Am I My Brother’s Keeper? African American Men’s Health Within the Context of Equity and Policy

Abstract

African American men’s health has at times been regarded as irrelevant to the health and well-being of the communities where they are born, grow, live, work, and age. The uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. There is a critical need for scholarship that better contextualizes African American Male Theory and cultural humility in terms of public health. Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy, but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective. The purpose of this article will be to examine African American men’s health within the context of social determinants of health status, health behavior, and health inequalities—elucidating policy implications for system change and providing recommendations from the vantage point of health equity.

Keywords

men’s studies masculinity cultural sensitivity health policy issues men of color

Introduction

Since the early 20th century, many scholar-activists have decried the unjust treatment of people of color with respect to their health and well-being (Byrd & Clayton, 2000; DuBois, 1899; Quinn & Thomas, 2011; Srinivasan & Williams, 2014; Washington, 2008). Men of color, in particular, have worse health outcomes than their White counterparts (Braithwaite, Taylor, & Treadwell, 2009; Giorgianni et al., 2012; Jack & Griffith, 2013; Leigh, 2004; Thorpe, Richard, Bowie, LaVeist, & Gaskin, 2013). Accordingly, why is men’s health important overall? It is a societal and family issue. Men’s health affects spouses and children, diminished productivity, poverty associated with widowhood, fatherlessness leading to increased risk of drug and alcohol use, lower college aspirations, and more encounters with the criminal justice system among youth. Likewise, it has become increasingly apparent that social factors (e.g., low socioeconomic status, poor neighborhood conditions, discrimination, reduced access to quality education, reduced access to employment, reduced access to quality health care, and incarceration) have a major impact on the health inequities affecting African American men (Treadwell, Xanthos, & Holden, 2012).

For example, African American men’s mortality risk for stroke is 60% greater than White men (Office of Minority Health, 2008); they have a 37% greater chance of developing lung cancer that White men (American Lung Association, 2007); they are more than nine times likely to die from AIDS as their White counterparts (Office of Minority Health, 2008); they are more than twice as likely to die from prostate cancer than White men (American Cancer Society, 2014b); the incidence rates of oral and pharyngeal cancers for Black males are 39.6% higher than for White males (20.8 vs. 14.9, respectively, per 100,000 males per year; U.S. Department of Health and Human Services, 2000); and among African American young men, the mortality rate for homicides is 51.5 per 100,000 of the population compared with 2.9 per 100,000 of the population for their White counterparts (Centers for Disease Control and Prevention, 2010).

Pragmatically, there is a critical need for public health studies to produce scholarship salient to African American Male Theory (AAMT) and cultural humility (Bush & Bush, 2013; Hook, Davis, Owen, Worthington, & Utsey, 2013). Using AAMT and cultural humility as a framework, the purpose of this article will be to examine African American men’s health within the context of social determinants of health status, health behavior, and health inequalities—elucidating policy implications for system change and providing recommendations from the vantage point of health equity.

Methodology

A review of literature was conducted. Electronic databases (PUBMED, Medline, PsycINFO, Google Scholar), current journals, and bibliographies of relevant articles were gathered from 1970 to 2014. Studies were considered in scope if they discussed masculinity, health disparities, health equity, social determinants of health, African American men, cultural humility, cultural competency, and policy implications.

African American Male Theory

AAMT is a theoretical framework that can be used to articulate the position and trajectory of African American boys and men by taking into account their spiritual, psychological, social, and educational stations in life (Bush & Bush, 2013). In other words, how have their experiences informed how they view the world and interface with the society at large? This is a critical question because it speaks to how African American men perceive themselves and describes the challenges they have had when interacting with the U.S. health care system (Braithwaite et al., 2009; Hammond, 2010b; Jack & Griffith, 2013; Metzl, 2013).

