Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities
Moving Upstream: How Interventions That Address the Social Determinants of Health Can Improve Health and Reduce Disparities
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DOI：
10.1097/01.phh.0000338382.36695.42
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发表时间：
2008-11-01
影响因子：
3.3
通讯作者：
Mohammed, Selina A.
中科院分区：
文献类型：
--
作者：
Williams, David R.;Costa, Manuela V.;Mohammed, Selina A.
在减少医疗保健和健康状况方面的社会经济和种族/民族差异方面，有相当大的科学和政策兴趣。目前，围绕减少健康差距的政策重点主要是改善医疗保健的可及性、覆盖面、质量和强度。然而，健康更多的是与生活和工作条件相关的生活方式的功能，而不是医疗保健的功能。因此，改善健康和缩小健康差距的有效努力需要更加重视解决保健系统内外健康的社会决定因素。本文重点介绍了研究证据，证明解决健康的社会决定因素可以减少健康差距。它既侧重于医疗保健系统内的干预措施，以解决健康的一些社会决定因素，也侧重于上游因素的干预措施，如住房，邻里条件和提高社会经济地位，可以导致健康的改善。回顾的研究强调了对可能产生健康后果的社会和经济政策进行系统评估的重要性，以及决策者、医疗保健提供者和社会多个部门的领导者应用现有知识改善影响人口健康的基础条件的必要性。
There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared toward improving access, coverage, quality, and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This article highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health and on interventions in upstream factors such as housing, neighborhood conditions, and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.