Although recent declines in life expectancy among non-Hispanic Whites, coined “deaths of despair,” grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America’s health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites.
To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being.
We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans. (Am J Public Health. Published online ahead of print September 25, 2018: e1–e6. doi:10.2105/AJPH. 2018.304585)
Improving the patient experience through nurse leader rounds Cover Page Footnote We would first like to acknowledge the incredible work and leadership of the teams and leaders of the regions, hospitals and emergency departments who implemented nurse leader rounds and achieved such positive results. Without their dedication and effort, this article could not have been written. We would also like to express our appreciation to the board and executive leaders whose oversight and guidance maintains patient experience and the work related to it as a high priority. We are particularly thankful to librarians Kathryn Gibbs and Basia Delawska-Elliott for their assistance in securing literature needed to inform this research. Advice provided by Tom French regarding statistical analyses was most valuable, and we are extremely grateful to have benefited from it. Michele Bedford deserves our eternal gratitude for her constant assistance to coordinate, support, and improve our efforts. Special thanks are extended to Michele Nafziger and Press Ganey for generous and ongoing support of our data analysis, reporting, and improvement work. This article is associated with the Culture & Leadership lens of The Beryl Institute Experience Framework.
The U.S. life expectancy lag could be considerably smaller if U.S. expenditures on education and incapacity programs were comparable with those in other high-income countries.
Link and Phelan’s pioneering 1995 theory of fundamental causes urged health scholars to consider the macro-level contexts that “put people at risk of risks.” Allied research on the political economy of health has since aptly demonstrated how institutions contextualize risk factors for health. Yet scant research has fully capitalized on either fundamental cause or political economy of health’s allusion to power relations as a determinant of persistent inequalities in population health. I address this oversight by advancing a theory of health power resources that contends that power relations distribute and translate the meaning (i.e., necessity, value, and utility) of socioeconomic and health-relevant resources. This occurs through stratification, commodification, discrimination, and devitalization. Resurrecting historical sociological emphases on power relations provides an avenue through which scholars can more fully understand the patterning of population health and better connect the sociology of health and illness to the central tenets of the discipline.
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