Improving the health of African Americans in the USA: an overdue opportunity for social justice.

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber legacy of years of racial and social injustice and a formidable challenge to equitable health care for all. Systemic causes of suboptimal black health require equally systemic solutions; positive trends in black health indicators seem to be driven by social development programs, economic investment in education, participation of African Americans in policy, and decision-making and expansion of access to health care.

Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications.

Sickle Cell Trait (HbAS), the heterozygous state for the sickle hemoglobin beta globin gene is carried by as many as 100 million individuals including up to 25% of the population in some regions of the world (World Health Organization, Provisional agenda item 4.8, EB117/34 (22 December 2005) or World Health Organization, Provisional agenda item 11.4 (24 April 2006)). Persons with HbAS have some resistance to falciparum malaria infection in early childhood (Piel FB, Patil AP, Howes RE, et al., Nat Commun 2010;1104:1-7 and Aidoo M, Terlouw DJ, Kolczak M, et al., Lancet 2002;359:1311-1312) and as a result individuals with HbAS living in malarial endemic regions of Africa have a survival advantage over individuals with HbAA. Reports from the US emphasize possible health risks for individuals with HbAS including increased incidence of renal failure and malignancy, thromboembolic disorders, splenic infarction as a high altitude complication, and exercise-related sudden death. The National Heart, Lung, and Blood Institute, National Institutes of Health convened a workshop in Bethesda, Maryland on June 3-4, 2010, Framing the Research Agenda for Sickle Cell Trait, to review the clinical manifestations of HbAS, discuss the exercise-related sudden death reports in HbAS, and examine the public health, societal, and ethical implications of policies regarding HbAS. The goal of the workshop was to identify potential research questions to address knowledge gaps.

The need for diversity in the health professions.

The Surgeon General's Report on Oral Health remains a baseline document for addressing the issues of oral health disparities in America. With the problems of access to care and quality of care, cultural differences, history of discrimination, and ongoing severity of poverty, today there are many disturbing disparities in oral health status between people of color and the majority population. While the number of people of color is increasing, the number being prepared to provide quality oral health care is declining. The nation, the dental profession, and dental schools have not made adequate progress in the effort to develop a workforce that can address the disparities in oral health problems based on race and ethnicity. The Office of the Surgeon General is developing a National Oral Health Action Plan to help address these problems, but the role of dental schools is critical. Building a pipeline that will bring diverse people to the dental workforce must be a high priority for all involved. A substantial improvement in the diversity of the oral health student body and eventual workforce is a critical and essential element to achieving the goals of improving oral health and quality of life and eliminating health disparities.

Summary of the 2000 Surgeon General's listening session: toward a national action plan on overweight and obesity.

OBJECTIVE: To provide insight into discussions at the Surgeon General's Listening Session, "Toward a National Action Plan on Overweight and Obesity," and to complement The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. RESEARCH METHODS AND PROCEDURES: On December 7 and 8, 2000, representatives from federal, state, academic, and private sectors attended the Surgeon General's Listening Session and were given an opportunity to recommend what to include in a national plan to address overweight and obesity. The public was invited to comment during a corresponding public comment period. The Surgeon General's Listening Session was also broadcast on the Internet, allowing others to view the deliberations live or access the archived files. Significant discussion points from the Listening Session have been reviewed by representatives of the federal agencies and are the basis of this complementary document. RESULTS: Examples of issues, strategies, and barriers to change are discussed within five thematic areas: schools, health care, family and community, worksite, and media. Suggested cooperative or collaborative actions for preventing and decreasing overweight and obesity are described. An annotated list of some programmatic partnerships is included. DISCUSSION: The Surgeon General's Listening Session provided an opportunity for representatives from family and community groups, schools, the media, the health-care environment, and worksites to become partners and to unite around the common goal of preventing and decreasing overweight and obesity. The combination of approaches from these perspectives offers a rich resource of opportunity to combat the public health epidemic of overweight and obesity.

Key roles of government in genomics and proteomics: a public health perspective.

This paper is based on the presentation of Dr. Allan Noonan at the third biennial Asan-Harvard Medical International Symposium on "Genomics and Proteomics: Impact on Medicine and Health" that took place in Seoul, Korea, July 3-4, 2001. Dr. Noonan is a senior advisor to the Surgeon General of the United States and was representing the then Surgeon General, Dr. David Satcher. In this final presentation of the symposium, Dr. Noonan reviews the key roles of government in US health care and discusses several areas where genomic- and proteomic-based information will necessitate changes in the functions of public health. In particular, Dr. Noonan discusses the need for appropriate training to meet the challenges of the genomic future; for sensitivity in the development of policies to address the ethical, legal, and social implications of genomic information; and for dissemination of genomic information to both the professionals and the public. Dr. Noonan concludes with a vision of the genomic future of the next 30 years and a reiteration of the need for partnership among health professionals, educators, and social services professionals.

Integrating genomics into US public health.

This paper presents an overview of how the US government is currently addressing the complex issue of integrating genomics into public health. The author, a public health provider with many years of experience, including several years spent in genetics and maternal and child health, is currently a senior advisor to the Surgeon General of the United States. At the time of the third biennial Asan-Harvard Medical International Symposium, "Genomics and Proteomics: Impact on Medicine and Health," in Seoul, Korea, July 3-4, 2001, the US Surgeon General was Dr. David Satcher. Dr. Allan Noonan attended the symposium as Dr. Satcher's representative. Dr. Noonan's paper discusses the challenges facing the US public health system as it strives to integrate and promote genomics and proteomics into its efforts to reduce morbidity and mortality in the US population.