Health Equity最新文献

{"title":"Outcomes of an Evidence-Based Telemental Health Program Across Sexual Orientation and Gender Identity.","authors":"Jocelynn T Owusu, Katherine B Shakman, Keren Lehavot, Robert E Wickham, Alethea A Varra, Connie Chen, Anita Lungu, Jennifer L Lee","doi":"10.1177/24731242251382353","DOIUrl":"10.1177/24731242251382353","url":null,"abstract":"<p><strong>Introduction: </strong>The effectiveness of evidence-based mental health programs across sexual orientation and minoritized gender identity groups is not well-understood.</p><p><strong>Objectives: </strong>To evaluate outcomes of an employer-offered, evidence-based telemental health program (video-based psychotherapy sessions supplemented by asynchronous, guided practice sessions) across gender identity and sexual orientation groups.</p><p><strong>Methods: </strong>This retrospective cohort analysis included 29,860 U.S.-based adults with clinically elevated anxiety and/or depression symptoms, who began a culturally responsive, telemental health program between April 2021 and April 2023. The primary outcomes were changes in anxiety (Generalized Anxiety Disorder-7) and depression symptoms (Patient Health Questionnaire-9) during, and at the end of, care.</p><p><strong>Results: </strong>Participants self-identified as female (63.7%), male (31.5%), and transgender and gender diverse (1.4%); participants also self-identified as bisexual (5.5%), gay or lesbian (4.1%), additional sexual orientation groups (5.4%), and straight (78.0%). Rates of end-of-care reliable improvement or recovery in anxiety or depression symptoms ranged from 82.4 - 87.5% across gender identity groups, and 84.3 - 86.9% across sexual orientation groups. In growth curve models, anxiety and depression symptoms significantly decreased during treatment. Compared with straight adults, bisexual adults and adults reporting additional sexual orientation groups exhibited statistically significantly less steep initial reductions in anxiety and depression symptoms. Compared with female adults, male adults had statistically significantly steeper initial reductions in anxiety and depression symptoms. Across these outcomes, statistically significant differences by gender identity and sexual orientation groups were small.</p><p><strong>Discussion: </strong>This employer-offered telemental health program provided clinically beneficial services to populations with diverse gender identities and sexual orientations, suggesting a potential pathway for accessing equitable mental health care.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"632-644"},"PeriodicalIF":2.5,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation and Evaluation of Postpartum Midwifery Care at Home at a Federally Qualified Health Center in Washington, DC.","authors":"Katie DePalma, Ebony Marcelle, Emma Clark, Teresa O'Brien, Sanjana Chimata, Erica Eliason, Bayyinah Muhammad, Sola Stamm, Nicole Vernot-Jonas, Pawel Olowski, Dawn Sherman, Christina X Marea","doi":"10.1177/24731242251382349","DOIUrl":"10.1177/24731242251382349","url":null,"abstract":"<p><strong>Background: </strong>The postpartum period is a critical time to support birthing people and infants, address and mitigate perinatal health inequities, and promote joy and connection. Yet many birthing people do not perceive value in postpartum visits, particularly when measured against the competing demands and barriers to care faced by those experiencing poverty and other systemic oppression. These inequities are particularly acute for Black birthing people insured by Medicaid due to structural and interpersonal racism, as well as economic disenfranchisement. We implemented an opt-in postpartum care at home program led by midwives at a federally qualified health center to increase the perceived value of postpartum care and increase patient engagement.</p><p><strong>Methods: </strong>We evaluated implementation using the reach, effectiveness, adoption, implementation, and maintenance framework. We assessed reach and effectiveness using electronic health record data for 2022 (pre-implementation) and 2023 (implementation).</p><p><strong>Results: </strong>Among 473 birthing people eligible during the evaluation period, 118 (28%) had a postpartum home care visit. Postpartum visit attendance rates increased from 78% in 2022 to 84% in 2023. In-home postpartum care increased family involvement, enabled longer and more comprehensive visits, and improved provider satisfaction.</p><p><strong>Conclusions: </strong>Postpartum care at home can reduce barriers to care, increase visit attendance, and promote joy. In-home postpartum care with a midwife has the potential to mitigate health inequities experienced by Black birthing people by fostering trust and shifting the power dynamic in the patient-provider relationship. Community-based care must be designed and implemented with antiracist and emancipatory approaches.