Medicine

Our understanding of race and human genetics has advanced considerably since 2003, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race. For example, despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice.

A centennial is a good time to reflect on history, and history reveals just how much progress has been made in the heterogeneous field of tropical medicine in the past one hundred years. However, the picture might look different if we start from the point of view of the Haitian poor. From that perspective, the rubric “tropical medicine,” coined to refer to a host of pathologies, has less to do with latitude than with persistent poverty.

This article combines health and water research results, evidence from confidential documents released under the Freedom of Information Act, legal analysis, and discussion of historical context to demonstrate that actions taken by the international community through the Inter-American Development Bank are directly related to a lack of access to clean water in Haiti. The article demonstrates that these actions constitute a clear violation of Haitians’ right to water under both domestic and international law.

This anthology, compiled by four of the top scholars in the field, gives a global view of public health. The editors begin with an introduction to public health and move on to legal, economic, and political implications. The editors also include contextual essays for each of the four sections.

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need.

Translated by Carolyn Shead.

We examined the association between racial/ethnic minority segregation and low birth weight (LBW) in Chicago and Toronto communities. While previous work has documented the importance of contextual effects on LBW, these studies have usually been conducted within a single city. We used Pearson correlation coefficients and OLS regression models to examine potential variability in the association between racial/ethnic minority segregation and LBW in Chicago (N = 77 communities) and Toronto (N = 140 communities).

The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers.

We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance dividing the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David Ansell has witnessed the lives behind these devastating statistics firsthand.