Content area
Full Text
ABSTRACT The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels.
Despite improvements in medical care and in disease prevention, health disparities persist and could be increasing for chronic conditions such as obesity, cardiovascular disease, and cancer.1,2 African Americans and other economically disadvantaged racial and ethnic minorities, and populations of all races with low socioeconomic status, experience large disparities in health. There is growing recognition that social determinants-the conditions in which people live, learn, work, play, and worship-can affect health and produce disparities. Social determinants that negatively affect health and well-being include poverty, lack of access to high-quality education or employment, unhealthy housing, unfavorable work and neighborhood conditions, and exposure to neighborhood violence.3 Exposure to disadvantage can have deleterious neurodevelopmental and biological consequences beginning in childhood that accumulate and produce disease.4 Yet current intervention strategies to reduce health disparities do not typically take a "life-course perspective" and tend to be disease specific, often targeting individual and health systems factors without addressing social determinants.
Interventions targeting individuals include improving health and lifestyle behaviors; reducing so-called socio-contextual barriers, such as access to adequate food and employment resources;5 and delivering culturally and linguistically tailored health programs to specific individuals or groups.6 Interventions targeting health systems that address discrimination, access to care, and quality of care are also important.7 However, these approaches are not sufficient to address social determinants such as neighborhood conditions or poverty, which are also fundamental drivers of persistent health disparities.3,8 For example, if one's neighborhood is unsafe even during daylight hours, interventions targeting outdoor physical activity are unlikely to be effective.3 As Thomas Frieden's...