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"618-630"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Exploration of Maternal Health Care Providers' Perspectives on Respectful Maternity Care in the United States: A Scoping Review Protocol.","authors":"Celestine Yayra Ofori-Parku","doi":"10.1177/24731242251384093","DOIUrl":"10.1177/24731242251384093","url":null,"abstract":"<p><strong>Background: </strong>Maternal mortality and morbidity rates in the United States among racially minoritized populations have continued to worsen over the past decade. Reviews have examined the maternity care experiences and outcomes of Black individuals in the United States. However, few reviews have examined maternal health care providers' experiences in the United States.</p><p><strong>Purpose: </strong>To comprehensively assess the current evidence and knowledge gaps related to maternal health care providers' perspectives on providing respectful maternity care to Black patients.</p><p><strong>Method: </strong>The methodology is in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines, and the Joanna Briggs Institute enhanced scoping review framework. A literature search using medical subject headings on the terms \"Maternity care providers,\" \"Perspective,\" \"Respectful maternity care,\" \"Person-centered maternity,\" \"Compassionate maternity care\" together with BOOLEAN operators (\"AND\"/\"OR\") will be conducted via PubMed, Embase, Web of Science, and CINAHL. The search will be limited to studies conducted in the United States, in English, and from 2013 to 2024. A Gray literature search will be conducted. Retrieved articles will be imported into Zotero to remove duplicates and imported to Covidence. Studies will be appraised using the Mixed Methods Appraisal Tool. A random-effects meta-analysis will be conducted based on the homogeneity of the included studies. If quantitative synthesis or meta-analysis is not appropriate due to the heterogeneity of the included studies, a combination of narrative and thematic synthesis methodology will be employed.</p><p><strong>Ethics and dissemination: </strong>Ethics approval is not required for the scoping review, and these findings will be submitted for open-access publication in peer-reviewed journals and presented at scientific conferences.</p><p><strong>Discussion: </strong>The findings from this scoping review will help provide a comprehensive summary of clinicians' perspectives on delivering facility-based maternity care free of discrimination and maltreatment, which can significantly inform policies to enhance quality and equitable maternity care services.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"612-617"},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Documentation of Stigmatizing Language in Electronic Health Records and Birth Outcomes.","authors":"Jihye Kim Scroggins, Ismael Ibrahim Hulchafo, Sarah Harkins, Hans Moen, Michele Tadiello, Kenrick Cato, Anahita Davoudi, Dena Goffman, Janice James Aubey, Coretta Green, Maxim Topaz, Veronica Barcelona","doi":"10.1177/24731242251381595","DOIUrl":"10.1177/24731242251381595","url":null,"abstract":"<p><strong>Introduction: </strong>Stigmatizing language represents biases. Understanding its impact is crucial to improve perinatal health. We aimed to examine the association between stigmatizing language in electronic health records (EHR) and birth outcomes.</p><p><strong>Methods: </strong>We analyzed EHR data of patients admitted for childbirth (<i>n</i> = 18,897) between 2017 and 2019 using natural language processing at two hospitals in the United States. Independent variables were any stigmatizing language, and by category: marginalized language/identities, difficult patient, and unilateral/authoritarian decisions. Outcome variables included low-risk cesarean birth (Society for Maternal and Fetal Medicine [SMFM] and nulliparous, term, singleton, vertex [NTSV] definitions), postpartum hemorrhage, and chorioamnionitis.</p><p><strong>Results: </strong>Compared with patients with no stigmatizing language, patients with any stigmatizing language had higher odds of SMFM low-risk cesarean birth (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI] = 1.23-1.50, <i>p</i> < 0.01), postpartum hemorrhage (aOR = 1.68, 95% CI = 1.51-1.88, <i>p</i> < 0.01), and chorioamnionitis (aOR = 1.23, 95% CI = 1.07-1.42, <i>p</i> < 0.01). Labeling patients as difficult was associated with higher odds of low-risk cesarean birth (SMFM aOR = 1.19, 95% CI = 1.07-1.33, <i>p</i> < 0.01), postpartum hemorrhage (aOR = 2.07, 95% CI = 1.85-2.30, <i>p</i> < 0.01), and chorioamnionitis (aOR = 1.33, 95% CI = 1.14-1.55, <i>p</i> < 0.01). Patients who had language from unilateral/authoritarian category had higher odds of low-risk cesarean birth (SMFM aOR = 1.46, 95% CI = 1.31-1.62, <i>p</i> < 0.01) and postpartum hemorrhage (aOR = 1.31, 95% CI = 1.17-1.46, <i>p</i> < 0.01).