Structural interventions to reduce and eliminate health disparities
Open accessAbstract
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, evidence-based structural interventions are needed to address multilevel structural determinants that systemically 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.
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When abusers fight for and obtain custody, what they are often looking for is not more meaningful involvement with their children, but rather acknowledgement of their status and importance.
“When abusers fight for and obtain custody, what they are often looking for is not more meaningful involvement with their children, but rather acknowledgement of their status and importance (Bancroft et al., 2002; Brown et al., 2019; Silverman et al., 2004; Slote et al., 2005).”
From Post‐separation abuse: A concept analysis (2023) · cites this paper as Brown et al., 2019
The available passages from Brown et al. discuss structural interventions and health disparities, not custody disputes or abusers’ motives. Searches for the custody claim and for domestic violence and parental involvement found no passage addressing it. (LLM, conf=0.76)
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“17 18–22 This important research notwithstanding, the increasing focus in the health literature on the more fundamental dimensions of racism has largely neglected cultural racism.”
BackgroundAzevedo, C. V., Hashiguchi, D., Campos, H. C., Figueiredo, E. V., Otaviano, S. F. S. D., Penitente, A. R., Arida, R. M., & Longo, B. M. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1131214 · Cited by 48 · see citing works
Advancing Health Equity Efforts to Reduce Obesity: Changing the Course
Kumanyika, S. (2022) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-092021-050805 · Cited by 46 · see citing works
“An NIMHD working group paper points to the need for more evidence on the effectiveness of structural interventions for eliminating disparities (23).”
BackgroundLi, C., Mowery, D. L., Ma, X., Yang, R., Vurgun, U., Hwang, S., Donnelly, H. K., Bandhey, H., Senathirajah, Y., Visweswaran, S., et al. (2024) · Journal of Clinical and Translational Science · doi:10.1017/cts.2024.571 · Cited by 54 · see citing works
“This collaborative approach helps create a more supportive environment for vulnerable individuals and mitigates unforeseen obstacles [261].”
Nouri, S. S., Lyles, C. R., Rubinsky, A. D., Patel, K., Desai, R., Fields, J., DeRouen, M. C., Volow, A. M., Bibbins-Domingo, K. B., & Sudore, R. L. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.29063 · Cited by 44 · see citing works
Návar, A. M., Fine, L. J., Ambrosius, W. T., Brown, A. F., Douglas, P. S., Johnson, K., Khera, A. V., Lloyd‐Jones, D. M., Michos, E. D., Mujahid, M. S., et al. (2022) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2022.100430 · Cited by 42 · see citing works
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“14 Although rigorous study designs are ideal with etiological and evaluation research, implementation research is typically conducted in real-world settings, making it critical to capture the context in which the strategies are operating (e.g., social, environmental, and economic).”
Fuemmeler, B. F., Shen, J., Zhao, H., & Winn, R. A. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-02006-1 · Cited by 41 · see citing works
“Policies that were once thought to be outside the field of cancer prevention, such as reducing food insecurity, improving stable housing, advancing education equity, addressing systemic racism where it occurs, implementing universal basic income strategies, and other structural interventions could be considered [117].”
BackgroundDisparities and social determinants of periodontal diseases
Albandar, J. M. (2024) · Periodontology 2000 · doi:10.1111/prd.12547 · Cited by 40 · see citing works
“98 Hence, intervention programs that address these disparities at multiple levels have been proposed to improve the general health 99–101 and oral health 102 of populations.”
Wilderink, L., Bakker, I. M. C., Schuit, A. J., Seidell, J. C., Pop, I. A., & Renders, C. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148384 · Cited by 40 · see citing works
“The main criticism of these theories is that they pay no attention to the socio-cultural and physical environment in which these behaviors occur [23].”
BackgroundAdvancing green space equity via policy change: A scoping review and research agenda
Rigolon, A., Owusu, R. O., Becerra, M., Cheng, Y., Christensen, J., Connolly, J. J., Corbin, C., Douglas, J. A., Fernandez, M., Jennings, V. L., et al. (2024) · Environmental Science & Policy · doi:10.1016/j.envsci.2024.103765 · Cited by 40 · see citing works
Interventions for young people aging out of the child welfare system: A systematic literature review
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How mental health professionals can address disparities in the context of the COVID-19 pandemic.
Loeb, T. B., Ebor, M. T., Smith-Clapham, A. M., Chin, D., Novacek, D. M., Hampton-Anderson, J. N., Norwood-Scott, E., Hamilton, A. B., Brown, A. F., & Wyatt, G. E. (2020) · Traumatology An International Journal · doi:10.1037/trm0000292 · Cited by 36 · see citing works
“Partnerships across a range of sectors are necessary to address more pronounced gaps in care and to address physical/mental health disparities at various levels of influence (Brown et al., 2019).”
