Citizen-Centered Health PromotionBuilding Collaborations to Facilitate Healthy Living

Where Health Disparities Begin: The Role Of Social And Economic Determinants—And Why Current Policies May Make Matters Worse

“…5,6,11,12 One may desire to eat a healthy diet but find nutritious foods too costly or live too far from a supermarket that sells fresh produce. 5 Parents might want to limit the time their children spend in front of a television or computer in favor of sending them outdoors for exercise, but their neighborhoods may be unsafe or lack playgrounds or sidewalks.…”

“…Downstream determinants include medical care; environmental factors, such as air pollution; and health behaviors, such as smoking, seeking or forgoing medical care, and not adhering to treatment guidelines. 5 Exposure to these determinants is influenced by "upstream" social determinants of healthpersonal resources such as education and income and the social environments in which people live, work, study, and engage in recreational activities. These contextual conditions influence people's exposure to environmental risks and their personal health behaviors, vulnerability to illness, access to care, and ability to manage conditions at home-for example, the ability of patients with diabetes to adopt necessary lifestyle changes to control their blood sugar.…”

“…Poor and minority neighborhoods are often "food deserts" with limited access to healthy foods but numerous fast-food outlets. 5 Schools in low-income neighborhoods often serve inexpensive processed foods and rely on revenue from vending machine contracts that promote soft drinks and high-calorie snacks. 5 But behavior is not the whole story.…”

“…5 Schools in low-income neighborhoods often serve inexpensive processed foods and rely on revenue from vending machine contracts that promote soft drinks and high-calorie snacks. 5 But behavior is not the whole story. 11,12 Distressed homes and neighborhoods can induce disease and contribute to disparities via pathways unrelated to behavior.…”

Inpatient Hospital Charge Variability of U.S. Hospitals

“…This could happen both through higher hospital charges to cross-subsidize uncompensated care or the known adverse health consequences of poverty, unemployment, lower educational attainment, crime, and poor social support. [8][9][10][11] To measure socioeconomic status, we used the percent of individuals who are uninsured, percent of a 9th grade cohort that graduates from high school in four years, percent of adults aged 25-44 years with some college education, prevalence of unemployment, percent of children living in poverty, percent of adults with inadequate social support, percent of children living in single-parent homes, and violent crime rate per 100,000 population.…”