</p><p><strong>Discussion and conclusion: </strong>Stigmatizing language in clinical notes was associated with birth outcomes. These findings highlight the need to improve perinatal health through examining individual behaviors and structural-level policies that reinforce bias.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"580-598"},"PeriodicalIF":2.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12926810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147285591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestations and Lived Experiences of Structural Racism for Racial and Ethnic Minority Communities Affected by HIV Across the United States.","authors":"Betelhem A Muno, Mariam Haris, Amra Zegeye, Rahel Behailu, Shukri A Hassan, Jessica Y Islam, Martez D Smith, Bridgette Picou, Chioma Nnaji, Jennifer Barnes-Balenciaga, Marissa Miller, Steven Sawyer, Dana McCullough, Luis Mares, Ulysses Burley Iii, Phyllis Bijole, Ian L Haddock, Bill William Hall, Mitchell Warren, Dustin T Duncan, Stephaun Elite Wallace-Marc Jacobs, Marlene Camacho-Rivera, Jessica Jaiswal, Rena C Patel","doi":"10.1177/24731242251375878","DOIUrl":"10.1177/24731242251375878","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate some of the manifestations of structural racism as a root cause of racialized inequities in HIV in the context of COVID-19, centered through the lens of community members with lived experiences.</p><p><strong>Methods: </strong>We partnered with eight community-based organizations to conduct focus group discussions structured around COVID-19 and HIV-related experiences. We utilized inductive coding and thematic analysis.</p><p><strong>Results: </strong>We conducted 10 focus group discussions (98 participants) across the United States between February and May 2023; 65% were ages 18-39, over 90% identified as Black, 39% were female, and 66% were cisgender. First, participants emphasized that structural racism intersects with other systems of oppression. Second, three main themes emerged as manifestations of structural racism: (1) lack of representation in state and federal decision-making levels, (2) differential access to resources, and (3) intergenerational mistrust and trauma.</p><p><strong>Conclusion: </strong>The intersecting impact of the HIV epidemic and COVID-19 pandemic underscores the pervasive effects of structural racism that manifests in the United States.</p><p><strong>Health equity implications: </strong>More than ever, researchers must champion the experiences and needs of racial and ethnic minority communities to affect structural change.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"474-490"},"PeriodicalIF":2.3,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Necessity of Diversity, Equity and Inclusion Training for Obstetrics and Gynecology: A Department-Wide Needs Assessment of an Academic Obstetrics and Gynecology Department.","authors":"Ayana G R DeGaia, Shilpa Darivemula, Omar M Young","doi":"10.1177/24731242251374427","DOIUrl":"10.1177/24731242251374427","url":null,"abstract":"<p><strong>Introduction: </strong>The persistent disparities in the field of obstetrics and gynecology (OBGYN) have become increasingly visible in the public eye, while at the same time public discourse regarding the appropriateness and efficacy of diversity, equity and inclusion (DEI) education has become increasingly politically polarized.</p><p><strong>Background: </strong>While it has long been accepted that DEI training is an essential component of curricula offered in academic OBGYN departments, there remains a great deal of uncertainty regarding the best practices for developing and provisioning such training.</p><p><strong>Methods: </strong>In this article, the authors outline lessons learned from the process of developing an evidence-based department-wide needs assessment in order to evaluate the knowledge, attitudes, and behavior of members of a large academic OBGYN department, including an evaluation of the impact of prior DEI educational programming.</p><p><strong>Results: </strong>Of the 113 clinicians, nurses and administrative staff, the majority desired more DEI training and endorsed significant barriers to accessing it. There were also significant opportunities for improvement of health equity knowledge and clinical practice.