultural Perspective. Boston, MA: Allyn & Bacon, 1998. $46.00. ISBN 0-205-29012-4. Provides an overview of the various issues that interventions to reduce health disparities must address. The first three chapters address a general overview of minority health, cultural differences, and the family. Chapters four through six address mental health issues including mental health stress, healthy eating behaviors, and drug usage. Chapters eight and nine deal with cardiovascular disease and infectious diseases. Chapter ten details sexual health and reproduction issues by gender.

Purnell LD, Paulanka BJ, eds. Transcultural Health Care: A Culturally Competent Approach. 2nd ed. Philadelphia, PA: F. A. Davis, 2003. $38.95. ISBN: 0-8036-1057-2. Offers an extensive review of how to perform cultural assessment on patients. Also documents the Purnell theory of cultural competence.

Rhoades ER, ed. American Indian Health: Innovations in Health Care, Promotion and Policy. Baltimore, MD: Johns Hopkins University Press, 2002. $48.00. ISBN: 0-8018-6904-8. An anthology of works by forty-three contributing authors. Provides a thorough explanation of the current issues that are faced in developing effective health policy and health care programs for the Native American population. Covers the history of the Native American population, including the impact of Europeans arriving in North America, a description of the health care system for Native Americans, data relating to Indian health services and governmental relations, an analysis of the disparities facing the Native American population, and cultural and ethical issues to be considered by health policy makers and providers.

Smedley BD, Stith AY, Nelson AR, eds, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Board on Health Sciences Policy, Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press, 2003. $79.95. ISBN: 0-309-08532-2. Requested by Congress. This landmark work documents health disparities in the United States health care system. This eight-chapter report includes a literature review on health disparities, system factors that lead to health disparities, and an assessment of the clinical encounter. The report also provides recommendations in the following areas: general recommendations for reducing health disparities; legal, regulatory, policy, and health system interventions; patient education and empowerment; cross-cultural education in the health professions; data collection and monitoring; and future research needs.

Smith DB. Health Care Divided: Race and Healing a Nation. Ann Arbor, MI: University of Michigan Press, 2000. $50.00. ISBN 0-472-10991-X. Addresses the way the health care system has addressed minority health since the 1920s and documents the impact of race on health care. The first section of the book covers the civil rights struggle in health care, and the second section addresses the impact of a divided health care system in terms of progress and the work still needed.

Spector RE. Cultural Diversity in Health and Illness. 5th ed. Upper Saddle River, NJ: Prentice Hall Health, 2000. $36.95. ISBN: 0-8385-1536-3. In this title on the Brandon/Hill list for nursing, Rachael Spector, from the Boston College School of Nursing, writes of how the individual's precept on illness from a cultural perspective can impact the care received. The author explores issues surrounding health care such as access, health traditions, and impact of culture and language on care.

Swift EK, ed. Committee on Guidance for Designing a National Healthcare Disparities Report, Institute of Medicine. Guidance for the National Healthcare Disparities Report. Washington, DC: National Academies Press, 2002. $44.25. ISBN: 0-309-08519-5. Offers guidelines on how to produce a health disparities report. Focuses on how to measure disparities in health care.

Periodicals

Ethnicity & Disease. Atlanta, GA. Quarterly. $125.00. ISSN: 1049–510X. Described as a journal that focuses on the disease patterns of ethnic minority populations. Includes international research devoted to multicultural health issues.

Health Promotion Practice. Thousand Oaks, CA. Quarterly. $330.00. ISSN: 1524–8399. A peer-reviewed journal that assists practitioners in the applications of health promotion and education. Includes a special column “Closing the Gap: Eliminating Racial and Ethnic Disparities in Health.” Each month, this column addresses a topic on how to reduce health disparities.

Journal of Health Care for the Poor and Underserved. Thousand Oaks, CA. Quarterly. $280.00. ISSN: 1049–2089. Information on health care and delivery to the poor and underserved communities. The focus is on access to health care, cost, and culturally sensitive care. The journal is targeted to policy makers and clinicians.

Journal of Immigrant Health. New York, NY. Quarterly. $231.00. ISSN: 1096–4045. Devoted to documenting the health of refugees and immigrants and the ways these groups affect the public health infrastructure. Includes information from a variety of fields including anthropology, public health, immigration law, and ethics.

Journal of Transcultural Nursing. Thousand Oaks, CA. Quarterly. $185.00. ISSN: 1043–6596. The journal of the Transcultural Nursing Society. Founded by Madeleine Leininger in the mid-1950s as a response to the multicultural nature of health care. The society's journal was established to promote culturally congruent health care. Promotes an exchange of ideas between nursing and other disciplines.

