Certain social/environmental factors put some groups at extraordinary risk for adverse health outcomes, creating health disparities. We present a downward causal model, originating at the population level and ending at disease, with psychological and behavioral responses linking the two. This approach identifies how specific social environments "get under the skin" to cause disease, illustrated with the disparity in mortality from aggressive premenopausal breast cancer suffered by black women. Broadening our lens to consider the entire chain of causal factors, spanning multiple levels and interacting across the life span, heightens our ability to craft specific interventions to address group differences in health. [Health Affairs 27, no. 2 (2008): 339-349; 10.1377/hlthaff.27.2.339] H e a lt h d i s pa r i t i e s o c c u r by r ac e , ethnicity, sex, socioeconomic status, and sexual orientation, with inequities in screening, incidence, treatment, and mortality across a number of diseases and conditions, including cancer, diabetes, cardiovascular disease, infant mortality, and HIV/AIDS. A black/white gap in mortality from common cancer sites has been noted since 1975, for instance, when cancer data were first collected systematically by race and ethnicity. In 1975, black women experienced 39.2 more deaths per 100,000 population from breast cancer than white women. By 2004, that gap had increased to 44.1 excess deaths per 100,000. During the same time period, breast cancer mortality rates among white women decreased from 31.8 to 23.8 per 100,000. Mortality rates

Group disparities in health have been documented for several decades. Despite recent efforts to eliminate them, group differences persist and challenge the ability of scientists to address them using traditional research paradigms. Because the determinants of disparities occur at multiple levels, from the molecular to the societal, and interact with one another in ways not yet fully understood, they represent a challenge to researchers attempting to capture their complexity. After reviewing existing models of disciplinary collaboration, we outline the challenges of a transdisciplinary approach and its ability to afford the holistic view of disparities needed to develop effective interventions.

The social status of groups is key to determining health vulnerability at the population level. The impact of material and psychological stresses imposed by social inequities and marginalization is felt most intensely during perinatal/early childhood and puberty/adolescent periods, when developmental genes are expressed and interact with social-physical environments. The influence of chronic psychosocial stresses on gene expression via neuroendocrine regulatory dysfunction is crucial to understanding the biological bases of adult health vulnerability. Studying childhood biology vulnerabilities to neighborhood environments will aid the crafting of multifaceted, multilevel public policy interventions providing immediate benefits and compounded long-term population health yields.

Particular coping strategies involving behavioral and psychological responses to stressors are viewed as protective in relation to harmful effects of stressors, including problematic drinking. One framework for examining modes of coping has classified responses into those deemed either protective of or detrimental to health. This study examined racial/ethnic differences in the use of nine coping strategies and their relation to problematic drinking. Using two waves of data from a study of university employees, we examined the extent to which modes of coping varied by race/ethnicity, and whether the coping strategies were protective or predictive of problematic drinking. Two modes of coping considered “maladaptive” (denial, self-blame) were protective for African American and Hispanic respondents in comparison to White respondents, while two “adaptive” measures of coping (positive reframing, humor) were protective against drinking for African Americans compared to Whites. Implications for these findings as well as directions for future research are discussed.

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