BackgroundSelf-citationFrank, D., Elliott, L. C., Cleland, C. M., Walters, S. M., Joudrey, P. J., Russell, D. M., Meyerson, B. E., & Bennett, A. S. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00893-9 · Cited by 35 · see citing works
“The risk environment framework is also a response to public health’s tendency to focus on risk as a product of individuated factors and at the expense of social and structural context [35–37].”
BackgroundReframing school-based restorative justice as a structural population health intervention
Todić, J., Cubbin, C., Armour, M., Rountree, M., & González, T. (2020) · Health & Place · doi:10.1016/j.healthplace.2020.102289 · Cited by 34 · see citing works
Touzani, R., Schultz, É., Holmes, S. M., Vandentorren, S., Arwidson, P., Guillemin, F., Rey, D., Rouquette, A., Bouhnik, A., & Mancini, J. (2021) · JMIR mhealth and uhealth · doi:10.2196/27768 · Cited by 33 · see citing works
“Broader approaches that intervene not only on individual and interpersonal factors but also upon structural determinants are needed [39].”
Vaughan, A. S., Schieb, L. J., & Casper, M. L. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235839 · Cited by 33 · see citing works
Enhancing primary stroke prevention: a combination approach
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Mereish, E. H., & Goldstein, C. M. (2020) · International Journal of Behavioral Medicine · doi:10.1007/s12529-020-09919-z · Cited by 32 · see citing works
“, insufficient access to preventive medical care) and uphold health disparities [42].”
BackgroundThe Complexity of Health Disparities: More Than Just Black–White Differences
Ellis, C., & Jacobs, M. (2021) · Perspectives of the ASHA Special Interest Groups · doi:10.1044/2020_persp-20-00199 · Cited by 30 · see citing works
Alvidrez, J., & Barksdale, C. L. (2022) · American Journal of Psychiatry · doi:10.1176/appi.ajp.21100969 · Cited by 30 · see citing works
Ogunwole, S. M., Oguntade, H. A., Bower, K. M., Cooper, L. A., & Bennett, W. L. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20136283 · Cited by 29 · see citing works
Phillips, G., McCuskey, D. J., Ruprecht, M. M., Curry, C. W., & Felt, D. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03167-2 · Cited by 29 · see citing works
Kroshus, E., Coakley, S., Conway, D., Chew, K., Blair, N., Mohler, J. M., Wagner, J. H., & Hainline, B. W. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-105891 · Cited by 29 · see citing works
Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities
Bonner, S. N., Powell, C. A., Stewart, J. W., & Dossett, L. A. (2023) · Annals of Surgery · doi:10.1097/sla.0000000000005858 · Cited by 28 · see citing works
Determinants of Implementation of a Clinical Practice Guideline for Homeless Health
Magwood, O., Hanemaayer, A., Saad, A., Salvalaggio, G., Bloch, G. C., Moledina, A., Pinto, N., Ziha, L., Geurguis, M., Aliferis, A., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17217938 · Cited by 23 · see citing works
“implementation criterion because we recognized its importance when developing and implementing guidelines among vulnerable populations [45], and in keeping with the belief that interventions promoting equity may be associated with increased sustainability [46].”
BackgroundPerceptions of Ethnoracial Factors in the Management and Treatment of Uterine Fibroids
Orellana, M. A., Riggan, K. A., DSouza, K. N., Stewart, E. A., Venable, S., Balls‐Berry, J. E., & Allyse, M. A. (2021) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-021-01059-8 · Cited by 25 · see citing works
“Systemic changes — including universal access to medical insurance and specialized care services — are required to ensure equitable access to patient-centered treatment options and support for uterine fibroids [36].”
BackgroundLiu, P. Y., Beck, A. F., Lindau, S. T., Holguin, M., Kahn, R. S., Fleegler, E. W., Henize, A. W., Halfon, N., & Schickedanz, A. B. (2022) · PEDIATRICS · doi:10.1542/peds.2021-053509o · Cited by 28 · see citing works
Ursache, A., Barajas-Gonzalez, R. G., & Dawson‐McClure, S. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.953304 · Cited by 24 · see citing works
“Taken together, experimental evidence strengthens confidence in the causal nature of the links in Figure 1, supports the value of interventions to protect children from neighborhood risk, and underscores the need for structural solutions to structural problems (Brown et al., 2019).”
