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Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities
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There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared toward improving access, coverage, quality, and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This article highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health and on interventions in upstream factors such as housing, neighborhood conditions, and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.
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“Perhaps the civil rights domain with the most obvious health consequences is assured equal access to health care opportunities-- likely to have greatest effects on lower income families, including many racial and ethnic minority families (Williams et al., 2008; Smedley, Stith & Nelson, 2002).”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Williams et al., 2008
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“Social determinants, including civil rights laws and their enforcement, affect health by affecting intermediate factors such as housing, employment, and transportation which, in turn, affect the distribution of health risk and protective factors, such as pathogens and environmental toxins, and the resources for prevention and treatment (Hahn, 1995, Williams et al., 2008, Braveman and Gottlieb, 201”
From Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States (2018) · cites this paper as Williams et al., 2008
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Metadata
- Authors
- Williams, D. R., Costa, M. V., Odunlami, A. O., & Mohammed, S. A.
- Affiliations
- Harvard University (US)
- National Heart, Lung, and Blood Institute (US)
- Venue
- Journal of Public Health Management and Practice
- Published
- 2008-11
- Volume
- 14
- Issue
- 6
- Pages
- S8-S17
- ISSN
- 1078-4659 (ISSN-L)
- PMC
- PMC3431152
- OpenAlex
- W2025820027
- Cited by
- 489
- References
- 44
- Citations by year
- 2026: 22 · 2025: 32 · 2024: 40 · 2023: 47 · 2022: 36 · 2021: 45 · 2020: 47 · 2019: 26 · 2018: 41 · 2017: 26 · 2016: 24 · 2015: 23 · 2014: 12 · 2013: 18 · 2012: 20
- FWCI
- 10.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Public Health Management and Practice (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01hl087322-05)
- National Heart, Lung, and Blood Institute (U01-HL 087322, U-01 HL 87322-02, 3U01HL087322-02S1, R01HL069413)
- National Institute of Mental Health (R01MH059575, R01 MH 59575)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
- Keywords
- social determinants of health, health disparities, racial and ethnic disparities, socioeconomic status, housing conditions, neighborhood conditions, upstream interventions, health policy evaluation, health equity
- MeSH terms
- Delivery of Health Care, Humans, Social Class, United States, Health Status Disparities, Healthcare Disparities
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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