Furthermore, the concepts of interconnected organisms (i.e., social relationships) and systems (i.e., family, peer groups, neighborhoods) serve as the foundation for systems and ecological thinking. This is in line with African thought and practice and thus serves as a suitable framework for a comprehensive theory for African American boys and men (Asante & Vandi, 1980; Bronfenbrenner & Morris, 2005; Bush & Bush, 2013). According to Bronfenbrenner and Morris (2005), there are five interconnected environmental systems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The microsystem and mesosystem consider individuals’ own biology, personality, beliefs and perceptions, and intellectual gifts and how they interact with their families, peer groups, and other social networks. The exosystem serves as the external environmental setting that may affect an individual even if that person is not a direct participant. The macrosystem considers the larger culture that may include economics, politics, and ideology. The chronosystem takes into account patterns of events that may take place over the life course. AAMT expounds on the mesosystem by adding a sixth division called the subsystem, which creates a space to consider collective will and collective consciousness (Bush & Bush, 2013). Likewise, social justice is a tenet of public health; and AAMT embraces resilience theory, which addresses the ability, capacity, and powers that people or systems exhibit that allow them to overcome in the very face of adversity (Benard, 2004; Bush & Bush, 2013; Cohen, Chavez, & Chehimi, 2010). Ultimately, the intent of AAMT is to investigate, expose, and correct those practices, policies, programs, systems, concepts, and institutions that perpetuate its continuation from a social justice perspective.

So the uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. This is necessary across areas and disciplines in order to create specialized programs, pedagogies, and curricula in education that focuses on specific medical and psychological treatment modalities (Bush & Bush, 2013). From a structural standpoint, this approach can also be used to inform the Health In All Policies (HiAP) framework. HiAP emphasizes the need to collaborate across sectors to achieve common health goals and is an innovative approach to the processes that inform how policies are created and implemented. It also addresses the complex factors that influence health and equity, which include educational attainment, housing, transportation, and neighborhood safety (American Public Health Association, 2014; National Association of County and City Health Officials, 2014). Cultural humility may be one way to address these health inequities at the interpersonal level.

Cultural Humility

Cultural humility requires practitioners to engage in self-reflection as lifelong learners, addresses power imbalances, and develops mutually respectful and dynamic partnerships based on mutual trust (Cohen et al., 2010; Tervalon & Murray-Garcia, 1998). Humble individuals are able to maintain an interpersonal stance that is focused on the “other” rather than on “self.” Humility is very important in order to develop a strong working relationship and to conduct effective counseling with patients or clients from different cultural backgrounds (Hook et al., 2013). Thomas, Quinn, Butler, Fryer, and Garza (2011) describe this phenomenon as cultural confidence and go further to describe a culturally confident person as one who is humble enough to admit ignorance and who is willing to address racialized issues. The pervading discourse, however, in recent years has been centered on cultural competency. The need for cultural competency is frequently discussed at the level of the patient–provider relationship (Betancourt, Green, Carrillo, & Ananeh-Firempong, 2003; Brach & Fraser, 2000; Ngo-Metzger et al., 2006). It is defined as understanding the importance of social and cultural influences on patients’ health beliefs and behaviors; it considers how these factors interact at multiple levels of the health care delivery system, and it devises interventions that take these issues into account to assure quality health care delivery to diverse patient populations (Betancourt et al., 2003). The Centers for Disease Control and Prevention (2014) defines cultural competency as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” “Competence” in the term cultural competence implies that an individual or organization has the capacity to function effectively “within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities” (Centers for Disease Control and Prevention, 2014). While some progress has been made toward infusing cultural competency into health professions training, this must be examined further within the context of social determinants of health.

Social Determinants

Social Determinants of Health Status

Socioeconomic status (SES) is one of the strongest known determinants of variations in health (Adler, Boyce, Chesney, Folkman, & Syme, 1993; LaVeist, 2005; Williams, 2008). The relationship between SES and stress is well documented, with African American men disproportionately affected (Baum, Garofalo, & Yali, 1999; Treadwell et al., 2012). African American men are paid less than 75% of what their White counterparts are paid and are more likely to be in lower income jobs as compared with their White counterparts (Treadwell et al., 2012). While the comparative approach (e.g., African American vs. Whites) in monitoring health disparities has been helpful, it does not go far enough to critically examine the social and political contexts in which African American men live on a daily basis. Further understanding the physical environment, economic circumstances, and sociocultural norms of African American men may necessitate an emic (within-group) approach, which may yield multiple pathways for ameliorating health disparities and as a consequence achieving health equity (Bediako & Griffith, 2008).

While the relationship between SES and race is complex, it is a determining factor in the extent to which African American men can live the highest quality of life possible. Furthermore, racial discrimination plays a significant role in the daily lives of African American men (e.g., racial profiling, employment discrimination). Black boys are generally more likely to attend the poorest and most segregated public schools as compared with their White counterparts (Schott Foundation, 2006). It is also well documented that racism-related stress may cause disproportionate physiological deterioration and, as a consequence, greater morbidity and mortality among African Americans (Geronimus, Hicken, & Keene, 2006; Krieger & Sidney, 1996; Taylor et al., 2007; Treadwell et al., 2012).

