Socioeconomic Disparities In Health: Pathways And Policies

Harvard University, Cambridge, Massachusetts, United States
Health Affairs (Impact Factor: 4.97). 03/2002; 21(2):60-76. DOI: 10.1377/hlthaff.21.2.60
Source: PubMed


Socioeconomic status (SES) underlies three major determinants of health: health care, environmental exposure, and health behavior. In addition, chronic stress associated with lower SES may also increase morbidity and mortality. Reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health. Lessons for U.S. policy approaches are taken from the Acheson Commission in England, which was charged with reducing health disparities in that country.

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    • "Being a member of a racial minority ( Cook, McGuire, & Miranda, 2007; Larson et al., 2008; Smedley, Stith, & Nelson, 2003; Williams & Jackson, 2005) and having a lower socioeconomic status (SES) ( Adler & Newman, 2002; Braveman et al., 2011) are associated with physical health problems ( Adler & Newman, 2002; Larson et al., 2008) such as cancer, heart disease, and diabetes ( Smedley et al., 2003). Health disparities are characterized by having limited or no access to health insurance and having more exposure to factors that are linked to poorer health outcomes (Dubay & Lebrun, 2012; Williams & Jackson, 2005). "
    Health & social work 08/2015; DOI:10.1093/hsw/hlv058 · 0.94 Impact Factor
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    • "conditions , and social networks ( Adler and Newman , 2002). Given the long follow - up of participants in this study , it is possible that education - al attainment may have also influenced their diabetes risk in such indi - rect ways . "
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    ABSTRACT: Educational attainment is inversely associated with type 2 diabetes risk, but it is unknown whether education impacts individuals' diabetes prevention efforts. We examined the comparative efficacy of intensive lifestyle intervention and metformin by educational attainment among participants in the Diabetes Prevention Program (DPP), an ongoing U.S. multi-site trial beginning in 1996. We studied 2,910 DPP participants randomized to receive lifestyle intervention, metformin, or placebo. Stratifying by educational attainment, diabetes incidence and relative risk reductions by treatment assignment were estimated using Cox proportional hazards regression. 47% of participants had completed college and 53% had not. Compared to placebo, lifestyle participants who had completed college demonstrated a 68% reduction in diabetes incidence (95% CI=56, 77), whereas those with less education experienced a 47% risk reduction (95% CI=29, 61). For metformin participants, college graduates experienced a 49% relative risk reduction (95% CI=33, 62), compared to 23% (95% CI=1, 41) among those with lower educational attainment. There was a statistically significant education-by-treatment interaction with incident diabetes (p=0.03). Intensive lifestyle intervention and metformin have greater efficacy among highly educated individuals. Future efforts to deliver these treatments and study their dissemination may be more effective if tailored to individuals' educational background. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 05/2015; 77. DOI:10.1016/j.ypmed.2015.05.017 · 3.09 Impact Factor
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    • "However, as the literature already suggests, it is not just that in many cases the public faces a reality in which the channels for participating in healthcare policy are blocked (Cohen, 2012). It is also a fact that socio-economic status is related to many healthcare variables (Adler and Newman, 2002). Usually, disadvantaged populations are not familiar with the benefits of healthy behavior for themselves. "
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    ABSTRACT: The health promotion literature points out a significant gap between declared health promotion policy and practice. The common assumption is that one of the main obstacles to progress is "political will" and the intersectoral action necessary to create healthy environments. The concept of political will is most frequently invoked to explain a lack of action usually rooted in politicians' lack of personal courage or good sense. While stressing the fact that health and its promotion are profoundly political, we claim that the lack of political will is usually not because politicians have shown insufficient personal courage or good sense. Rather, we suggest that one of the reasons for the gap between the need for health promotion policies and political will derives from politicians' lack of attraction to several aspects associated with this policy area. In many cases, politicians are not attracted to the issue of health promotion because of the unique structural conditions usually associated with this policy domain. Using tools related to public policy theory, we suggest a conceptual framework that explains what those conditions are and answers the question of why politicians seem to lack the political will to undertake the design of health promotion policies. Copyright © 2013 John Wiley & Sons, Ltd.
    International Journal of Health Planning and Management 03/2015; 30(1). DOI:10.1002/hpm.2203 · 0.97 Impact Factor
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