</p><p><strong>Discussion: </strong>Although DEI training has been lauded for addressing health inequities, the findings of this needs assessment highlight existing gaps between desired and actual outcomes. It is essential that academic departments design, implement, and evaluate DEI strategies that are inclusive of the entire medical team, offer iterative and ongoing training opportunities, provide support for minoritized groups within the department, and involve a variety of stakeholders to improve our ability to provide equitable reproductive health care for all.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"442-449"},"PeriodicalIF":2.5,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions, Beliefs, and Knowledge of Oral and Familial Cancer in an Indigenous Community of Chile: A Mixed Quantitative-Qualitative Study.","authors":"Cynthia Cantarutti, Gerardo Yévenes, Águeda Muñoz-Del-Carpio-Toia, Daniela Adorno-Farias, Ricardo Fernández-Ramires, Alan Roger Santos-Silva, Jean Nunes Dos Santos, Ignacio Molina-Ávila, Francisco J Bravo, Wilfredo Alejandro González-Arriagada","doi":"10.1177/24731242251372703","DOIUrl":"10.1177/24731242251372703","url":null,"abstract":"<p><strong>Background: </strong>Oral cancer is one of the 10 most common cancers globally and represents a public health problem. Cultural practices and access to care are recognized as determinants of oral diseases, including cancer. Understanding the perceptions of indigenous communities is crucial for developing culturally appropriate interventions. This study aims to evaluate the perceptions, beliefs, and knowledge about oral and familial cancer within a specific indigenous community (Quechua and Aymara) in Chile using a mixed-methods approach.</p><p><strong>Methods: </strong>This exploratory study was conducted in two phases: an oral cavity clinical examination and a qualitative phase, consisting of semi-structured interviews with a subset of participants from the clinical examination. A total of 77 volunteers with no prior history of oral cancer underwent an oral cavity clinical examination, and 53% reported a familial history of cancer. The interview was conducted with 18 participants.</p><p><strong>Results: </strong>No significant differences were found in the clinical oral health status between the indigenous and nonindigenous populations. However, a lack of knowledge of oral cancer was noted in the indigenous community. A higher proportion of participants from the indigenous population reported a family history of cancer.</p><p><strong>Conclusion: </strong>The community demonstrated limited knowledge about oral cancer. Therefore, it is necessary to implement culturally and linguistically appropriate strategies for oral health promotion and oral cancer prevention to address the specific needs of these communities.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"433-441"},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persons Experiencing Housing Instability Perspectives on Medicaid Managed Care Organizations and Homeless Shelters.","authors":"Emily R Clear, Allison M Scott, Kelsie Kwok, Mark A Ribott, Teresa M Waters, Rachel Hogg-Graham","doi":"10.1177/24731242251371428","DOIUrl":"10.1177/24731242251371428","url":null,"abstract":"<p><strong>Background: </strong>Persons experiencing housing instability (PEHIs) are medically vulnerable and at increased risk for poor health outcomes, high clinical service utilization, and mortality. Unstable housing is just one of many social determinants of health or nonmedical factors influencing health outcomes.</p><p><strong>Methods: </strong>Focus groups were conducted on-site at two Kentucky homeless shelters to assess the structure and perceived effectiveness of Medicaid managed care organizations (MCOs) and community-based organizations (CBOs) partnerships. We share perspectives of homeless Medicaid enrollees who are living without housing on the interaction between Medicaid MCOs and homeless shelters addressing unmet social needs.</p><p><strong>Results: </strong>Three themes emerged from our qualitative analysis: (1) Benefits of and barriers to receiving various services through Medicaid, (2) Medicaid does not appear to interface well with community-based shelters, and (3) Medicaid enrollees living without housing perceive a lack of information from Medicaid. Concerns raised by participants included barriers to receiving services, strengthening resource and referral processes, and increasing communication with both CBOs and Medicaid enrollees. These concerns must be addressed to improve care and outcomes.</p><p><strong>Conclusions: </strong>PEHIs rely on homeless shelters to help them enroll and utilize Medicaid rather than relying on Medicaid to identify and utilize CBOs. There are opportunities for improvement in how MCOs interact with PEHI enrollees. PEHIs utilize Medicaid and navigate cross-sector relationships in different ways than other Medicaid enrollees.