Economically, there are enormous costs associated with men’s premature death and disability. As members of the workforce, men are employers and employees who also play critical roles as fathers and providers for their families. When men are absent due to preventable injury or poor health conditions, American businesses lose billions of dollars in productivity and tax revenue (Giorgianni et al., 2012). Thorpe et al. (2013) and colleagues calculated the total direct medical care expenditures for African American men to be $447.6 billion, while indirect costs were $317.6 billion. The largest portion of the total indirect costs was due to premature mortality of African American men. This is consistent with previous studies that report African American men as bearing the greatest morbidity, earlier onset, and more progressed illness than any other men’s race/ethnic group in the United States (DHHS, 2014; Thorpe et al., 2013; Treadwell et al., 2012). With health expenditures expected to continue to rise, it will be vitally important to keep at the forefront the economic consequences of this often undersupported demographic.

Social Determinants of Health Behavior

The reasons for the increased morbidity and mortality associated with being male are complex and involve biological, behavioral, and social issues. Males of all ages are more likely than females to engage in high-risk behaviors including tobacco use/overuse, alcohol, drugs, high-risk sexual activity, and violence (Courtenay, 2000a; Treadwell et al., 2012). However, this notion becomes problematic when attempts are made to explain unhealthy behaviors as a matter of individual choice without taking into account the social and environmental conditions that can have an adverse impact on men’s health. African American men are often forced to reside in unfavorable neighborhood locations and high-crime areas. These unsafe areas encourage a sedentary lifestyle and poorer nutrition due to the food desert phenomenon (Treadwell et al., 2012; Williams & Collins, 2001). This speaks to the issue of how health can be “structured,” which unfortunately is not new. Civil Rights activist Stokely Carmichael argued that structural forces were “less overt, far more subtle, less identifiable, and no less destructive of human life” (Carmichael & Hamilton, 1968, p. 151). While the notions that African American men should visit their doctor, exercise more, track their blood pressure, and stop the violence are encouraged and necessary, it may run counter to the larger cultural, economic, and political notions of “health.” In fact, these attempts to improve the lives of African American men may actually be bolstered by the very structures and institutions that are in place. For example, African American men work disproportionately in unsafe working conditions and reside disproportionately in prisons (Alexander, 2010; E-Race, 2013; Metzl, 2013). Evidence also suggests that tobacco, gun, and fast-food companies sell even more cigarettes, guns, and unhealthy foods to lower income African American men in urban areas (Metzl, 2013; Terhune, 2006). This calls for increasing awareness on the part of health care providers, public health scholars, policy makers, and laypersons of these structural forces that produce, sustain, and even benefit from these barriers. Correspondingly, a question that would be helpful to keep within the narrative is how definitions of health and illness shift over time relative to shifting cultural assumptions about race, gender, and class?

From a gender perspective, the notion of masculinity particularly within the African American context is another aspect affecting health behavior and an area of emerging scholarship. Studies suggest links between masculinity, mortality, health behavior, and health care use (Courtenay, 2000a; Hammond, 2010a; Mahalik, Burns, & Syzdek, 2007). For example, evidence suggests that men delay using preventive health services due to the traditional social construct of masculinity defined as extreme self-reliance, stoicism, and health care avoidance (Courtenay, 2000b; Hammond, 2010b). Women, on the other hand, are more likely to engage in a broad range of preventive and health-promoting behaviors than men (Evans, Blye, Oliffe, & Gregory, 2011; Giorgianni et al., 2012; Williams, 2008). Because health-promoting behaviors are often associated with femininity, and risk-taking behaviors are often associated with masculinity, the idea is that men tend to align themselves with masculine ideals that have been identified to contribute to the health disparities between men and women (Courtenay, 2000a; Evans et al., 2011; Ratner, Bottorff, Johnson, & Hayduk, 1994).

