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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“Yet, it is important to acknowledge that universal programs can sometimes increase disparities (Brown et al., 2019), and that not all societal interventions promote equity.”
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“Public health interventions should extend beyond education to challenge the structural and systemic inequalities that marginalise PLWE, particularly vulnerable groups (Brown et al. 2019).”
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“28 Strengthening primary care resources can increase patient accessibility while leveraging community partnerships to eliminate healthcare access barriers.”
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“While we were guided by terminologies used in previous literature (active and soft [44], strict and soft [45], structural [46]), we developed the final categorisation to best reflect the characteristics of the interventions identified.”
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Background
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“However, the more upstream, structural interventions that are required to address root causes of racial/ethnic inequities require signi ﬁ cant time, resources, and political will (Brown et al., 2019).”
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“15,17,22 The HEIAs also provided mitigation strategies to address the identi ﬁ ed unintended health impacts.”
Background
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“40 In this review we will use the term Indigenous to refer to groups of Indigenous people of Canada (First Nations, Inuit, and Métis), the United States (American Indians, Alaskan Natives, and Pacific Islanders), Australia (Aboriginal and Torres Strait Island [ATSI]), and New Zealand (Māori).”
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“33 A community-based approach that addresses structural barriers to “health accountability,” such as access to safe places to exercise, healthy food access, exposure to environmental pollutants, and social factors, such as noise and safety, may positively impact individual health accountability.”
Influential
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Monitoring privilege for health equity: building consensus on indicators to monitor socioeconomic advantage through a modified Delphi survey
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Community Supervision Engagement to Examine Health Outcomes: A Scoping Review
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The Promise of School‐Based Health Centers to Enhance Youth Mental Health Equity
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“The structural nature of these interventions leverages community partnerships and emphasizes collaboration to alter social, physical, economic, and/or political environments to advance health equity [12, 13].”
Bridging the Gap Between Research and Policy: Exploring Political Determinants of Immigrant Health in an Urban County With High Cervical Cancer Disparities
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Perspectives and experiences with equitable data collection in oral health: a qualitative investigation
Schroeder, K. L., Heaton, L. J., Martin, P., Cheung, H. J., Tranby, E. P., Rafia, K., & Tiwari, T. (2025) · BMC Oral Health · doi:10.1186/s12903-025-06388-2 · Cited by 2
“Access to affordable dental and overall health care is considered a fundamental right and equitable data collection processes are needed to understand who is experiencing barriers to care and why [2, 3].”

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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