Racial meanings and scientific methods: changing policies for NIH-sponsored publications reporting human variation

Conventional wisdom holds that race is socially constructed and not based on genetic differences. Cutting-edge genetic research threatens this view and hence also endangers the pursuit of racial equality and useful public health research. The most recent incarnation of racial genetics is not due to scientific discoveries about population differences per se, but follows from how the United States and other governments have organized racial categories. This article explains tensions in U.S. government guidelines and publications on the study of human genetic diversity, points out the absence of any compelling public health benefits that might justify this research, introduces conceptual tools for addressing the complicated heuristic and policy problems posed by medical population genetics, and offers two policy proposals to remedy the current problems.     

Reframing the racial disparities issue for state governments

Although racial and ethnic disparities in health have been on the federal government's agenda since 1985, no policy reforms have significantly reduced disparities. The question arises whether states can effectively address this issue without waiting for solutions from the national government. The purpose of this article is to propose ways of reframing the disparities issue that might give state policy makers more leverage and might strengthen political will to address the issue. I suggest a moral frame based on a concept of distributive justice in which medical care must be distributed according to need. I explain the rationales for such a frame and consider its strategic advantages and disadvantages. In the last section, I suggest some policies based on this framing that are within the power of state legislatures.     

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.     

My health policy nightmare

Imagine that the United States did not have universal public education. What would the politics of extending access to education look like? It might have a nightmarish cast but also look rather familiar. Thinking about that yields some disturbing implications about the politics of health reform and, in particular, the politics of universal coverage within the broader policy discussion about "health reform."     

PUNISHING THE “MODEL MINORITY”: ASIAN‐AMERICAN CRIMINAL SENTENCING OUTCOMES IN FEDERAL DISTRICT COURTS*

Research on racial and ethnic disparities in criminal punishment is expansive but remains focused almost exclusively on the treatment of black and Hispanic offenders. The current study extends contemporary research on the racial patterning of punishments by incorporating Asian‐American offenders. Using data from the United States Sentencing Commission (USSC) for FY1997–FY2000, we examine sentencing disparities in federal district courts for several outcomes. The results of this study indicate that Asian Americans are punished more similarly to white offenders compared with black and Hispanic offenders. These findings raise questions for traditional racial conflict perspectives and lend support to more recent theoretical perspectives grounded in attribution processes of the courtroom workgroup. The article concludes with a discussion of future directions for research on understudied racial and ethnic minority groups.     

Prejudice and the Medical Profession: A Five-Year Update

Over the past decades the mortality rate in the United States has decreased, and life expectancy has increased. Yet a number of recent studies have drawn Americans' attention to the fact that racial and ethnic disparities persist in health care. It is clear that the U.S. health care system, which is the envy of the world, is not only flawed by basic injustices, but may be the cause of both injury and death for members of racial and ethnic minorities. Progress has been made in several areas since the original Institute of Medicine 2002 report. However, five years later, the 2007 National Healthcare Disparities Report (NHDR) reported that overall, disparities in quality and access for minority groups and poor populations have not been reduced since the original report. The three key themes that have emerged from this report are the following: (1) overall, disparities in health care quality and access are not getting smaller; (2) progress is being made, but many of the biggest gaps in quality and access have not been reduced; and (3) the problem of persistent uninsur-ance is a major barrier to reducing disparities. Unless measures are taken to address this racism, unless a new sense of trust is established between the medical establishment and racial and ethnic minorities, these injustices will continue to deepen and expand, and more lives will be placed in jeopardy. What is needed is a comprehensive, multi-level, culturally relevant strategy that contains interventions that target individuals, communities, and the nation as a whole. This will entail understanding the causes of racism in the medical profession, identifying practical interventions that address racism in individuals, communities, and the nation as a whole, and forming partnerships that will work to develop a new sense of trust between the medical establishment and the minority communities.     

U.S. experiences with racial and ethnic profiling: history, current issues, and the future

The issue of racial and ethnic bias in policing has been the focus of legal and criminal justice scholarship, court action, and public debate in the U.S. for a number of years. The issue has also been prominent in criminal justice scholarship, public discussion, and policy making in other countries, particularly the U.K., for an even longer period. This article surveys the history of the issue in the U.S. and attempts to give scholars and policy makers the benefit of the insights gained through the U.S. experience in handling the issue. Among these are the importance of the empirical question of the “hit rate” and how police use of race or ethnicity as a criterion changes it, and the difficulties of dealing with the thorny benchmarking issue. The article also discusses how advocates in the U.S. have attempted to meet and overcome arguments that police and their supporters have made in an attempt to minimize the problem or justify doing little or nothing about it.     

