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Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements. Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities. Rigorously evaluated, evidencebased structural interventions are needed to address multilevel structural determinants thatsystemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research. (Am J Public Health. 2019;109:S72-S78. doi:10.2105/AJPH.2018.304844)
Reducing health disparities to improve health outcomes is a complex challenge that extends farbeyond the reach of traditional health care settings. Increasingly, the structural conditions in which people are born, live, learn, work, worship, play, and age1,2 are recognized as critical determinants of health and health disparities. Minority populations often face multiple levels of mutually reinforcing structural disadvantage that contribute to poor health.3,4 Although many promising health interventions have targeted individual-, interpersonal-, and, to some extent, community-level factors, the evidence on how enduring these interventions are in supporting sustained improvements in population health and reducing health disparities is limited. Inherent in the challenge to support individual behavioral change is the dynamic interplay of risk and protective factors that cut across social and environmental contexts that can help individuals and their communities attain the highest level of health. Take, for example, the case of obesity disparities: interventions that improve nutrition and physical activity at the individual level are unlikely to succeed when the food and social environments (e.g., unsafe and limited recreational space, ready access to low-cost, calorie-dense food options) and high rates of poverty present severe barriers...