Preface From Edited Book                    

The Handbook of Black American Health (2^nd Edition): Policies and Issues Behind Disparities in Health, is a 47-chapter collection of original scholarly presentations covering a variety of areas relating to the health of Blacks or African Americans. It must be noted that the terms Black and African American are used interchangeably throughout the book. Because of the varying views expressed by certain authors, the decision was made to include both terms; however, an attempt was made to have consistency within a chapter, when either term was used.

Initial thoughts that led to the first edition of this book, which in turn contributed to this second edition, began over two decades ago, when I was pursuing postgraduate work in public health at the Harvard School of Public Health (HSPH). During this period, I was responsible for coordinating a conference entitled "Selected Health Care Issues in the Black American Community," sponsored, in part, by the minority students at the HSPH. Apart from this conference, the class discussions at the HSPH and later experiences I had while pursuing postdoctoral studies in the Department of Behavioral Sciences and Heath Education, at the then Johns Hopkins School of Hygiene and Public Health (now called the Johns Hopkins Bloomberg School of Public Health) new name is the , helped to stimulate my initial ideas for the first edition of the book. These experiences also formulated my professional research agenda relating to my two decade-long pursuit of the social epidemiology of cardiovascular and immunological disease in Black populations in America, Africa and the Caribbean. These initial experiences, and also my subsequent research over the years in the area of Black and minority health, uncategorically suggested a void in the comprehensive illumination of "salient" health problems and issues in Black America and, hence the need for the first volume, its scope, and its timely importance.

It is a sad testimony of the times that just about the same reasons that motivated me to edit the first volume also motivated me to edit the second edition of the Handbook of Black American Health. Although the first edition addressed issues related to racial and ethnic disparities, because of the greater need and attention paid to health disparities today, it became more of a direct theme of the book and throughout its forty-seven chapters.

As I labored over the scope and the ultimate direction the second volume would take, I came to two inescapable conclusions: 1) The second volume must be more expansive to include issues and conditions that were not visibly important twenty years ago, so the second volume was expanded form 27 to 47 chapters; 2) when completed, the volume must make a significant contribution to the area of racial and ethnic disparities in health. This need for the volume to make a contribution led in turn to the purpose of the book, which is threefold: 1) to go beyond the traditional areas covered in past publications on health of blacks (i.e., cardiovascular and cerebrovascular disease and caner) and adopt a multidisciplinary focus on a variety of other conditions and issues (e.g., Rural America, Human Genome, complementary/alternative health). 2) apart from presenting a representative selections of conditions and issues that contributed to poorer morbidity and mortality rates for blacks, to provide and illuminating forum to provoke dialogue and debate for academicians, clinicians, researchers, and politicians alike to debate and discuss the urgency of the Black health crisis, and it is hoped, how best to intervene now and in the future to reduce racial disparities in health.

Blacks in this country have made improvements to their health; however, a multitude of racial disparities still exists. A major reason is that, although legislation may have made health care relatively more available and affordable, the fundamental and unequal structure of American society, which is primarily responsible for racial disparities in health, did not and has not changed.

The Report of the Secretary’s Task Force on Black and Minority Health(1985), a landmark clarion call for change, was revealing, showing for example, that there are 60,000 excess black deaths annually compared with White Americans. However, since its publication much as changed for the worse and little has changed for the better. Not only do Black babies die earlier the White babies, but in recent years reports suggest that a continued reduction and leveling off in life expectancy for Blacks has occurred while there been, in contrast, and extension for Whites.

Understanding health in general is a difficult undertaking, and understanding Black health in particular is perhaps even more difficult. The complexities associated with understanding Black health are compounded by several factors, for example, intraracial variations, socioeconomic status or poverty, racial admixture, health practices, and the compelling realities of an unequal, unjust, insensitive, and institutionally racist American society. Many changes over the last twenty-five years in the geopolitical, sociopolitical, and technological arenas, both in this country and overseas, while ushering in many new opportunities, have also brought new miseries or exacerbated old ones, especially for minority communities.

This volume is not intended to provide and exhaustive coverage for all major conditions and issues affecting the health of Blacks. Instead, its 47 chapters, divided among the 5 parts of the book, provide a mosaic of salient conditions, issues, and policies that are behind disparities in health related to Black American health, heretofore not covered under a single volume. This multidisciplinary approach to health adopted in this volume is one of its major advantages. The forty-four contributing authors, drawn from institutions across America, are premier scholars in their respective fields. The scope and multidisciplinary nature of the volume are, in par, reflected in areas from which there authors came: clinical medicine, epidemiologist, health care administration, medical sociology, nursing, nutritional sciences, political science, physiology, public health, and background of most of the authors, which lent itself not only to an illuminating presentation of epidemiologic data, where applicable, but also to the discussion of designated problems from prevention and internventionist points of view. It also supported the discussions of how best to intervene to address a problem, allowing authors to discuss prospects and suggest recommendations. By way of a summary, two questions need to be answered about this handbook: 1 who is the intended audience? 2What is its significance?

Because of the multidisciplinary focus of this handbook it can be used by a variety of professionals and disciplines in the behavioral sciences, allied sciences, and clinical sciences. Whether the volume is used as a reference text, a main-text, or a supplementary text from which selected readings are taken, it provides a cross-section of readers with a wealth of current information pertaining to the disproportionate incidence of morbidity and mortality in the Black American population.

This handbook is significant because of (a) its timely presentation of crucial issues pertaining to the health of Black Americans, especially now when the United States Congress and administration, policy-makers, and others are debating the need and direction of health care form; its multidisciplinary and public health foci; (c) its ability to stimulate and provoke serious tough, debate, and policy decisions in a variety of forums involving crucial areas influencing the health of Blacks living in America; and (d) the variety of models and recommendations suggested by knowledgeable scholars, all within a framework for social action and change, during the remainder of this century as well as the 21^st century. While racial parity in health will not be achieved by Blacks overnight, it is sustained improvements in health for vast numbers of the at-risk Black American population. Therefore, as we work toward a brighter 21^st century, which involves racial parity in health, it is further hoped that his handbook will help to make a brighter future out of the darkness of the past.