Correspondingly, African American men have greater odds than White men for coronary artery disease, hypertension, stroke, cancer, and diabetes (American Cancer Society, 2014a; Association of Black Cardiologists, 2014; Centers for Disease Control and Prevention, 2014). Other researchers identified masculinity to be defined as power, wealth, physical strength, emotional control, self-sufficiency, and virility within the American context (Connell, 1995; Courtenay, 2000b; Evans et al., 2011). As a consequence, many men may not feel that they are able to live up to this standard due to unemployment, incarceration, lower SES, perceived weakness, or other life circumstances. Hooker, Wilcox, Burroughs, Rheaume, and Courtenay (2012) reported that African American men defined manhood as the leader of a family, provider, strong work ethic, responsible, and being man of character. Researchers in Canada reported that African Canadian men in Nova Scotia may also be more affected by prostate cancer because from a cultural standpoint, sexual virility and prowess were perceived to be the primary avenues available for African American men to affirm their masculinity due to unemployment, SES, or education level (Connell, 1993; Courtenay, 2000b; Evans et al., 2011; Ratner et al., 1994). It is also important to take note of this social construct because evidence suggests that it determines the extent to which African American men may interface with the health care system and therefore encourage more positive health outcomes when taking the legacy of mistrust and historic lack of access to quality health care in to account (Hammond, 2010b).

Moreover, this raises the question of provider-level and patient-level factors as African American men interface with the health care system in terms of unequal treatment. While much of the existing literature focuses on patient-level factors, the role of provider-level factors has largely been ignored in public health literature. Health system–level factors are distinguished from social/behavioral risk factors in that they go beyond the individual’s control. In other words, what are the societal stereotypes and biases that affect health providers’ behavior? Provider-level factors specifically refer to biases, stereotypes, and clinical uncertainty among health care providers that manifest as health care interactions and health care decisions (Penner et al., 2007; Smedley et al., 2002; Treadwell et al., 2012). Aversive racism theory, developed by Gaertner and Dovidio (2004), is particularly applicable when it comes to discriminatory decision making in the health care setting. This theory posits that one can consciously support racially egalitarian values and at the same time have unconscious negative emotions and stereotypes about specific racial/ethnic groups. These aversive attitudes are likely to manifest when health care providers are under time constraints or are involved in tasks that require extensive thought and deliberation (Dovidio et al., 2008). As such, health care decision making is an important determinant of health among African American men and must be addressed with the goal of achieving health equity.

Policy Recommendations, Model, and Conclusions

Policy Recommendations

While the Patient Protection and Affordable Care Act of 2010 (H.R. 3590) provides support and resources for various cultural competency efforts, there appears to be a no explicit mention of cultural humility or cultural confidence particularly within the context of health equity in the legislation. As mechanisms are available to measure “competence,” the danger in assuming “competence” with respect to culture is that it may breed overconfidence and a false sense of superiority, which can be counterproductive when working with culturally diverse patients (Thomas et al., 2011). Likewise, Hook et al. (2013) posit that future research should ensure to take a phenomenological approach that examines the extent to which chronic exposure to racism affects the health and well-being of African Americans over the life course, thus facilitating a greater understanding of the lived experiences of African Americans—proposing meaningful solutions that empower African American men, families, and the community at large.

In an effort to address these challenges, the 44th President of the United States, Barack H. Obama, announced the creation of a “My Brother’s Keeper” Initiative—an interagency effort to measurably improve educational and life outcomes for and address the persistent opportunity gaps faced by boys and young men of color (The White House, 2014). Federal support of this groundbreaking initiative sends a strong message that men of color are to be valued as productive members of the global society. Part of the initiative’s goal is to ensure that the unique health-related challenges of African American men and boys are articulated to the My Brother’s Keeper Taskforce that has been created to propel this initiative forward.

Studies demonstrate that when African American men are empowered, their families and the community-at-large are empowered (Treadwell et al., 2012). In a period of constantly evolving national health reform, the push must be to provide and implement innovative, substantive, and meaningful evidence-based interventions that poignantly address the health concerns of African American men. One must become much more solutions oriented by reframing the narrative in order to create a culture of health and empowerment that does not diminish the understanding and/or need to address health disparities for women and girls. Walt et al. (2008) posit that policy analysis is crucial to health reform because it helps us understand both retrospectively the outcomes of past policy and prospectively the prospects for future policy adoption. It can also give context to the structural and functional aspects of ideas, interests, and institutions that influence and present barriers to policy adoption.

Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy; but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective (Embrett & Randall, 2014; Exworthy, 2008). This is due, in part, to (a) multiple causation between social conditions and health outcomes, (b) lack of technical feasibility, (c) life course perspective of policies with no immediate impact, (d) dominance of other policies, and (e) challenges obtaining data commensurate with social conditions and health outcomes. Therefore, a firm understanding of the diversity of current policies in their existing political, social, and economic settings will provide context for future analysis. This would be coupled with the astute use of policy analysis theory to ensure one moves beyond advocacy to better understanding and addressing some of the political barriers to reforms (Embrett & Randall, 2014).

What are other ways in which one can effect long-lasting positive change? Funding bodies must show a greater willingness to fund research and programs that address the social determinants of health among African American men. More support for diversity among health policy researchers and program developers would broaden research and targeted intervention agendas. Strengthening antidiscrimination legislation in the area of employment relative to hiring and promotion; providing support for and increasing the numbers of African American male teachers and faculty; developing walkable communities; implementing restorative justice to address the “pipeline to prison” phenomenon. Furthermore, training to promote gender-specific and gender-transformative health services (e.g., health providers’ offices should be tailored to improve men’s access outside of working hours); training to promote race equity in health services by more substantively addressing the unconscious racial attitudes and stereotypes relating to African American men. Interventions can draw on a social cognitive framework developed by Burgess, Van Ryn, Dovidio, and Saha (2007), which outlines evidence-based strategies and skills while addressing any shortcomings of cultural-competency curricula (Cardarelli & Chiapa, 2007; National Council on Crime and Delinquency, 2014; Treadwell et al., 2012; Van Ryn & Burke, 2000).

To effectively address the health crisis facing African American men, as a tenet of AAMT, one must ensure they participate in and benefit from decisions that shape the course of development in their neighborhoods and the systems that serve them. Part of what this entails is also considering the community-based participatory research (CBPR) approach to engage African American men and boys. Duran and Wallerstein (2010) define CBPR as a collaborative approach to research that benefits stakeholder partnerships. Stakeholders are defined as “persons or organizations having an investment in what will be learned from an evaluation and what will be done with the knowledge” (Centers for Disease Control and Prevention, 2014). Furthermore, the Institute of Medicine (2014) emphasized the significance of CBPR in evaluation research and outlined ways to achieve competency in this area.

The Health, Illness, Men, and Masculinities (HIMM) framework provides another opportunity to move beyond the individual and consider the larger social context within which masculinities are defined and produced. This would serve to inform health promotion, policy, education, and health care delivery as a consequence. Furthermore, this framework identifies masculinities as a social determinant of health that intersects SES, race, ethnicity, sexuality, employment, and other variables. The Families Controlling and Eliminating Tobacco program is an example of a gender-sensitive intervention that serves to encourage fathers who smoke to consider tobacco reduction (Evans et al., 2011).

While several federal agencies have initiated programs or awareness activities designed to promote the health and well-being of men and boys, creating a federal Office of Men’s Health in the Department of Health and Human Services similar to the Office of Women’s Health would provide a greater opportunity to place focus on African American men. There must be a transdisciplinary approach that must address health needs that extend beyond prostate cancer or what are considered uniquely male issues. Current national achievements include the following: National Men’s Health Week, Men’s Health Month, Prostate Cancer Awareness Month, the Congressional Men’s Health Caucus, State Commissions on Men’s Health, and the Office of Indian Men’s Health (Men’s Health Caucus, 2011).

As a matter of national men’s health policy, agenda priorities should help create a political and cultural environment that encourages constructive dialogue on men’s health but does not diminish the understanding and/or need to address health disparities for women and girls. This entails the inclusion of gender equity language in all governmental health policies and establishes a Department of Health and Human Services “Coordinating Committee on Men’s Health” chaired by the Assistant Secretary for Health This also calls for extending the scope of health education to better train the public health and health care provider workforce in terms of gender-related issues and, as a consequence, would translate into establishing evidence-based practices in the delivery of preventive health care (Men’s Health Caucus, 2011).

Model of Success

History is replete with the “invisibility” of African American men (Franklin, 2004). At the same time, history chronicles the indelible footprints of their history-making achievements throughout the diaspora. More targeted attention to the social determinants within the context of health equity can provide a mechanism to empower African American men. One example of this is the African-American Male Empowerment Network (AMEN). This model was adopted from Gutierrez, GlenMaye, and Delois (1995), which includes personal empowerment—ways to develop feelings of personal power and self-efficacy; interpersonal empowerment—helping people to help others and learning how to influence the political process; and political empowerment—social action and social change. The premise being that empowered African American men will make better decisions about themselves, their families, and their communities.

