Structural Interventions to Reduce and Eliminate Health Disparities

Abstract

Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements. Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities. Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.

Reframing implementation science to address inequities in healthcare delivery

“…Considering that vulnerable populations often receive services in low-resource settings, additional components and processes may be needed to support the implementation of EBIs in these communities such as, attention to financial resources, definition of roles and responsibilities, building and sustaining local capacity, restructuring the delivery of care, having leadership support and staff buy-in, among others [56,57]. Additionally, because of the multiple economic, political, and historical forces that shape the delivery of EBIs in low-resource communities, implementation strategies for EBIs that focus on vulnerable populations need to consider the multifactorial determinants of healthcare inequities.…”

“…Additionally, because of the multiple economic, political, and historical forces that shape the delivery of EBIs in low-resource communities, implementation strategies for EBIs that focus on vulnerable populations need to consider the multifactorial determinants of healthcare inequities. Researchers may need to include components that engender trust in the community, enhance cultural competence, raise critical consciousness, support advocacy, and reduce language barriers, [45,[57][58][59].…”

The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families

“…Partnerships like MLPs work best when they extend the reach of each partner, authentically engage key stakeholders, and consistently evaluate whether they are achieving the desired outcomes. 107,[114][115][116][117] Clinical-community partnerships can extend to broader community-based investment strategies considered by healthcare systems. The Healthy Neighborhood, Healthy Families Initiative in Columbus, OH involves a hospital making direct housing interventions within a "blighted" neighborhood.…”

Advancing health equity through CTSA programs: Opportunities for interaction between health equity, dissemination and implementation, and translational science

“…Examples of interventions at personal and inter-personal levels include exposure to counter-stereotypical exemplars to overcome implicit biases in health professionals [29], and stigma reduction and management [30,31], which have shown some evidence of effectiveness. Structural interventions that aim to change the physical and built environments (such as housing mobility interventions [32]), sociocultural determinants, and multiple levels of influences [33] are complex and more difficult to assess [34] but still show promise in addressing health inequities. As interest in and evidence for such interventions grows, more robust planning and evaluation of sustainability, scalability, and replicability of successful interventions are needed [34].…”

“…Structural interventions that aim to change the physical and built environments (such as housing mobility interventions [32]), sociocultural determinants, and multiple levels of influences [33] are complex and more difficult to assess [34] but still show promise in addressing health inequities. As interest in and evidence for such interventions grows, more robust planning and evaluation of sustainability, scalability, and replicability of successful interventions are needed [34]. Fig.…”