From the relationship between - NCBI - NIH

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the research and findings of the two researchers. ... the Committee on Cancer Research among Ethnic Minorities .... vention and National Cancer Institute, 2002.

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Realized Religion: Research on the Relationship between Religion and Health Theodore J. Chamberlain and Christopher A. Hall; Philadelphia: Templeton Foundation Press, 2000; ISBN 1-890151-53; 239 pages

if =0XMaf well-organized; the subcategories within each chapter contain a heading and are easily accessed via the table of contents. At the end ofeach chapter are the bibliographic entries so information can be retrieved readily. A must-read for all interested in the role of religion and health! Reviewed by Sunil Khanna, PhD [email protected]

The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved Research on the Relationship Between Religion and Health is a "bibliographic essay" based on the research and findings of the two researchers. The introduction explains that the authors used the phrase realized religion "...in order to approach the conundrum of studying the mystery of faith from the perspective of objective scientific methodology." In other words, it is used to bring the religion aspect to the concrete, everyday atmosphere. The authors strive to achieve this explanation the realized religion-in my view, they succeed in this endeavor. From the relationship between prayer and healing to the overall well-being of the individual, the health benefits of religion are thoroughly reviewed. Part two of the book details individual difficulties in life (such as suicide and alcohol abuse) related to prayer and religion. The content is broad and spans over various topics within the framework of Christianity. The material presented is

Edited by M. Alfred Haynes and Brian D. Smedley; Committee on Cancer Research among Minorities and the Medically Underserved, Institute of Medicine; Washington, DC: National Academy Press, www.nap.edu, 1999; ISBN 0-309-07154-2; 338 pages

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In 1997, Congress requested a review of National Institutes of Health (NIH) programs relevant to ethnic minority and medically underserved populations. The Institute of Medicine assembled the Committee on Cancer Research among Ethnic Minorities and Med-

858 JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION

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ically Underserved, an ensemble of medical and public health professionals, to assess the burden of cancer and the status of cancer research in these groups. Burden of Cancer is the report on the committee's findings and their recommendations on how NIH can further enhance its efforts to address ethnic and socioeconomic disparities in cancer outcomes. The committee focused on one overarching question: Is there a strategic plan for reducing the number of deaths from cancer among poor and minority individuals, and when can results be expected? As a consequence of this practical, results-driven approach, Burden of Cancer provides valuable insights into the disproportionate burden of cancer experienced by ethnic minorities and medically underserved communities. The Committee considered its charge carefully, and as a result offers an enlightening discussion aimed at defining "race" and "ethnicity" as well as "medically underserved" and "socioeconomic status." As a clue to how complex these definitions are, a significant proportion of the book is devoted to this topic. Emphasis is placed on the catholic nature of the human race and the need to progress toward measurement strategies that focus on ethnic groups. In our society, ethnicity is closely intertwined with socioeconomic status. This creates a demand for incorporating socioeconomic status data into ongoing cancer surveillance, if we hope to tease apart the variations in the cancer burden due to being medically underserved vis-a-vis being an ethnic minority. High-quality data to identify and characterize the magnitude of disparities in cancer outcomes provide the essential building blocks to develop strategies to VOL. 96, NO. 6, JUNE 2004

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eliminate disparities. Thoughtful consideration of surveillance data provides a rationale for resource allocation and can fuel research by leading to new hypotheses. Burden of Cancer stresses the importance of nationwide surveillance data. The United States currently has two sources of cancer surveillance data-the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries and the Centers for Disease Control and Prevention's National Program of Cancer Registries (NPCR). The SEER program has the highest-quality data, but the committee argues that it lacks adequate representation of ethnic minorities. In contrast, a strength of the nationwide NPCR is representativeness, but the data quality does not measure up to that of SEER, with a notable lack of data to address cancer survivorship. The committee recommends further investment in developing these resources with an eye toward richer data that is more nationally representative. Part of this investment would be used to more comprehensively assess the ethnic group membership of cancer patients, a data element that the committee found wanting. Since Burden of Cancer was published, the first report on nationwide cancer incidence, which incorporated SEER and NPCR data, was published.' As an example of how nationally representative data may be helpful, the percentage difference in lung cancer incidence rates between African-American and Caucasian men was 26% in the NPCR/SEER data, compared to 45% in the SEER data alone. A clear ethnic group disparity exists regardless of data source, but in gauging the extent of the disparity, a lingering question is to what extent the NPCR versus SEER difference is attributable to representativeness versus data quality. By characterizing disparities,

cancer surveillance data provides a blueprint for setting an agenda for in-depth studies within and across ethnic and medically underserved groups. The committee identifies a need for expanding populationbased research in this area. The topic of cancer survivorship is accorded an important place in the research agenda. Minority group participation in research studies is also touched upon. The capacity of the nation's cancer research enterprise to address the issue of ethnic and socioeconomic disparities hinges on the ethnic and socioeconomic composition of the researchers themselves. The committee points out that ethnic composition of the research community needs to better reflect the ethnic diversity of the U.S. population. It would be unreasonable to expect Burden of Cancer to provide a detailed map for how to eliminate the existing disparities, but through a series of well-reasoned recommendations, it does well to provide us with a description of where we are, a vision of where we need to be, and a compass. The ultimate value of this publication will be evidenced by the progress we make toward eliminating the existing ethnic and socioeconomic disparities in cancer outcomes in the coming years. The control of cancer, the second leading cause of death in the United States, is so vitally important to the public's health that Burden of Cancer is highly relevant to all those working to eliminate health disparities. Burden of Cancer will be a particularly critical addition to the bookshelves of population-based cancer researchers with interests in cancer epidemiology, prevention, and control. By providing a cogent summary and overview of the ethnic and socioeconomic cancer disparities, it also provides an excellent reference for a much wider audience.

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION

Reviewed by AnthonyJAlberg, PhD, MPH Tram Kim Lam, MPH Department ofEpidemiology Johns Hopkins Bloomberg School ofPublic Health Baltimore, MD [email protected] edu

REFERENCES 1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics: 1999 Incidence. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, 2002.

Eating Disorders Edited by Mario Maj, Katherine Halmi, Juan Jose Lopez-lbor, and Norman Sartorius; Wiley Publishers, 2003; ISBN 0470848650; 435 pages

Eating Disorders is the sixth volume in the series, Evidence and Experience in Psychiatry of the World Psychiatric Association's WPA series. This publication derives largely from studies in North America and Europe involving white subjects. As such, it may have limited application in better understanding eating disorders commonly found among black Americans. Since at least the time of Homo erectus a million or so years ago on the African continent, we have been hunters and gatherers living in a world of food scarcity. As such, we ate any sugars, fats, and salt we could find because we did not know from where our next meal was coming. We not only developed practices to increase our access to these foods, but our bodies developed a physiology to conserve those foods once they were eaten. About 10,000 years ago, we began to move from a hunting and gathering society to an agricultural society. This occurred first in the area of the Fertile Crescent (present Iraq) and only later moved south. The shift VOL. 96, NO. 6, JUNE 2004 859

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