Pragmatic elements of the AMEN model included weekly small group meetings facilitated by African American male behavioral health professionals through a multisection curriculum created by the Atlanta chapter of the Association of Black Psychologists. Four parts were covered: spiritual health, mental health, physical health, and social health. The spiritual component involved the introduction to meditation, African history, defining African American manhood, and affirming the self. The mental health section focused on decision making, problem solving, and anger management among other areas. The physical health section focused on substance abuse, nutrition, cancer, and so on. The social health module included domestic violence, community organizing, financial planning, and practical legal advice. At the conclusion of the experience several weeks later, group feedback was that they overcame a fatalistic view of life and affirmed significant habit changes (e.g., more frequent physicals, improved nutrition, and more physical activity; Treadwell et al., 2012).

Conclusions

Policy development requires the presence of an evidence base and adequate data to measure where one is and to measure one’s success when one gets where they are going. Bonnefoy et al. (2007) states that while evidence is important, there must be problem recognition, solutions, the transferability of evidence into relevant social strategies, and appropriate scalability of best practices and models into different contexts and settings. At every level, African American men and boys must be better valued, validated, better targeted for interventions, and more involved in terms of health equity and the social determinants of health. It is when men and boys are empowered that they, in turn, empower their families and the society at large.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Adler

N. E.

Boyce

W. T.

Chesney

M. A.

Folkman

Syme

S. L.

(1993). Socioeconomic inequalities in health. No easy solution. Journal of the American Medical Association, 269, 3140-3145.

Alexander

(2010). The new Jim Crow: Mass incarceration in the age of colorblindness. New York, NY: New Press.

American Cancer Society. (201a). Colorectal cancer. Retrieved from http://www.cancer.org/cancer/colonandrec-tumcancer/index

American Cancer Society. (2014b). Prostate cancer. Retrieved from http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-risk-factors

American Lung Association. (2007). State of lung disease in diverse communities: 2007. Retrieved from http://www.lung.org/assets/documents/publications/lung-disease-data/SOLDDC_2007.pdf

Asante

Vandi

(1980). Contemporary Black thought. Beverly Hills, CA: Sage.

Association of Black Cardiologists. (2014). Home page. Retrieved from https://www.abcardio.org/

Baum

Garofalo

Yali

(1999). Socioeconomic status and chronic stress: Does stress account for SES effects on health? Annals of the New York Academy of Sciences, 896, 131-144.

Bediako

Griffith

(2008). Eliminating racial/ethnic health disparities: Reconsidering comparative approaches. Journal of Health Disparities Research and Practice, 2(1), 49-62.

10.

Benard

(2004). Resiliency: What we have learned. San Francisco, CA: WestEd.

11.

Betancourt

J. R.

Green

A. R.

Carrillo

J. E.

Ananeh-Firempong

(2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118, 293-302.

12.

Bonnefoy

Morgan

Kelly

Butt

Bergman

Jadue

(2007). Constructing the evidence base on the social determinants of health: A guide. London, England: National Institute for Health and Clinical Science.

13.

Brach

Fraser

(2000). Can cultural competence reduce racial and ethnic health disparities? A review and conceptual model. Medical Care and Research Review, 57(Suppl. 1), 181-217.

14.

Braithwaite

Taylor

Treadwell

(2009). Health issues in the Black community. San Francisco, CA: Jossey-Bass.

15.

Bronfenbrenner

Morris

(2005). The bioecological model of human development. Making human beings human. Thousand Oaks, CA: Sage.

16.

Burgess

Van Ryn

Dovidio

Saha

(2007). Reducing racial bias among health care providers: Lessons from social cognitive psychology. Journal of General Internal Medicine, 22, 882-887.

17.

Bush

(2013). Introducing African American Male Theory (AAMT). Journal of African American Males in Education, 4(1), 1-12.

18.

Byrd

W. M.

Clayton

L. A.

(2000). A medical history of African-Americans and the problem of race. New York, NY: Routledge.

19.

Cardarelli

Chiapa

(2007). Educating primary care clinicians about health disparities. Osteopathic Medicine and Primary Care, 1(5). doi:10.1186/1750-4732-1-5

20.