Reducing racial and ethnic health disparities: exploring an outcome-oriented agenda for research and policy

Eliminating racial and ethnic disparities in health status and health care, a major focus of Healthy People 2010, remains on the national agenda and among the priorities for the administration of President George W. Bush. Even though the elimination of racial and ethnic health disparities challenges the whole nation, individual states are on the front line of many initiatives and are often the focus of important policy efforts. In addition, it is important to focus on states because they are already responsible for much of the health and public health infrastructure, and several states have developed initiatives dating back to the release of Margaret Heckler's report on the gaps in health outcomes by race in 1985. This article makes the case for an outcome-oriented approach and provides a summary of lessons learned based upon preliminary investigations into constructing and applying two indices, the disparity reduction profile to measure effort and the disparity index to measure outcomes.     

Rule-making, rule-breaking? Law breaking by government in the Netherlands and the United Kingdom

This article concerns a relatively novel issue: rule breaking and unlawful conduct by government bodies; to which degree does it occur, what is the nature of this misconduct, what are the underlying motives, and what are the consequences and possible solutions? Rule and law breaking is harmful for the credibility and integrity of a state and its law enforcement system. However, very little empirical research has been carried out into this issue, in comparison to research into state crime. There is little clarity about how public actors deal with criminal and administrative laws and rules in areas like environmental protection, safety regulations and working conditions. Do government bodies set a good example? Is their behaviour better or worse than the public and businesses? An analytical framework for research will be presented and also the results of an extensive research project in the Netherlands; the main themes of which have been benchmarked against data from the United Kingdom. The article will conclude with a summary of the main findings and a number of suggestions for further research and policy development.     

“Good moral characters”: how drug felons are impacted under state marijuana legalization laws

This article examines how drug felons will be impacted by marijuana legalization in the United States. What will happen to drug felons whose charges would be legal under current law? Can drug felons work in the newly developing legal marijuana industries? In this article we will overview the statistics on arrests and convictions with their high rates of racial disparities. The war on drugs has inspired the development of more repressive criminal justice tactics such as asset forfeiture, high rates of re-incarceration during parole for marijuana violations, drug courts and their further reach into lifestyles, and the difficulties of prisoner reentry, especially for drug felons, who are barred from many jobs and social services. We will look at the regulations of felony offenders working in the cannabis industry. And we will consider the outcomes of retroactive ameliorative relief for this case of marijuana possession felonies under legalization.     

Public values, health inequality, and alternative notions of a "fair" response

The fact that disadvantaged people generally die younger and suffer more disease than those with more resources is gaining ground as a major policy concern in the United States. Yet we know little about how public values inform public opinion about policy interventions to address these disparities. This article presents findings from an exploratory study of the public's values and priorities as they relate to social inequalities in health. Forty-three subjects were presented with a scenario depicting health inequalities by social class and were given the opportunity to alter the distribution of health outcomes. Participants' responses fell into one of three distributive preferences: (1) prioritize the disadvantaged, (2) equalize health outcomes between advantaged and disadvantaged groups, and (3) equalize health resources between advantaged and disadvantaged groups. These equality preferences were reflected in participants' responses to a second, more complex scenario in which trade-offs with other health-related values - maximizing health and prioritizing the sickest - were introduced. In most cases, participants moderated their distributive preferences to accommodate these other health goals, particularly to prioritize the allocation of resources to the very sick regardless of their socioeconomic status.     

Providing health insurance in rural china: from research to policy

The focus of this case study is utilizing research to influence policy in a large developing country. Our experiences involve the lack of health insurance for China's rural populations and how our research helped shape China's recent policy attention and efforts on this issue. More than 80 percent of China's 700 million rural residents have no health insurance. This has been the case for the past thirty years, since the collapse of the once-successful Rural Cooperative Medical System after the economic reforms of the early 1980s. In 2002, the Chinese government announced a new rural health financing policy to provide health insurance for its rural populations, financed by a matching fund with contributions from central and local governments, as well as from individual households. This article documents the authors' experiences in addressing several critical questions for converting research results into policy actions, including the following: How are researchers to address policy relevant questions? How are they to acquire the attention of top policy makers to a specific problem? When is the issue at hand serious but not yet critical? And lastly, how are researchers to develop policy recommendations that stand a good chance of being accepted and enacted? Major lessons learned include the need to better understand the mandates and institutional constraints of the policy makers, the appropriateness of timing of both research result and policy efforts, how to use a country's cultural context to garner support of the government, how to enhance the policy's impact by combining formal and informal channels of communication for research dissemination, and the importance of following the policy process through the implementation phase to ensure the original objectives are achieved.     

