Documented disparities exist in the United States between the majority white population and various racial and ethnic minority populations on several health and health care indicators, including access to and quality of care, disease prevalence, infant mortality, and life expectancy. However, awareness of these disparities-a necessary first step toward changing behavior and compelling action-remains limited. Our survey of 3,159 adults age eighteen or older found that 59 percent of Americans in 2010 were aware of racial and ethnic disparities that disproportionately affect African Americans and Hispanics or Latinos. That number represents a modest increase over the 55 percent recorded in a 1999 survey. Meanwhile, in our survey, 89 percent of African American respondents were aware of African American and white disparities, versus 55 percent of whites. Yet the survey also revealed low levels of awareness among racial and ethnic minority groups about disparities that disproportionately affect their own communities. For example, only 54 percent of African Americans were aware of disparities in the rate of HIV/AIDS between African Americans and whites, and only 21 percent of Hispanics or Latinos were aware of those disparities between their group and whites. Policy makers must increase the availability and quality of data on racial and ethnic health disparities and create multisectoral partnerships to develop targeted educational campaigns to increase awareness of health disparities.

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Resumen Muchas sociedades indigenas están preocupadas por su futuro. Las personas mayores no saben cómo las nuevas generaciones van a continuar viviendo y transmitiendo su herencia y se critica a la juventud por cambiar u olvidar las tradiciones. En el caso Shipibo‐Konibo, los mayores creen que a los jóvenes solo les interesa vivir en la ciudad y olvidar sus raíces. Sin embargo, no todos piensan así necesariamente. Hay muchas formas de ser Shipibo y de expresar la identidad shipiba. Este artículo discute cómo los valores culturales y morales ayudan a la juventud shipiba a enfrentar los nuevos desafíos de esta época. Asimismo, cómo las organizaciones juveniles shipibas constituyen una forma de lidiar con los dilemas que los y las jóvenes shipibas enfrentan. La pregunta central no es “ser o no ser Shipibo”, sino qué significa ser joven shipibo ahora, en nuevos contextos sociales y culturales.

Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population’s health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group, and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$ 4487.5 per YLL avoided (14.7 million COP at 2019 prices) and US$ 5180.8 per QALY gained (17 million COP at 2019 prices), around one times the GDP per capita. To our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed care health system.

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