The Future of Social Determinants of Health: Looking Upstream to Structural Drivers

Milbank Quarterly, Journal Year: 2023, Volume and Issue: 101(S1), P. 36 - 60

Published: April 1, 2023

Policy Points Policies that redress oppressive social, economic, and political conditions are essential for improving population health achieving equity. Efforts to remedy structural oppression its deleterious effects should account multilevel, multifaceted, interconnected, systemic, intersectional nature. The U.S. Department of Health Human Services facilitate the creation maintenance a national publicly available, user-friendly data infrastructure on contextual measures oppression. Publicly funded research social determinants be mandated (a) analyze inequities in relation relevant (b) deposit available repository.

Language: Английский

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Because its power remains naturalized: introducing the settler colonial determinants of health

Frontiers in Public Health, Journal Year: 2023, Volume and Issue: 11

Published: July 11, 2023

Indigenous people suffer earlier death and more frequent severe disease than their settler counterparts, a remarkably persistent reality over time, across colonized geographies, despite ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious comprehensive convincing explication, let alone remediation. Settler colonial studies, fast-growing multidisciplinary interdisciplinary field, is promising candidate rectify this impasse. colonialism’s relationship inequity at once obvious incompletely described, paradox arising from epistemic coloniality perceived analytic challenges that we address here in three parts. First, considering colonialism an enduring structure rather past event, by wedding fundamental insight the ascendant structural paradigm for understanding inequities, picture emerges which system of power serves as foundational configuration determining social political mechanisms impose on human health. Second, because modern racialization has served solidify maintain hierarchies relations, adds explanatory racism’s impacts potential amelioration historicizing process differentially racialized groups. Finally, advances racism methodologies work few visionary scholars already begun elucidate possibilities body literature linking health, illuminating future research opportunities pathways toward decolonization required equity.

Language: Английский

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Instruments for racial health equity: a scoping review of structural racism measurement, 2019-2021

Epidemiologic Reviews, Journal Year: 2024, Volume and Issue: 46(1), P. 1 - 26

Published: Jan. 1, 2024

Progress toward racial health equity cannot be made if we measure its fundamental driver: structural racism. As in other epidemiologic studies, the first step is to exposure. But how racism an ongoing debate. To characterize approaches epidemiologists and researchers use quantitatively racism, highlight methodological innovations, identify gaps literature, conducted a scoping review of peer-reviewed gray literature published during 2019-2021 accompany 2018 work Groos et al., which they surveyed scope measurement up 2017. We identified several themes from recent literature: current predominant focus on measuring anti-Black racism; using residential segregation as well segregation-driven measures proxies spatial exposures; increasing calls by multidimensional, multilevel determinant related innovations; development policy databases; utility simulated counterfactual understanding drives inequities; lack antiracism limited later life effects. Our findings sketch out steps improve science measurements, key advancing policies.

Language: Английский

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Social Isolation: An Unequally Distributed Health Hazard

Annual Review of Sociology, Journal Year: 2023, Volume and Issue: 49(1), P. 379 - 399

Published: March 31, 2023

Social isolation is a potent predictor of poor health, mortality, and dementia risk. A great deal research across national contexts provides causal evidence for these linkages identifies key explanatory mechanisms through which affects health. Research on social recognizes that some people are more likely than others to be isolated, but over the past several decades, researchers have focused primarily consequences health rather systematic assessment conditions foster life course. In this article, we review available inequities in develop conceptual framework guide future structural systems fuel Future work area has potential identify root causes inequality isolation, as well targeted policy levers reduce vulnerable populations.

Language: Английский

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Measuring Structural Racism and Its Association with Racial Disparities in Firearm Homicide

Journal of Racial and Ethnic Health Disparities, Journal Year: 2022, Volume and Issue: 10(6), P. 3115 - 3130

Published: Dec. 12, 2022

Abstract Introduction Structural racism is strongly related to racial health disparities. However, surprisingly few studies have developed empirical tools measure structural racism. In addition, the measures that been employed only considered at neighborhood level. To expand upon previous studies, this paper uses a novel county level for non-Hispanic Black population. Methods We used confirmatory factor analysis create model latent construct of 1181 US counties. The included five indicators across dimensions: segregation, incarceration, educational attainment, employment, and economic status/wealth. equation modeling were generate scores weighted in order produce best fit. resulting represented each county. demonstrated utility by demonstrating its strong correlation with Black-White disparities firearm homicide rates. Results Our calculations revealed striking geographic differences counties magnitude racism, highest values generally being observed Midwest Northeast. was significantly associated higher rates, lower White disparity homicide. Conclusions These new can be utilized researchers relate

Language: Английский

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Frontiers in measuring structural racism and its health effects

Health Services Research, Journal Year: 2022, Volume and Issue: 57(3), P. 443 - 447

Published: April 25, 2022

Authors have no conflicts of interest.

