Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?

Harvard Center for Population and Development Studies, Harvard School of Public Health, USA.
Annual Review of Public Health (Impact Factor: 6.47). 05/2009; 30(1):27-41. DOI: 10.1146/annurev.publhealth.031308.100310
Source: PubMed

ABSTRACT The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.

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    • "The need for theoretical models describing the relationship of researcher identities within communities is made clearer with an understanding of social determinants and power structures long identified by social epidemiology, i.e. poverty, status hierarchies, racism, and corporate-industrial policies, among others (Berkman, 2009; Krieger, 2004; Marmot, 2009; Navarro, 2009; Phelan et al., 2010; Wallerstein et al., 2011; Williams, 2012). Post-colonial theory has added explanatory models for communities of color, the particular histories of genocide, forced migrations, appropriation of lands, and attempted assimilations of indigenous cultures and languages (Duran and Duran, 1995; King et al., 2009); as well as the more hidden micro-aggressions (Walters et al., 2009) and hegemonic discourse that reinforces internalized oppression (Gaventa and Cornwall, 2008). "
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