DR. LEIYU SHI is Professor of health policy and health services research in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health. He is Director of Johns Hopkins Primary Care Policy Center. Dr. Shi is also well known for his extensive research on the nation's vulnerable populations, in particular community health centers that serve vulnerable populations, including their sustainability, provider recruitment and retention experiences, financial performance, experience under managed care, and quality of care. Dr. Shi is the author of eleven textbooks and over 240 scientific journal articles.

DR. GREGORY STEVENS is Professor of public health in the Department of Public Health in the Rongxiang Xu College of Health and Human Services at California State University, Los Angeles. His research focuses on health care and social policy, with an emphasis on health equity for vulnerable populations. Dr. Stevens is well known for his work on children's health and health care disparities, especially in the delivery of primary care and preventive services.

Figures, Tables, Exhibits xi

Preface xv

The Authors xxi

1 A General Framework to Study Vulnerable Populations 1

Learning Objectives 1

Why Study Vulnerable Populations? 3

Models for Studying Vulnerability 7

The Vulnerability Model: A New Multilevel Conceptual Framework 15

Summary 27

Key Terms 27

Review Questions 28

Essay Questions 28

2 Community Determinants and Mechanisms Of Vulnerability 29

Learning Objectives 29

Race and Ethnicity 30

Socioeconomic Status 43

Health Insurance 68

Multiple Risk Factors 81

Summary 86

Key Terms 86

Review Questions 87

Essay Questions 87

3 Influence of Individual Risk Factors 88

Learning Objectives 88

Racial and Ethnic Disparities 89

Health Care Access 89

Health Care Quality 93

Health Status 97

Socioeconomic Status Disparities 103

Health Care Access 104

Health Care Quality 105

Health Status 108

Health Insurance Disparities 114

Health Care Access 114

Health Care Quality 116

Health Status 119

Summary 123

Key Terms 123

Review Questions 123

Essay Question 123

4 Influence of Multiple Risk Factors 124

Learning Objectives 124

Health Care Access 128

Quality of Health Care 135

Health Status 144

Summary 155

Key Terms 155

Review Questions 156

Essay Questions 156

5 Current Strategies to Serve Vulnerable Populations 157

Learning Objectives 157

Programs to Eliminate Racial and Ethnic Disparities 161

Programs to Eliminate Socioeconomic Disparities 176

Programs to Eliminate Disparities by Health Insurance 186

Summary 194

Key Terms 195

Review Questions 196

Essay Questions 196

6 Resolving Disparities in the United States 197

Learning Objectives 197

The Healthy People Initiative 198

Framework to Resolve Disparities 205

Resolving Disparities in Health and Health Care 210

Integrative Approaches to Resolving Disparities 227

Challenges and Barriers in Implementing the Strategies 236

Course of Action for Resolving Disparities 241

Summary 251

Key Terms 251

Review Questions 251

Essay Questions 251

References 253

Index 281

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