Carmichael

Hamilton

(1968). Black power: The politics of liberation. New York, NY: Vintage.

21.

Centers for Disease Control and Prevention. (2010). Youth violence: National statistics. Retrieved from http://www.cdc.gov/violenceprevention/youthviolence/stats_at-a_glance/hr_age-race.html

22.

Centers for Disease Control and Prevention. (2014). Social determinants of health. Retrieved from http://www.cdc.gov/socialdeterminants/

23.

Cohen

Chavez

Chehimi

(2010). Prevention is primary: Strategies for community well-being. San Francisco, CA: Jossey-Bass.

24.

Connell

(1993). The big picture: Masculinities in recent world history. Theory and Society, 22, 597-623.

25.

Connell

(1995). Masculinities. Oakland: University of California Press.

26.

Courtenay

(2000a). Behavioral factors associated with disease, injury, and death among men: Evidence and implications for prevention. Journal of Men’s Studies, 9(1), 81-142.

27.

Courtenay

(2000b). Engendering health: A social constructionist examination of men’s health beliefs and behaviors. Psychology of Men and Masculinity, 1(1), 4-15.

28.

Department of Health and Human Services. (2014). Home page. Retrieved from http://www.hhs.gov/

29.

Dovidio

Penner

Albrecht

Norton

Gaertner

Shelton

(2008). Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and health care. Social Science & Medicine, 67, 478-486.

30.

DuBois

W. E. B.

(1899). The Philadelphia Negro: A social study. Philadelphia, PA: University of Pennsylvania Press.

31.

Duran

Wallerstein

(2010) Community-Based Participatory Research for Health: From Process to Outcomes. Am J Public Health. 100(Suppl 1): S40–S46.

32.

Embrett

Randall

(2014). Social determinants of health and health equity policy research: Exploring the use, misuse, and nonuse of policy analysis theory. Social Science & Medicine, 108, 147-155.

33.

E-Race. (2014). The E-Race initiative. Retrieved from http://www.eeoc.gov/eeoc/initiatives/e-race/

34.

Evans

Blye

Oliffe

Gregory

(2011). Health, illness, men and masculinities: A theoretical framework for understanding men and their health. Journal of Men’s Health, 8(1), 7-15. doi:10.1016/j.jomh.2010.09.227

35.

Exworthy

(2008) Policy to tackle the social determinants of health: using conceptual models to understand the policy process. Health Policy Plan 23: 318-327.

36.

Franklin

(2004). From brotherhood to manhood: How Black men rescue their relationships and dreams from the invisibility syndrome. Hoboken, NJ: Wiley.

37.

Gaertner

Dovidio

(2004). Aversive racism. Advances in Experimental Social Psychology, 36, 1-52.

38.

Geronimus

Hicken

Keene

(2006). “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. American Journal of Public Health, 96, 826-833.

39.

Giorgianni

Berger

Bonhomme

Bothwell

Brott

Butler

. . . Williams

(2012). A framework for advancing the overall health and wellness of America’s boys and men. Washington, DC: Men’s Health Braintrust: Dialogue on Men’s Health.

40.

Gutierrez

GlenMaye

Delois

(1995). The organization context of empowerment practice: Implications for social work administration. Social Work, 40, 249-258.

41.

Hammond

P. W.

(2010a). Psychosocial correlates of medical mistrust among African American men. American Journal of Community Psychology, 45, 87-106.

42.

Hammond

P. W.

(2010b). Psychosocial factors associated with routine health examination scheduling and receipt among African American men. Journal of the National Medical Association, 102, 276-289.

43.

Hook

J. N.

Davis

D. E.

Owen

Worthington

E. L.

Utsey

S. O.

(2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60, 353-366.

44.

Hooker

S. P.

Wilcox

Burroughs

E. L.

Rheaume

C. E.

Courtenay

(2012). The potential influence of masculine identity on health-improving behavior in midlife and older African American men. Journal of Men’s Health, 9(2), 79-88.

45.

Institute of Medicine. (2014). Home page. Retrieved from http://www.iom.edu/

46.

Jack

Griffith

D. M.

(2013). The health of African American men: Implications for research and practice. American Journal of Men’s Health, 7, 4S-6S.

47.

Krieger

Sidney

(1996). Racial discrimination and blood pressure: The CARDIA study of young Black and White adults. American Journal of Public Health, 86, 1370-1378.

48.

