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A Trajectory Model for Understanding & Assessing Health Disparities in…

- - - - Their vulnerability & exposure to disease, & the systems of knowledge, attitude, & practice related to health that developed in response to their vulnerability & historical experience within a larger society
        
        Vulnerability, circumstance, & response
        
        Better interventions
        
        Ongoing relationship between a pop & the health-related system
        
        Dynamic systems - changes over time
- - - - Says what data should be collected that represent dimensions of the health-related trajectory for each pop studied
      - May increase or decrease the “distance” between a pop trajectory & the mainstream health-related systems
        
        Marginalization
        
        May include positive & negative aspects
- - - - Civil conflict
  - - - Verbal abuse, denigration, exclusion, etc
        
        Interlocked w/ political & economic contributing factors
  - - - May experience
        
        Generational family disruption
        
        Economic hardship
        
        Social role changes
        
        Language
      - Children often serve as interlocutors b/c they’re more English-fluent & familiar w/ public transportation & logistics
        
        Strain family decision making & lines of authority
      - Itself is dangerous
  - - - Reluctant to make complaints regarding conditions
        
        Feel that they can’t do anything to change the community
  - - - Significant gap in understanding & utilization of standard Western medical care
      - Lack adequate information about preventive & treatment procedures
  - - - Many pop are lumped together
  - - - Afford care
      - Understand medical advice & embrace recommendations from doctors & nurses
    - - Not prepared to handle
        
        Providing care to individuals w/ non-Western health beliefs
        
        Care to new immigrants
        
        Care to individuals whose religious beliefs affect treatment
        
        Don’t have the skills to identify cultural customs impacting on medical care
  - - - Increased group identification
      - Collective well-being may coexist w/ negative effects
        
        “Dual-process” model
  - - - Compared to 15% for native citizens
    - - More than 2x the rate for US natives
        
        Reduce access to care & poor health status
    - - Low income
      - No health insurance
  - - - Low SES
        
        Unemployment
        
        Low income
        
        Environmental pollution
        
        Family dysfunction
        
        Psychosocial stress
        
        Injuries
        
        Presence of community violence
        
        Smoking
        
        Limited recreational space
        
        Nutrition
    - - Generates patterns of living that focuses more on survival & achieving social goals
        
        Family needs, access to resources, etc
        
        Within a limited sphere
    - - Greater hardships
        
        Health care
        
        Least likely to exercise even 20 mins a day, 3x per week
        
        Nervous b/c of legal status or potential legal status
        
        Housing
        
        4x more likely to live in crowded housing
        
        Food
    - - Structural-constructivist model / health trajectories
- - - - Propose an approach of the diachronic interaction of ecological factors contributing to health disparities
- - - - Deteriorated housing
      - Pollution
      - Crime/violence
      - Lack of community resources
- - - - New measures will need to be created & psychometric properties of the measures established