Can education policy be health policy? Implications of research on the social determinants of health

Research on the social determinants of health has demonstrated robust correlations between several social factors, health status, and life expectancy. Some of these factors could be modified through policy intervention. National-level public policies explicitly based on population health research are in various stages of development in many Western countries, but in spite of evident need, seemingly not at all in the United States. Because research shows such a strong association between education and good health, we offer evidence to show that at least two pressing problems in American society, namely the uneven distribution of educational attainment and health disparities linked to socioeconomic position, may be ameliorated through policy initiatives that link quality early childhood care, child development programs, and parental training in a seamless continuum with strengthened K-12 education.     

Risk,response, and mental health policy: learning from the experience of the United Kingdom

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.     

RACIAL THREAT,PARTISAN POLITICS,AND RACIAL DISPARITIES IN PRISON ADMISSIONS: A PANEL ANALYSIS*

Why are racial disparities in imprisonment so pronounced? Studies of alternative outcomes in the criminal justice system find positive relationships between minority presence and punitive outcomes. Therefore, it is puzzling that the studies of racial incarceration ratios find negative relationships between this presence and such discrepancies. We use a pooled time‐series design to resolve this dilemma. Successful Republican attempts to link crime with public concerns about a dangerous racial underclass also suggest that where these racial appeals are successful, African Americans should face higher incarceration rates than whites. In contrast to prior research, our results are consistent with findings about other criminal justice outcomes. They show that an inverted, U‐shaped, nonlinear relationship is present between African‐American presence and racial disparities in imprisonments. Additional results indicate that the presence of African Americans in deep southern states and greater support for Republican presidential candidates together with increases in the most menacing crime (which often is blamed on African Americans) also help to explain these discrepant racial prison admission rates.     

THE CENTRAL PLACE OF RACE IN CRIME AND JUSTICE—THE AMERICAN SOCIETY OF CRIMINOLOGY'S 2011 SUTHERLAND ADDRESS*

In the United States and elsewhere, racial and ethnic disparities in crime and criminal justice are relatively ubiquitous. Yet the meaning of such disparities is not well understood. To address this concern, periodically there have been calls for research that takes into account the broader structural context of the racially and ethnically inequitable crime and justice patterns. However, a comprehensive approach to understanding such inequality is seldom applied in research. In this article, I review findings from a program of research on crime across race–ethnic neighborhoods that I have undertaken with Lauren J. Krivo and other colleagues to provide, and assess, such a framework. The starting point of our approach is that ethnoracial inequality in neighborhood crime is an outgrowth of a racialized social structure maintained largely through racial residential segregation. As anticipated, the findings illustrate the value added from research that embeds its assessment of crime and justice within an understanding of structured societal inequality. From these results, I call for placing race and ethnicity at the center of the study of crime and justice.     

Is the Process the Only Punishment?: Racial–Ethnic Disparities in Lower-Level Courts

Although misdemeanors make up the bulk of criminal cases in the United States, the majority of research on court decision-making examines felony sentencing. In contrast to felony courts, lower-level courts are characterized by higher case volumes and increased reliance on informal sanctions, which may contribute to greater racial–ethnic disparities. To assess this possibility, we examine pretrial detention and case processing outcomes for misdemeanants in Miami-Dade County, Florida. Utilizing temporal (detention time) and monetary (bond amount) measures of pretrial detention, we assess whether and to what extent there are racial–ethnic disparities in formal and informal sanctions facing misdemeanants. Results indicate that black defendants, especially black Latinx defendants, face greater informal sanctions (longer detention and higher bond amounts), are more likely to be convicted, and experience more severe formal sanctions than do white non-Latinx defendants. These findings complicate Feeley's (1979) argument about lower-level cases, revealing that black defendants are punished by both the court process and formal sanctions. In this way, “the process is the punishment” for lower-level white and nonwhite defendants, while the punishment is also the punishment for black defendants.