BackgroundNiederdeppe, J., Liu, J., Spruill, M., Lewis, N. A., Moore, S. T., Fowler, E. F., & Gollust, S. E. (2023) · Milbank Quarterly · doi:10.1111/1468-0009.12651 · Cited by 25 · see citing works
Gamble‐George, J., Longenecker, C. T., Webel, A. R., Au, D. H., Brown, A. F., Bosworth, H. B., Crothers, K. A., Cunningham, W. E., Fiscella, K. A., Hamilton, A. B., et al. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.03.006 · Cited by 22 · see citing works
Self-citationLinking Urban Planning, Community Environment, and Physical Activity: A Socio-Ecological Approach
Zhang, X., & Warner, M. E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20042944 · Cited by 24 · see citing works
“Addressing health disparities requires a multi-level analytical approach [16,30], but the linkage between policy and other levels is understudied.”
BackgroundResultInfluentialFramework for Understanding and Addressing Racial and Ethnic Disparities in Children’s Mental Health
Alegria, M. M., O’Malley, I. S., DiMarzio, K., & Zhen‐Duan, J. (2022) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2021.11.001 · Cited by 23 · see citing works
Lovinsky‐Desir, S., Riley, I. L., Bryant-Stephens, T. C., Keyser, H. H. D., Forno, E., Kozik, A. J., Louisias, M., Matsui, E. C., Sheares, B. J., Thakur, N., et al. (2024) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202407-767st · Cited by 21 · see citing works
DeRouen, M. C., Yang, J., Jain, J. P., Weden, M. M., Gomez, S. L., & Shariff‐Marco, S. (2021) · Urology · doi:10.1016/j.urology.2021.05.085 · Cited by 21 · see citing works
The Community As A Full Partner: A New Model For Public Health
Chen, A. T., Smith, D. O., Ojikutu, B. O., & Auerbach, J. M. (2024) · Health Affairs · doi:10.1377/hlthaff.2024.00033 · Cited by 21 · see citing works
Valdovinos, E. M., Niedzwiecki, M. J., Guo, J., & Hsia, R. Y.-J. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241785 · Cited by 20 · see citing works
“Addressing longstanding racial disparities in health outcomes requires careful examination of whether population-level interventions exacerbate or narrow such disparities [24].”
BackgroundGayathiri, E., Prakash, P., Chaudhari, S. Y., Sabarathinam, S., Priyadharshini, S. D., Al‐Sadoon, M. K., Panneerselvam, J., Chang, S. W., Ravindran, B., & Mani, R. R. (2024) · Energy Nexus · doi:10.1016/j.nexus.2024.100351 · Cited by 20 · see citing works
Advancing health equity and the role of digital health technologies: a scoping review
Bitomsky, L., Pfitzer, E., Nißen, M., & Kowatsch, T. (2025) · BMJ Open · doi:10.1136/bmjopen-2025-099306 · Cited by 21 · see citing works
Kim, E. T., Franz, L., Fannin, D. K., Howard, J., & Maslow, G. (2021) · Autism Research · doi:10.1002/aur.2492 · Cited by 19 · see citing works
Better together: Coalitions committed to advancing health equity
Crowder, S. J., Tanner, A., Dawson, M. A., Felsman, I. C., Hassmiller, S. B., Miller, L. C., Reinhard, S. C., & Toney, D. A. (2022) · Nursing Outlook · doi:10.1016/j.outlook.2022.02.013 · Cited by 19 · see citing works
A Qualitative Investigation of the Experiences of Tobacco Use among U.S. Adults with Food Insecurity
Kim, J. E., Shaw, S. J., Yen, I. H., & Tsoh, J. Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19127424 · Cited by 19 · see citing works
“For instance, longer-term investments in policies and programs that can lift people out of poverty are needed to address a critical root cause of health disparities [22].”
BackgroundSpatial Analysis of Access to Psychiatrists for US Military Personnel and Their Families
Bacolod, M., Heissel, J. A., & Shen, Y. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.49314 · Cited by 19 · see citing works
Jones, S. C. T., Simon, C. B., Yadeta, K., Patterson, A., & Anderson, R. E. (2023) · Development and Psychopathology · doi:10.1017/s0954579423000986 · Cited by 20 · see citing works
“…available to an individual in the face of systemic-level problems like racism is insufficient; systemic adversities and trauma need to be prevented and reduced, thereby lessening the load that processes of resilience are often employed to mitigate (Brown et al., 2019; Dankwa-Mullen et al., 2010).”
BackgroundSsemata, A. S., Smythe, T., Slivesteri, S., Menya, A., Hameed, S., Waiswa, P., Mbazzi, F. B., & Kuper, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-086194 · Cited by 18 · see citing works
The Association Between Social Determinants of Health (SDoH) and Mental Health Status in the US
Faruque, F., Shah, G. H., & Bohler, R. M. (2025) · European Journal of Investigation in Health Psychology and Education · doi:10.3390/ejihpe15050087 · Cited by 19 · see citing works
“Mental health disparities can be addressed through targeted policies and interventions that promote access to education, ensure food and housing stability, and mitigate economic hurdles (Brown et al., 2019; Gordon-Achebe et al., 2023; Rolfe et al., 2020).”
