Cited by 468Health disparities and outcomesPublic Health and Social InequalitiesPublic Health Policies and Education

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Structural Interventions to Reduce and Eliminate Health Disparities

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Brown, Arleen F., Ma, Grace X., Miranda, Jeanne, Eng, Eugenia, Castille, Dorothy, Brockie, Teresa, Jones, Patricia, Airhihenbuwa, Collins O., Farhat, Tilda, Zhu, Lin, Trinh-Shevrin, Chau·2019·American Journal of Public Health

DOI 10.2105/ajph.2018.304844PMC PMC6356131

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Abstract

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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“specific social, cultural, environmental, economic, and political contexts [7].”
Background
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“It is important to note that different policies and ways of practice contribute to the structural forces that ultimately shape longitudinal care and patient satisfaction (24).”
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“often resource intensive and time consuming (30).”
Background
Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth
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Spatio-Temporal Comprehensive Measurements of Chinese Citizens’ Health Levels and Associated Influencing Factors
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“[28], and other scholars used health indices such as life expectancy, cancer mortality, obesity, and weight problems to measure differences in citizens’ health levels across different regions.”
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Across-Agency Partnerships and Within-Agency Capacities Facilitate Holistic, Tailored Approaches to Addressing Food Insecurity: A Qualitative Study
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“23 27 Promoting local community and stakeholder engagement is a crucial factor in identifying the needs of low-resource communities to create shared goals and to support meaningful, sustainable, and scalable interventions.”
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“…discourses effectively silenced (or even challenged) the body of evidence supporting the importance of structural-level (as opposed to individual-level) (Agurs-Collins et al., 2019; Brown et al., 2019) community-informed public health interventions to address health inequities (Trickett, 2011).”
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“…to address structural inequities – as opposed to interventions targeting ‘at risk’ or marginalised communities and individuals – is still in its infancy (Brown et al., 2019). this paper aims to advance conceptual and analytical thinking for the study of structural drivers of entrenched advantage…”
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Self-citation
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“36 In addition to the potential for implicit bias based on race and/or ethnicity, stigma related to IBS as a disease may exist and negatively influence both patient care and outcomes.”
Background
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Community and Healthcare Perspectives on Implementing Hypertension Interventions for a Multiethnic Safety-Net Population
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Self-citation
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Structural Nutrition Intervention Proposals Reduce the Perceived Legitimacy of Health-Promotion Institutions: A Randomized Population-Based Survey Experiment
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“Since health disparities are a systemic and multi-level issue, evidence-based actions are needed to reduce them [28].”
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Neighborhood Factors Related to Cancer Screening in Texas: A Spatioecological Study
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Structural racism and racial disparities in stroke mortality in the United States, 2021
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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...
ORCID: Brown, Arleen F.
Miranda, Jeanne
Brockie, Teresa
Airhihenbuwa, Collins O.
Farhat, Tilda
Zhu, Lin
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
DOI: 10.2105/ajph.2018.304844
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
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 › Medicine › Public Health, Environmental and Occupational Health › 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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