Journal of Urban Health: Bulletin of the New York Academy of Medicine. Cary, NC. 4 issues annually. Print: $110.00. ISSN: 1099–3460. Online: $99.00. ISSN: 1468–2869. Focuses on urban health in the United States and the changing epidemiological patterns of diseases and disability, specifically on how clinical practice and health policy affect urban health. The journal publishes data, original journal articles, and symposia literature.

Social Science & Medicine. Oxford, UK. Semimonthly. $302.00. ISSN: 0277–9536. Considered to be the cornerstone of any collection on health disparities. The journal covers issues such as access to health care, society, culture, and language. Devotes attention to medical anthropology and the care of refugees and immigrants on a global scale.

Government publications

United States Department of Health and Human Services, Health Resources and Services Administration, President's Initiative on Race. Health Care Rx: Access for All. [Rockville, MD]: US Department of Health and Human Services, Health Resources and Services Administration, 1998. Chart book of data that provides a picture of the health of racial and Americans who are ethnic minorities and the factors that limit access to health care.

United States Department of Health and Human Services, Office of Minority Health. Closing the Gap: A Newsletter of the Office of Minority Health. Washington, DC: US Department of Health and Human Services, Office of Public Health and Science, Office of Minority Health Resource Center, 1998–. Monthly newsletter devoted to health topics of concern to minority communities.

United States Department of Health and Human Services, Office of Minority Health. Eliminating Racial and Ethnic Disparities in Health: Report to Congress FY 1998/1999. [Rockville, MD]: US Department of Health and Human Services, Office of Minority Health, 1999. Summarizes all of the activities of the Office of Minority Health (OMH) in the previous fiscal years. It provides information on OMH grantees and cooperative agreement recipients and discusses special initiatives and other activities designed to eliminate racial and ethnic disparities in health.

United States Department of Health and Human Services, Office of Minority Health. Patients Who Don't Speak English: Improving Language Minorities' Health Care with Professional Interpreters. Final Report. [Rockville, MD]: US Department of Health and Human Services, 2001. A study of the effects of professional interpreter services on health visit levels and patterns of a sample of limited English proficiency (LEP) patients.

United States Department of Health and Human Services, Office of Minority Health, Task Force on Black and Minority Health. Report of the Secretary's Task Force on Black and Minority Health. Vols. 1–8. Washington, DC: US Department of Health and Human Services, Public Health Service, 1985–1986. Landmark report on the state of minority health that created the Office of Minority Health in the Department of Health and Human Services. The report identified six key disease disparities for the minority population and prompted federal policy to eliminate the disparity.

United States Department of Health and Human Services, Office of the Surgeon General. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health, a Report of the Surgeon General. [Web document]. [Rockville, MD]: US Department of Health and Human Services, US Public Health Service, 2001. [cited 13 Nov 2003]. <http://www.surgeongeneral.gov/library/mentalhealth/cre/sma-01-3613.pdf>. Clearly documents that the tragic and devastating effects of mental illness touch people of all ages, colors, and cultures.

United States Department of Health and Human Services, Office of the Surgeon General. The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. [Web document]. Washington, DC: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001. [cited 13 Nov 2003]. <http://www.surgeongeneralgov/topics/obesity/calltoaction/CalltoAction.pdf>. Promotes the recognition of being overweight and obese as major public health problems and assists Americans in balancing healthful eating with regular physical activity to achieve and maintain a healthy or healthier body weight. The disproportionate number of minorities who are obese or overweight makes this publication a necessity for public health officials interested in health promotion in the minority community.

United States Department of Health and Human Services, Office of the Surgeon General. Tobacco Use Among U.S. Racial/Ethnic Minority Groups, African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics: A Report of the Surgeon General. [Atlanta, GA]: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998. The first surgeon general's report to focus on tobacco use among four US racial or ethnic minority groups: African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics. It is useful for organizations involved in developing health promotion and prevention messages for minority communities.

United States Department of Health and Human Services, Public Health Service. Healthy People 2010: National Health Promotion and Disease Prevention Objectives: Full Report (2 v.), 2000. Updates the baselines and targets for the health policy objectives for the federal government. It also identifies twenty-eight key areas for improving the health of all Americans.