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"425-432"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing Racial Disparities in Hypertension Control Using a Multicomponent, Equity-Centered Approach.","authors":"Susan Mwikali Kioko, Christina Council, Cecilia Tomori","doi":"10.1177/24731242251371424","DOIUrl":"10.1177/24731242251371424","url":null,"abstract":"<p><strong>Introduction: </strong>Black Americans have the highest prevalence of hypertension among all racial or ethnic groups in the United States. They are 40% more likely to have uncontrolled blood pressure (BP) and are five times more likely to die from hypertension compared with non-Hispanic Whites. Experiences of discrimination in health care, clinician and institutional bias, and socioeconomic and environmental inequities driven by structural racism contribute to uncontrolled hypertension in this population. Multilevel, multicomponent interventions have effectively improved BP control among Black Americans but remain inadequately implemented in the clinical setting. An integrated nursing/public health quality improvement study was designed to address this gap between evidence and integration into clinical practice.</p><p><strong>Methods: </strong>Using a one group pre/posttest design, we examined the effect of an innovative, evidence-based 12-week intervention on BP among Black Americans with uncontrolled hypertension aged 18 and older in the primary care setting. Intervention components included remote BP monitoring, weekly phone coaching with culturally congruent care, medication intensification, and a standardized hypertension protocol.</p><p><strong>Results: </strong>The average age of the participants (<i>n</i> = 35) was 64 years, and two thirds (<i>n</i> = 23) were female (66%). The mean difference in systolic BP from pre to postintervention decreased significantly (M = 23, standard deviation [SD] = 14.0), <i>t(34)</i> = -9.7, <i>p</i> < 0.001). A significant reduction in the mean difference in diastolic BP from pre to postintervention was also observed (M = 11, SD = 11.8), <i>t(34)</i> = -5.5, <i>p</i> < 0.001). At 12 weeks, 87% of participants had achieved BP control. The intervention also improved medication adherence and hypertension knowledge (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>A multicomponent, culturally congruent quality improvement intervention may effectively improve BP among Black Americans.</p><p><strong>Health equity implications: </strong>Scaled up implementation of equity-centered, culturally congruent approaches is needed to reduce racial disparities in hypertension control.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"416-424"},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Holistic Ecosystem Model to Diversify the Physician Workforce and Enhance Health.","authors":"Erik J Porfeli, Sunny Nakae, Leila Amiri, Leila E Harrison, Will Ross","doi":"10.1177/24731242251371526","DOIUrl":"10.1177/24731242251371526","url":null,"abstract":"<p><strong>Importance: </strong>The U.S. medical education system attracts and trains the next generation of physicians to advance the health care needs of a growing and increasingly diverse nation. This system can be credited for supplying a physician workforce achieving remarkable growth and innovation, yielding one of the world's most technologically advanced health care systems on the planet. This system, unfortunately, also contributes to educational, workforce, and health disparities.</p><p><strong>Observations: </strong>The successes and challenges of the medical education and health care system align with broader economic, health, and educational patterns in the United States. An ecological model can be employed to unite a network of partners spanning four developmental stages to support a greater diversity of students for and from underrepresented communities to enter the physician workforce, enjoy the rewards granted by a career in medicine, and enact needed changes to eliminate health, economic, and educational disparities.</p><p><strong>Conclusions and relevance: </strong>Comprehensive and ecologically attuned pathways to the physician workforce could be especially beneficial to states and communities suffering from the looming high school enrollment cliff, outflows of residents to other states, challenges in recruiting and retaining physicians, and significant educational and health disparities. The ecosystem model spurs significant changes in how we think about the developmental pathways to the physician workforce and how we may mobilize resources to promote progress and ease transitions, especially for underrepresented students who face many fewer opportunities and many more challenges along their journey.</p>","PeriodicalId":36602,"journal":{"name":"Health Equity","volume":"9 1","pages":"405-411"},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12412384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}