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Social Determinants of Health

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Subject:
From:
Robert C Bowman <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Tue, 20 Mar 2007 09:56:45 -0500
Content-Type:
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Don't believe that a gap narrows because of improvements in just one group.

My review of the demographics is that whites are more distant from the
major population centers, benefit the least from the centralization going
on, and have the greatest declines in education, income, and opportunity.
All of these are measured by social, geographic distance from the major
medical centers or the major urban concentrations.

The most intense forms of poverty remain lowest income, minority, rural or
urban. However the entire white group is shifting down, as are all
populations in the world most distant and different from those concentrated
in top levels of influence. With the shifts in income and education and
opportunity go health care coverage, types of jobs, and more.

Remember 47 - 51% of the Asian population of the United States is located
in top income quartile locations with medical schools, only 20% of the
total population, 23% of black population, 31% of the Hispanic population,
and 17% of the white population. This is just a 51 county area with 57
million people and only 1% of the land area of the United States, areas
that control major segments of states with the most electoral votes.

There are also attitudes and behaviors that come from the most educated and
professional of all nations that come to the United States. These attitudes
provide important influences as in Dade-Miami Florida with 51% foreign
born, California with 23% foreign born, Florida, Texas, and New York.


Whites are no longer a good marker of progress in education, income,
health, or other areas. It will take decades to realize this however.
Measuring against Asian populations would be the appropriate gold standard
using race or ethnicity, but Eight Americas already demonstrated these gaps
and few would be able to handle the work that would be needed with gaps
between all other groups and Asians in America.

Race markers are getting more and more difficult to use or understand.
Class measures are getting to be better indicator. Not that racial barriers
do not exist, but fast rising Asian, Hispanic, black, and other populations
and all with foreign born components (outside of populations adding Central
American immigrants) are making gains relative to whites as a group.

The United States will also take much time to realize that education and
opportunity for the concentrated higher income groups in other nations
allow others to move to the United States and do better than most
Americans, especially if speaking reasonable English and if moving in to
America to stay with established "family" (broad definition) to ease the
transition. Immigration policies insure that only those with greater
education and professional training gain entry, other than those who come
illegally and they usually come in desperation and not as much to welcoming
"family" members.


Robert C. Bowman, M.D.
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