Protecting vulnerable groups from tobacco-related harm during and following the COVID-19 pandemic
Melamed, O. C., Zawertailo, L. A., Schwartz, R. M., Buckley, L., & Selby, P. L. (2021) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.41.10.02 · Cited by 18 · see citing works
Agénor, M., Geller, A. B., Crowley, J. S., & Boyer, C. B. (2022) · Sexually Transmitted Diseases · doi:10.1097/olq.0000000000001695 · Cited by 18 · see citing works
Garrett, S. B., Walia, A., Miller, F., Tahir, P., Jones, L., Harris, J.-G. B., Powell, B., Chambers, B., & Simon, M. A. (2022) · Clinical obstetrics and gynecology · doi:10.1097/grf.0000000000000761 · Cited by 13 · see citing works
Gray space and default mode network-amygdala connectivity
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Digital pathology, deep learning, and cancer: a narrative review
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“Health disparities can be reduced by addressing multi-level structural determinants and ensuring access to disadvantaged populations (8).”
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“’ [IDI-12, Age-59]”
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“Within the Stroke Belt (a band of southern US states with high stroke mortality), stroke death rates for both Black and White populations are persistently high (3).”
Purrington, K. S., Hastert, T. A., Madhav, K. C., Nair, M., Snider-Hoy, N. G., Ruterbusch, J. J., Schwartz, A. G., Stoffel, E. M., Peters, E. S., & Rozek, L. S. (2023) · Cancer Medicine · doi:10.1002/cam4.6065 · Cited by 16 · see citing works
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Radiation Therapy for WHO Grade 4 Adult-Type Diffuse Glioma: An ASTRO Clinical Practice Guideline
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Rajkumar, V., McCausland, K., & Lobo, R. C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105947 · Cited by 16 · see citing works
Maternal Mental Health and Offspring Brain Development: An Umbrella Review of Prenatal Interventions
Lugo-Candelas, C. I., Talati, A., Glickman, C., Hernández, M., Scorza, P., Monk, C. E., Kubo, A., Wei, C., Sourander, A., & Duarte, C. S. (2023) · Biological Psychiatry · doi:10.1016/j.biopsych.2023.01.026 · Cited by 16 · see citing works
“interventions aim to modify structural factors that impact health to produce better health outcomes (41,42).”
BackgroundEvidence Clearinghouses as Tools to Advance Health Equity: What We Know from a Systematic Scan
Hirsch, B. K., Stevenson, M., & Givens, M. L. (2023) · Prevention Science · doi:10.1007/s11121-023-01511-7 · Cited by 16 · see citing works
- Authors
- Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., Jones, P., Airhihenbuwa, C. O., Farhat, T., Zhu, L., & Trinh-Shevrin, C.
- Affiliations
- Fox Chase Cancer Center (US)
- Arleen F. Brown is with General Internal Medicine and Health Services Research, University of California Los Angeles (UCLA) and Olive View-UCLA Medical Center, Los Angeles, CA. Grace X. Ma is with Center for Asian Health, Fox Chase Cancer Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA. Jeanne Miranda is with the Department of Psychiatry and Biobehavioral Sciences, Jonathan and Karin Fielding School of Public Health, UCLA. Eugenia Eng is with the Gillings School of Global...
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2019-01
- Volume
- 109
- Issue
- S1
- Pages
- S72-S78
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC6356131
- OpenAlex
- W2912527863
- Cited by
- 465
- References
- 45
- Citations by year
- 2026: 52 · 2025: 97 · 2024: 86 · 2023: 79 · 2022: 58 · 2021: 53 · 2020: 30 · 2019: 9 · 2014: 1
- FWCI
- 36.42
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- TUScholarShare (Temple University) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR001881)
- National Cancer Institute (U54CA153513)
- National Institute of Neurological Disorders and Stroke (U54NS081764)
- National Center for Chronic Disease Prevention and Health Promotion (U58 DP005828, U48DP005008)
- National Center for Advancing Translational Sciences
- National Institute on Minority Health and Health Disparities (U54MD000538)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Health › Public Health and Social Inequalities
- Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
- Keywords
- health disparities, structural interventions, structural determinants of health, minority health, health care access, socioeconomic factors, environmental factors, health policy, multilevel interventions, evidence-based interventions
- MeSH terms
- Health Status, Humans, Minority Groups, Socioeconomic Factors, United States, Healthcare Disparities
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