Editors’ Notes* (2014)

This volume of New Directions for Adult and Continuing Education explores factors that have contributed to health disparities among racial, ethnic, and sexual minorities. Minority status in the United States often accompanies diminished access to education, employment, and subsequently healthcare. Limited access to education decreases access to healthcare since it is through education that individuals learn about the necessity of seeking regular and preventive healthcare, learn how to read information provided by health professionals, and research health conditions. Employment discrimination still occurs for racial, ethnic, and sexual minorities despite legal protection for some of these groups. Through employment, people become insured, and insurance provides access to healthcare that even educated people do not take advantage of when they are uninsured. Access to a good education and employment are some of the basic issues racial, ethnic, and sexual minority people face in terms of healthcare. Another issue is the lack of research on the differences between races, ethnicities, genders, and sexual minorities in terms of disease symptoms and treatments. For instance, the lack of research and knowledge of how heart disease symptoms appear differently in African Americans than in White Americans has had very real consequences for at least one editor's family. Two of Rocco's Black male relatives have had heart disease misdiagnosed, and this caused the death of her 34-year-old nephew just days before finishing this volume. Her husband has needed open-heart surgery three times in five months for similar reasons. While she cannot prove the misdiagnoses were racially motivated, ignorance about racial differences on the part of healthcare workers has clear consequences, and there are consequences when a doctor dismisses complaints of a patient. Her husband's complaints about his health after his second surgery were dismissed by his cardiologist who told him to wait six months before returning for a check-up. If not for the nurse representing the insurance company insisting he get another opinion, he would surely have died. The second doctor stated he needed surgery again within weeks to correct the mistreatment of the first doctor. The other two editors (and many of the chapter authors) have firsthand experience with healthcare's focus on White, heterosexual, middle-class health concerns over the concerns of others, this uneven focus causing their own personal tragedies. This volume is the first to address the concern of disparities and discrimination in healthcare experienced by racial, ethnic, and sexual minorities. This volume develops and advances strategies for understanding these disparities and promoting wellness in minority communities. The authors of the chapters in this volume highlight social forces such as racism, ethnocentrism, sexism, and homophobia, which continue to influence not only access to and quality of care but also perceptions of and trust in healthcare professionals. Several common themes emerge in the authors’ work, including the importance of communication, both intentional and unintentional discriminatory structures, and perhaps most significantly, the role of culturally relevant learning sites in overcoming health and wellness concerns. Scholars, adult educators, and healthcare professionals will be interested to read about these insights. The remainder of our editors’ notes provides a brief overview of each chapter's contribution to the volume. In Chapter 1, Joshua C. Collins and Tonette S. Rocco discuss both crosscutting and divergent issues affecting healthcare access and quality for racial, ethnic, and sexual minorities. This chapter sets the tone for the volume by defining each of these minority groups and explaining, in part, the foundations of the disparities they face. Michael L. Rowland and E. Paulette Isaac-Savage, in Chapter 2, demonstrate how powerful social institutions, such as the Black church, can play a crucial role in combating inequality and injustice in, and lack of knowledge about, the healthcare system. In Chapter 3, Esther Prins and Angela Mooney explore how literacy and health disparities are inextricably bound, related, and even intensified within minority communities. The authors also document recommendations for addressing the issue through calculated and careful adult education interventions. Using a postcolonial framework, in Chapter 4, John P. Egan develops his perspective as a strong ally to the Canadian Aboriginal population to paint an understanding of disease, community engagement, and the problems caused and perpetuated by a history of colonialism. Continuing along this line of critical thought, in Chapter 5, Julie Gedro reflects on the causes and prevalence of, as well as recovery from, alcoholism among lesbians. In doing so, Gedro brings to light potential solutions for related problems among other sexual minorities. In Chapter 6, Lawrence O. Bryant and Lorenzo Bowman weave their own perspective into Gedro's conversation by discussing tobacco use among sexual minorities, and how bar culture and targeted advertising contribute to a mounting substance abuse problem in some communities. In Chapter 7, Joshua C. Collins and Tonette S. Rocco argue that disclosure and communication struggles are among the many factors impacting the experiences of HIV-negative gay men with autoimmune diseases. Collins and Rocco further contend that because of the gay community's focus on HIV as the premiere health concern of the community, other concerns such as autoimmune diseases are often brushed over or silenced. Continuing on the theme of silence, in Chapter 8, Lisa M. Baumgartner examines the challenges faced by African American women with HIV/AIDS. Baumgartner argues that these women are often disregarded in the dialogue about HIV/AIDS, and that silence about the disease within their own communities can disadvantage them in the process of learning to live with it. Finally, Lawrence O. Bryant, in Chapter 9, provides a closing perspective on partnerships and collaborations that may be leveraged to help racial, ethnic, and sexual minorities overcome health and wellness concerns such as those addressed in this volume. As the editors, our hope for this volume is that it will illustrate some of the ways in which privilege and marginalization are manifest in healthcare. This volume aims to bring attention to a diverse and complex public health crisis that involves multiple minority communities across many contexts. The lessons learned from this volume may influence research and practice in such arenas as patient and doctor education, community engagement, adult basic education, and health education, among others. Joshua C. Collins is a doctoral candidate in the program for adult education and human resource development at Florida International University. Tonette S. Rocco is a professor and program leader in the adult education and human resource development graduate program in the Department of Leadership and Professional Studies, and the director of the Office of Academic Writing and Publication Support at Florida International University. Lawrence O. Bryant is an assistant professor at Georgia State University, Byrdine Lewis School of Nursing and Health Profession, Department of Respiratory Therapy.