LaVeist

(2005). Disentangling race and socioeconomic status: A key to understanding health inequalities. Journal of Urban Health, 82(2 Suppl. 3), 26-34.

49.

Leigh

W. A.

(2004). Factors affecting the health of men of color in the United States. Washington, DC: Joint Center for Political and Economic Studies.

50.

Mahalik

Burns

Syzdek

(2007). Masculinity and perceived normative health behaviors as predictors of men’s health behaviors. Social Science & Medicine, 64, 2201-2209.

51.

Men’s Health Caucus. (2011). 2011-2012 Men’s Health Caucus national policy agenda. Washington, DC: Author. Retrieved from http://www.menshealthcaucus.net/wp-content/uploads/2011-12-Mens-Health-Caucus-Policy-Agenda.pdf

52.

Metzl

(2013). Structural health and the politics of African-American masculinity. American Journal of Men’s Health, 4, 68S-72S.

53.

National Association of County and City Health Officials. (2014). Home page. Retrieved from http://www.naccho.org/

54.

National Council on Crime and Delinquency. (2014). Research. Retrieved from http://www.nccdglobal.org/research

55.

Ngo-Metzger

Telfair

Sorkin

Weidmer

Maldonado

Hurtado

Hays

(2006). Cultural competency and quality of care. New York, NY: The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/usr_doc/Ngo-Metzger_cultcompqualitycareobtainpatientperspect_963.pdf

56.

Office of Minority Health. (2008), Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=28

57.

Office of Minority Health. (2008). Retrieved from http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=21

58.

Penner

Dovidio

West

Gaertner

Albrecht

Dailey

(2007). Aversive racism and medical interventions with Black patients: A field study. Journal of Experimental Social Psychology, 46, 436-440.

59.

Ratner

Bottorff

Johnson

Hayduk

(1994). The interaction effects of gender within the health promotion model. Research in Nursing and Health, 17, 1-30.

60.

Schott Foundation. (2006). Public education and Black male students. Retrieved from http://www.schottfoundation.org/drupal/publications/Schott_06_report_final.pdf

61.

Smedley

(2002). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: National Academic Press.

62.

Srinivasan

Williams

(2014). Transitioning from a health disparities to health equity agenda: The time is now. Public Health Reports, 129(Suppl. 2), 71-76.

63.

Taylor

William

C. D.

Makambi

K. H.

Mouton

Harrell

J. P.

Cozier

. . . Campbell

L. L.

(2007). Racial discrimination and breast cancer incidence in U.S. Black women: The Black Women’s Health Study. American Journal of Epidemiology, 165, 46-54.

64.

Terhune

(2006, October 5). Lighten up: Pepsi sales force tries to push “healthier” snacks in inner city. The Wall Street Journal, p. A1.

65.

Tervalon

Murray-Garcia

(1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Healthcare for the Poor and Underserved, 9, 117-125.

66.

Thomas

Quinn

S. C.

Butler

Fryer

C. S.

Garza

M. A.

(2011). Toward a fourth generation of disparities research to achieve health equity. Annual Review of Public Health, 32, 399-416.

67.

Thorpe

Richard

Bowie

LaVeist

Gaskin

(2013). Economic burden of men’s health disparities in the United States. International Journal of Men’s Health, 12, 195-212.

68.

Treadwell

H. M.

Xanthos

Holden

(2012). Social determinants of health among African American men. Hoboken: NJ: Wiley.

69.

U.S. Department of Health and Human Services. (2000). Oral health in America: A report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health. Retrieved from http://silk.nih.gov/public/hck1ocv.@www.surgeon.fullrpt.pdf

70.

Van Ryn

Burke

(2000). The effect of patient race and socioeconomic status in physician perception of patients. Social Science & Medicine, 50, 813-828.

71.

Walt

Shiffman

Schneider

Murray

Brugha

Gilson

(2008). “Doing” health policy analysis: Methodological and conceptual reflections and challenges. Health Policy and Planning, 5, 308-317.

72.

Washington

(2008). Medical apartheid: The dark history of medical experimentation on Black Americans from colonial times to the present. New York, NY: Doubleday.

73.

The White House. (2014). My brother’s keeper. Retrieved from http://www.whitehouse.gov/my-brothers-keeper

74.

Williams

(2008). The health of men: Structured inequalities and opportunities. Men’s Health, 93, 724-731.

75.

Williams

Collins

(2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416.