Inner city dwellers are at great risk for adverse health outcomes. Children and youths are a particularly high risk group. The mechanisms producing adverse health outcomes are complex, resulting from biologic factors, increased exposure to risk/risk behaviors, and reduced access to interventions designed to ameliorate health risks. While substantial progress has been made with regard to understanding these factors, the overall impact of these advances on the health status of the urban poor has been insubstantial. To be effective, intervention efforts must be at both the policy and the program level, must involve coordinated efforts of the multiple disciplines concerned with the underlying factors, and will require behavioral change. Adequate addressing of these multiple factors will require application of an analytic and programmatic framework which offers both flexibility and rigor. Modification of one framework proposed for health programming for disadvantaged populations, the Iterative Loop Model potentially offers such a structure consisting of 5 """"""""steps"""""""": 1. Assessment of Burden of Illness; 2. Determination of Etiology/Causation; 3. Assessment of Efficacy, Effectiveness and Efficiency; 4. Synthesis and Dissemination; and 5. Policy Formulation, Implementation, and Monitoring. Accordingly, the University of Maryland at Baltimore, with the Baltimore community and the Maryland and Baltimore City Health Departments, and Advocates for Children and Youth is establishing a Center for Minority Health Care Research. Drawing upon data-gathering techniques, research frameworks, and analytic strategies from multiple disciplines, the researchers will select (and/or develop), implement and evaluate intervention options to identify those that are technically, developmentally and socio-culturally appropriate and cost- effective. Thus the objectives of the Center are fourfold: 1) To identify interventions which improve the health outcome of inner city African Americans; 2) To influence local, state and national health policy and program implementation based on these findings; 3) To advance the methodology for data gathering, implementation and evaluation of programs involving multiple and at times potentially competing health outcomes and inputs; and 4) To increase the number of minority professions involved in the health services. The Center Director, Center Advisory Group and an interdisciplinary Scientific Branch will delineate and prioritize selected components of these objectives and expand the research, service, advocacy and dissemination agenda to serve overall Center goals.
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