In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicatorsâ€"measures of utilization and outcomeâ€"that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

The report reveals that the Native American health care system created by the federal government has used only limited and incremental responses to the health care challenges faced by Native Americans.

American Indian affairs are much in the public mind today—hotly contested debates over such issues as Indian fishing rights, land claims, and reservation gambling hold our attention. While the unique legal status of American Indians rests on the historical treaty relationship between Indian tribes and the federal government, until now there has been no comprehensive history of these treaties and their role in American life. Francis Paul Prucha, a leading authority on the history of American Indian affairs, argues that the treaties were a political anomaly from the very beginning. The term "treaty" implies a contract between sovereign independent nations, yet Indians were always in a position of inequality and dependence as negotiators, a fact that complicates their current attempts to regain their rights and tribal sovereignty. Prucha's impeccably researched book, based on a close analysis of every treaty, makes possible a thorough understanding of a legal dilemma whose legacy is so palpably felt today.