Robert H. Keefe

Structural Violence and Racial Disparity in HIV Transmission

Abstract Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Barriers to healthcare among Asian Americans.

The myth of the well-adjusted Asian American resulted from sample-biased research studies that concluded that Asian Americans are physically healthier and financially better off than Caucasians. The myth has been perpetuated by researchers who have often categorized Asian Americans as a single, undifferentiated group rather than as distinct ethnic groups. Consequently, data analysis techniques do not reveal distinctions that may exist had the researchers controlled for ethnic group variation. The authors discussed four major barriers—language and culture, health literacy, health insurance, and immigrant status—to healthcare that may influence within-group disparities among Asian Americans that may go unreported. The authors argue that healthcare policy makers and researchers should consider Asian Americans as members of discrete ethnic groups with unique healthcare needs. Recommendations for health policies and future research are provided.

Use of Electronic Technologies to Promote Community and Personal Health for Individuals Unconnected to Health Care Systems

Ensuring health care services for populations outside the mainstream health care system is challenging for all providers. But developing the health care infrastructure to better serve such unconnected individuals is critical to their health care status, to third-party payers, to overall cost savings in public health, and to reducing health disparities. Our increasingly sophisticated electronic technologies offer promising ways to more effectively engage this difficult to reach group and increase its access to health care resources. This process requires developing not only newer technologies but also collaboration between community leaders and health care providers to bring unconnected individuals into formal health care systems. We present three strategies to reach vulnerable groups, outline benefits and challenges, and provide examples of successful programs.

Health disparities: a primer for public health social workers.

In 2001, the U.S. Department of Health and Human Services published Healthy People 2010, which identified objectives to guide health promotion and to eliminate health disparities. Since 2001, much research has been published documenting racial and ethnic disparities in healthcare. Although progress has been made in eliminating the disparities, ongoing work by public health social workers, researchers, and policy analysts is needed. This paper focuses on racial and ethnic health disparities, why they exist, where they can be found, and some of the key health/medical conditions identified by the U.S. Department of Health and Human Services to receive attention. Finally, there is a discussion of what policy, professional and community education, and research can to do to eliminate racial and ethnic disparities in healthcare.

Having our say: African-American and Latina mothers provide recommendations to health and mental health providers working with new mothers living with postpartum depression

ABSTRACT Although the research on postpartum depression has grown substantially within the past 20 years, very little research has focused on mothers of color. This article draws on first-person accounts of 30 (19 African-American and 11 Latina) mothers who experienced postpartum depression and links their experiences to existing research to guide health and mental health care providers to render culturally relevant services. The mothers were interviewed regarding their perspectives on postpartum depression, the informal and formal services they used, and their recommendations for service providers. Informal social networks offering emotional and instrumental support partially relieved the mothers of childcare burdens, but were absent or even detrimental for other mothers. Formal services offering responsive and accommodating services were identified as helpful. In contrast, rigid formal mental health treatment and antidepressant medications were identified as unhelpful.

Examining Health-Related Factors Among an Ethnically Diverse Group of Asian-American Mental Health Clients

As currently developed, health policies and practices consider Asian Americans as one homogenous group, ignoring the unique differences of each group regarding its own healthcare needs. In fact, the healthcare needs of mental health clients have received little attention in the professional literature. The purpose of this article is to investigate the diverse healthcare needs of Asian Americans seeking mental health services. The authors reviewed the literature on healthcare for ethnic minority groups while focusing primarily on Asian Americans and analyzing these needs as they relate to mental health-seeking clients. The results indicate that Korean Americans are faring less well than either Japanese or Chinese Americans. The authors discuss the implications for health policy, practice, and education.

Postpartum Depression and the Affordable Care Act: Recommendations for Social Work Educators

The Patient Protection and Affordable Care Act (ACA) mandates ongoing research on postpartum depression; however, very little research has been published in social work journals and in advanced-level textbooks on this topic. This article describes the problem of postpartum depression and argues that social work educators and researchers must pay greater attention to this issue in light of the ACA mandates, so that social workers can provide effective services to postpartum mothers and their children. The Council on Social Work Education’s recently published Educational Policy and Accreditation Standards are considered while making curriculum recommendations on postpartum depression for social work educators.

African American Fathers: Disproportionate Incarceration and the Meaning of Involvement

Impoverished and African American fathers are often criticized by policy makers for lack of involvement in their childrens lives. These criticisms are limited to defining responsible fatherhood as providing economic support while ignoring other forms of nurturing. Recent studies provide a broader perspective on how impoverished and African American fathers nurture their children. This article analyzes data from five studies carried out in Syracuse, New York, between 1996 and 2011. The studies support the contention that structural violence, inherent in the disproportionate incarceration of African American fathers, is a critical factor impeding the fathers from fulfilling their paternal roles. We discuss policy issues affecting incarcerated fathers that limit the extent to which they are able to bond with their children.

Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective

ABSTRACT This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care–system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers’ micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.

“I find peace there”: how faith, church, and spirituality help mothers of colour cope with postpartum depression

ABSTRACT This article reports the findings of 30 semi-structured, qualitative interviews with new African American and Latina mothers who have histories of postpartum depression (PPD) to learn how their faith, church participation, and spiritual practices helped them cope with PPD. Six themes emerged: relief from stress, feeling valued and less alone, experiencing gratitude, developing perspective and accepting God’s guidance, changing and developing relationships, and preventing self-harm. Specifically, mothers who adhered to their faith beliefs and engaged in spiritual practices described shifts in their perspectives on various life stressors known to contribute to PPD such as negative thoughts and feelings, and strained family relationships, which in turn led them to make positive changes in their lives.