Language: Английский

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The relationship between state-level structural racism and disparities between the non-hispanic black and non-hispanic white populations in multiple health outcomes

Journal of the National Medical Association, Journal Year: 2023, Volume and Issue: 115(2), P. 207 - 222

Published: Feb. 15, 2023

While several studies have examined the impact of individual indicators structural racism on single health outcomes, few explicitly modeled racial disparities in a wide range outcomes using multidimensional, composite index. This paper builds previous research by examining relationship between state-level and wider array focusing mortality from firearm homicide, infant mortality, stroke, diabetes, hypertension, asthma, HIV, obesity, kidney disease.We used previously developed state index that consists score derived averaging eight across five domains: (1) residential segregation; (2) incarceration; (3) employment; (4) economic status/wealth; (5) education. Indicators were obtained for each 50 states Census data 2020. We estimated Black-White disparity outcome dividing age-adjusted rate non-Hispanic Black population White population. These rates CDC WONDER Multiple Cause Death database combined years 1999-2020. conducted linear regression analyses to examine states. In multiple analyses, we controlled potential confounding variables.Our calculations revealed striking geographic differences magnitude racism, with highest values generally being observed Midwest Northeast. Higher levels significantly associated greater all but two outcomes.There is robust Programs policies reduce heath must include strategies help dismantle its consequences.

Language: Английский

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Racial Capitalism and Firearm Violence: Developing a theoretical framework for firearm violence research examining structural racism

Social Science & Medicine, Journal Year: 2024, Volume and Issue: 358, P. 117255 - 117255

Published: Aug. 15, 2024

Despite the early promise of centering structural racism in explanatory models firearm violence, there are noticeable gaps what's been produced thus far; particular, a deeper and more serious engagement with long-standing theories is needed to further enrich our understanding how inequalities produce unequal burdens firearm-related harms. Thus, building on concepts from range academic fields Black philosophical perspectives, we developed theoretical framework help explain role place-based violence disparities. A central component concept racial capitalism, which contends that exploitation accumulation assets depend reinforce one another. In this article, present highlight two processes related capitalism-racialized dispossession racialized spatial stigma-are connected geographic disparities violence. We also results an ecological cross-sectional study reveals potential key association between capitalism neighborhood-level. used intersectionality approach descriptive epidemiological methods quantitatively describe could potentially be linked varying exposure dimensions capitalism-historical redlining contemporary subprime mortgage lending. found sustained disadvantaged census tracts (tracts were historically redlined experienced higher lending) highest burden Baltimore City 2015 2019. Our research suggests root cause based can inform development usage indicators analytic for racism-related research. Moreover, identify factors prioritize equity-based prevention policies programs.

Language: Английский

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A State-Level Examination into Structural Racism and Racialized Disparities in Sexually Transmitted Infections

Spatial Demography, Journal Year: 2025, Volume and Issue: 13(1)

Published: Feb. 10, 2025

Abstract The population health literature recognizes structural racism as a fundamental determinant of racialized disparities. However, the role in continued persistence disparities sexually transmitted infections (STIs) has not been investigated despite Black Americans’ disproportionate experience STIs comparison to White Americans. Past research largely individual racial/ethnic identity an individual-level factor predictive STIs, failing engage with multitude racially structured contexts which likely shape STI rates. This study combines multiple datasets, including data from Centers for Disease Control and Prevention, American Community Survey, Current Population conduct state-level analysis investigating contributing Black–White between 2010 2020. Random effects spatial autoregressive models suggest that contributes STIs. literatures on by better understanding how institutions contraction infections. results have important implications states institutional actors relevant patterns geography racism.

Language: Английский

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Structural Racism, Geographies of Opportunity, and Maternal Health Inequities: A Dynamic Conceptual Framework

Journal of Racial and Ethnic Health Disparities, Journal Year: 2025, Volume and Issue: unknown

Published: March 3, 2025

Abstract Addressing the grave racial inequities in maternal health requires a new generation of research that better operationalizes root causes these outcomes. Recent frameworks improving conceptualization structural racism have illuminated need for conceptual clarity when investigating neighborhoods as site marginalization Black birthing populations well. In particular, dynamic feedback how are constructed and experienced, especially they embed vicious cycles place-based racialization, is integral to producing conceptually relevant translatable evidence address health. This study presents newly developed framework integrates insight on neighborhood contexts from multiple disciplines conceptualize it operates during childbearing window drive inequitable morbidity rates among people. I also compare contrast this with existing based represent key domains social determinants, context, feedback. Illustrating strengths weaknesses each can improve researchers’ ability leverage developing project-specific models racism, Building comparative repository frameworks, conjunction will field’s capacity follow best practices rooting explicit operationalization translation eventually eliminate

Language: Английский

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