United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. Cultural Competence Standards in Managed Care Mental Health Services: Four Underserved/Underrepresented Racial/Ethnic Groups. [Web document]. [Rockville, MD]: US Department of Health and Human Services, 2000 [cited 13 Nov 2003].<http://www.samhsa.gov/search/search.html>. Designed to provide readers with the tools and knowledge to help guide the provision of culturally competent mental health services in today's managed care environment.

Websites

Addressing Health Disparities: The NIH Program of Action. <http://healthdisparities.nih.gov>. Serves as a gateway to information about the strategies that each national health institute and center will use to address health disparities. It includes the National Library of Medicine's plan of action.

Assuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcomes-Focused Research Agenda (CLAS Standards). <http://www.omhrc.gov/clas/>. Federal mandates, guidelines, and recommendations to provide culturally competent care. They are grouped by themes: patient care (cultural competence), language access (communication), and organization support/development.

California Health Interview Survey (CHIS). <http://www.chis.ucla.edu>. The largest state health survey in the United States. It is a telephone survey conducted every two years and covers public health topics and access to health care. Surveys are conducted in six languages—English, Spanish, Chinese, Vietnamese, Korean, and Khmer (Cambodian)—and contain large samples of African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Latinos.

Center for Research on Ethnicity, Culture and Health (CRECH), University of Michigan. <http://www.sph.umich.edu/crech/main.html>. Established in 1998 as a research center devoted to applying public health research on relationships among ethnicity, culture, socioeconomic status, and health. The center funds research on health disparities.

The Commonwealth Fund. <http://www.cmwf.org>. Philanthropic foundation that funds and produces research. Program areas include: health care services, minority health, the elderly, and development of the capacities of children and young people.

The Cross Cultural Health Care Program (CCHCP). <http://www.xculture.org>. A not-for-profit agency whose aim is to serve as a bridge between cultural practices and health care institutions through cultural competency training, interpreter training, and research.

Culturemed, SUNY Institute of Technology Library. <http://www.sunyit.edu/library/html/culturedmed/>. Created by Jacquelyn Coughlan of the State Unniversity of New York (SUNY) Institute of Technology Library. Provides resources on culturally competent health care. Includes bibliographies on cultural groups as well as policy information on how to serve minority groups.

DiversityRx. <http://www.diversityrx.org>. Focuses on culturally competent care and diversity in the health professions. It is supported by The National Conference of State Legislatures, Resources for Cross-Cultural Health Care (RCCHC), and the Henry J. Kaiser Family Foundation.

The Henry J. Kaiser Family Foundation. <http://www.kff.org>. Independent philanthropy that develops and runs its own research and communications programs, often in partnership with outside organizations. Focuses on three main areas: health policy, media and public education, and health and development in South Africa.

Minority Health Project, University of North Carolina at Chapel Hill School of Public Health. <http://www.minority.unc.edu>. Conducts educational programs, provides information on research and sources of data on minority health, and maintains an extensive set of links to organizations at the University of North Carolina at Chapel Hill and elsewhere.

The National Center for Cultural Competence (NCCC). <http://www.georgetown.edu/research/gucdc/nccc/>. Mission is to increase the capacity of health care programs to design, implement, and evaluate culturally competent service delivery systems. The resource center offers reports and technical assistance to develop cultural competence programs.

National Center on Minority Health and Health Disparities. <http://ncmhd.nih.gov>. Conducts and supports research, training, dissemination of information, and other programs with respect to minority health conditions and other populations with health disparities.

National Public Health and Hospital Institute.<http://www.naph.org>. An organization of large urban hospitals. Contains information about legal and health care policy issues that have an impact on the poor and underserved populations.

Office of Minority Health (OMH). <http://www.omhrc.gov>. Works with sister agencies in the US Department of Health and Human Services and their minority health representatives to improve the health of racial and ethnic populations through the development of effective health policies and programs that help to eliminate disparities in health.

The Right to Equal Treatment: An Annotated Bibliography of Studies on Racial and Ethnic Disparitiesin Healthcare, Their Causes, and Related Issues.<http://www.phrusa.org/research/domestic/race/race_report/bibliography.html>. An annotated list of peer-reviewed articles about racial and ethnic disparities in medical care, provided by Physicians for Human Rights. The list is divided into seventeen disease or clinical categories with four additional topics: clinical trials, research methods, patient trust, and cultural competence. Coverage is from the 1960s to 2002.

The Robert Wood Johnson Foundation. <http://www.rwjf.org>. Provides research grants in health care and works toward the reduction of health disparities. Findings of each grant report are available online.